Schizophrenia, Childhood

Child PTSD Symptom Scale (CPSS; Foa et al., 2001 (link)). The CPSS is designed to assess PTSD diagnosis and symptom severity in children ages 8–18 who have experienced a traumatic event. It has 24-items, 17 of which correspond to the DSM-IV symptoms. Each of the 17 items is rated on a scale from 0 to 3 with total score ranging from 0 to 51. An additional seven items that inquire about daily functioning (e.g. relationships with friends, schoolwork) are rated as either absent (0) or present (1) and yield a total impairment severity score ranging from 0 to 7. The total impairment score does not contribute to the overall score. The CPSS has shown good internal consistency (α =.89 for total score, .80 for reexperiencing, .73 for avoidance, and .70 for arousal), and scores on the measure have shown good test-retest reliability (.84 for total score, .85 for reexperiencing, .63 for avoidance, and .76 for arousal), and convergent validity (Foa et al., 2001 (link); see Introduction section of the current report).
The Schedule of Affective Disorders and Schizophrenia for School-Age Children–Revised for DSM-IV (K-SADS; Kaufman et al., 1997 (link)) is a semi-structured interview administered by trained clinical interviewers. The K-SADS assesses the presence of previous and current psychiatric disorders based on information provided by both the patient and the patient’s guardian. Diagnoses based on the K-SADS have shown excellent reliability and validity among clinical samples (Kaufman et al., 1997 (link)).
The Beck Depression Inventory (BDI;Beck, Ward, Mendelsohn, Mock, & Erbaugh, 1961 (link)) is a 21-item measure of depressive severity that is widely used in a variety of populations and has been normed for adolescents. Each item is rated on a 4-point scale (0–3) with total scores ranging from 0 to 63. This measure was chosen to examine the concurrent validity of CPSS scores, as depression is a construct that tends to show strong overlap with PTSD. Split-half reliability of BDI scores is .93, and correlations with clinician ratings of depression range from .62 to .65 (Beck et al.).
Spielberger State-Trait Anger Expression Inventory-2 (STAXI-2; Spielberger, Sydeman, Owen, & Marsh, 1999 ) is a 57-item self-report inventory assessing the experience, expression and control of anger. The inventory is divided into three parts. State and trait anger are assessed by asking the respondent to rate the intensity and frequency of angry feelings and reactions using a 4-point Likert-type scale. Anger control is assessed by presenting descriptions of reactions and asking the respondent to rate how often he or she behaves in the manner described when angry or furious, again using a 4-point Likert-type scale. Internal consistency of the STAXI-2 scales and subscales ranged from alpha = .73 to .95 (Mdn. α = .88). High scores on the STAXI-2 scales (≥75^th percentile) suggest anger experience and expression that interferes with normal functioning (Spielberger et al.).
Trauma History Interview. In order to precisely assess the presence of trauma exposure that meets PTSD Criterion A (Diagnostic and Statistical Manual of Mental Disorders 4th ed., text rev.; DSM–IV–TR; American Psychiatric Association, 2000 ), the Trauma History Interview (THI) was administered. This clinician-administered interview includes questions about the nature of the trauma and the individual’s response to it (e.g., helplessness, terror). The THI is a revised version of the Standardized Assault Interview (SAI) that has been administered in studies of adult trauma survivors (e.g. Foa, Hearst-Ikeda, & Perry, 1995 (link); Foa, Rothbaum, Riggs, & Murdock, 1991 (link)). The SAI has shown satisfactory inter-rater reliability (K = .81; Foa et al., 1991 (link)).

To develop the carved depression and mania scales, secondary analyses pooled nine samples: two clinical youth samples and seven non-clinical adult samples (Supplemental Table 1). Of 741 youths, 83 met strict DSM-IV criteria for BD I, and 118 for other bipolar spectrum diagnoses; 266 for unipolar depression, 204 for ADHD or disruptive behavior disorders without comorbid mood disorder, and 67 with a variety of other diagnoses. The median number of Axis I diagnoses per youth was 3.0. The adult samples were largely students, and Supplemental Table 1 shows that adult modal age was early-mid 20s.
General Behavior Inventory (GBI, Depue et al., 1981 (link)). The GBI identifies lifetime diagnoses of BD as well as syndromal and subsyndromal affective tendencies in clinical and non-clinical populations (Danielson et al., 2003 (link); Depue et al., 1989 (link)). Items cover lifetime propensities to experience depressive symptoms (e.g., “Have you become sad, depressed, or irritable for several days or more without really understanding why?”), and hypomanic symptoms (e.g., “Have there been periods of several days or more when your thinking was so clear and quick that it was much better than most other people's?”). Responses are rated on a four-point Likert scale ranging from “never or hardly ever” to “very often or almost constantly”. The GBI also includes some Biphasic items to capture tendencies for mood states to vary from extremely high to extremely low. Biphasic and Hypomania items are commonly collapsed into a single scale (the Hypomanic/Biphasic, or Mania scale) which prospectively predicts onset of manic episodes (Alloy et al., 2012 (link)). The GBI Mania and Depressive scale scores display sound psychometric properties across multiple samples including internal reliability alphas exceeding .90, test-retest reliabilities exceeding .70, strong predictive validity, and adequate convergent and discriminant validity across multiple samples (reviewed in Johnson et al., 2008 ; Youngstrom, 2007 ). Exploratory factor analyses typically find two strong factors of depression and hypomanic/biphasic mood, along with various small factors that capture less variance and are not typically scored separately (e.g., Depue et al., 1981 (link); Murray, Goldstone, & Cunningham, 2007).
Schedule for Affective Disorders and Schizophrenia for School-Age Children-Present and Lifetime version (K-SADS-PL;Kaufman et al., 1997 (link)). The KSADS is a commonly used, well-validated interview for establishing bipolar diagnoses among youth. Youths and primary caregivers completed KSADS interviews in the youth samples. Raters were highly trained and inter-rater reliability was sustained throughout the study (kappa for symptom severity ≥ .85 in both samples). Diagnoses were reviewed by either a board certified child psychiatrist or licensed clinical psychologist. Diagnoses conformed to strict DSM-IV criteria for bipolar I, bipolar II, cyclothymic disorder, and bipolar NOS (typically due to insufficient duration of the index hypo/manic episode).
The youth samples included the Young Mania Rating Scale (YMRS, Young, Briggs, & Meyer, 1978 (link)), which has good inter-rater reliability, correlates with other manic severity measures, and is sensitive to treatment effects; and the Child Depression Rating Scale – Revised (CDRS, Poznanski, Miller, Salguero, & Kelsh, 1984 (link)) to quantify depressive symptom severity. In the youth samples, the primary caregiver completed the Parent-report GBI (P-GBI, Youngstrom, Findling, Danielson, & Calabrese, 2001 (link)) and the Internalizing Problems score on the Child Behavior Checklist (CBCL; Achenbach & Rescorla, 2001 ) about the youth's mood traits, providing a cross-informant perspective.
The Mood Disorder Questionnaire (MDQ: Hirschfeld et al., 2000 (link)) is a 15-item self-report measure of hypomanic symptoms: 13 yes/no items cover DSM manic symptoms, the 14th item asks about simultaneous occurrence, and the last item rates impairment. We used a threshold of 7 or more symptoms co-occurring at least once (Miller, Johnson, Kwapil, & Carver, 2011 (link)). The TEMPS-A measured Affective Temperaments, with five rationally derived subscales: Dysthymic, Cyclothymic, Hyperthymic, Irritable, and Anxious Temperament (published alphas from 0.67 to 0.91, Akiskal, Akiskal, Haykal, Manning, & Connor, 2005 (link)). Hyperthymic scales differentiate BD from other mood disorders, and Dysthymic temperament predicts the severity of depression within BD (e.g., Karam et al., 2010 (link)). The 5-item Satisfaction with Life scale (SWL, Diener, Emmons, Larsen, & Griffin, 1985 (link); Diener, Suh, Lucas, & Smith, 1999 ) measured Satisfaction with Life, as both manic and depressive traits are associated with low life satisfaction (Freeman et al., 2009 (link); Murray & Michalak, in press ). BD is associated with an evening chronotype (Wood et al., 2009 (link)) and elevated seasonal variation in mood and behavior (Shin, Schaffer, Levitt, & Boyle, 2005). The Morningness-Eveningness Questionnaire (MEQ, Horne & Ostberg, 1976 (link)) measured chronotype; higher scores indicate greater morningness. The Seasonal Pattern Assessment Questionnaire (SPAQ, Rosenthal, Bradt, & Wehr, 1984 ) assessed seasonality. Creativity has reliable associations with bipolar diagnosis (Murray & Johnson, 2010 (link)). The 90-item Creative Behavior Inventory (CBI, Hocevar, 1979 ) quantified creative products generated during adolescence and adulthood. Respondents rated the frequency of creative behaviors since adolescence on a 4-point scale from “Never” to “5 or more times.”