Étude utilisant le DSM-IV et le CBCL qui porte sur le trouble des conduites et la maladie affective bipolaire chez des adolescents admis à l’Institut Philippe-Pinel de Montréal

We conducted our internship in criminology at the Youth Program of the Philippe-Pinel Institute of Montreal. Our sample consists of 106 adolescents suffering from a conduct disorder (CD) in association, or not, with an attention deficit hyperactive disorder (ADHD)or a bipolar disorder (BPD). A rising amount of research agrees that BPD can have an atypical presentation in a juvenile population, which explains why it is rarely diagnosed in youths and is often mistaken as a severe ADHD or an aggressive CD in irritable, impulsive and aggressive juvenile delinquents. Some clinicians evoke the possibility that these delinquents may suffer from a dysphoric conduct disorder, which is described as a type of CD associated with a typical (adult) or an atypical (juvenile) BPD. Through an eight years retrospective study, we evaluated the prevalence of a possible juvenile BPD in adolescents with a CD. In order to do so, we compared the characteristics noted in delinquents suffering from a BPD diagnosed from the DSM-IV to the characteristics of delinquents with a potential juvenile BPD identified on the basis of the Child Behavior Checklist (CBCL). Furthermore, we evaluated the possibility that a dysphoric conduct disorder can be identified among juvenile delinquents admitted to the Institute for evaluation. To identify symptoms of juvenile bipolar disorder, we used the Child Behavior Checklist(CBCL) from Achenbach (1991). A meta-analysis conducted by Mick and coll. (2003)establish that a significant score on three subscales – anxious/depressed, attention problems, and aggression – would assist in detecting a BPD in a juvenile population. We rated these three subscales according to the adolescents’ chart recorded during the evaluation period (60 days) at the Institute before calculating an inter-judges reliability on the behaviors included into these three subscales. In our sample of delinquents, the official prevalence of BPD (5,7%) is similar to the one identified in a representative sample of adolescents, whereas the prevalence of juvenile BPD (18,9%) is similar to the one identified in juvenile delinquents in detention facilities. The delinquents diagnosed with a BPD and those suffering from a potential juvenile BPD present several individual, familial, social, and psychiatric characteristics generally met by young delinquents with a juvenile BPD in clinical researches. Almost all of them were diagnosed with an ADHD, presented severe long term conduct problems, school difficulties, relational issues as well as aggressive and impulsive behaviors. Without questioning the diagnosis issued at the end of the evaluation or concluding that a dysphoric CD exists, it seems that a group of irritable, impulsive, and young delinquents suffering from ADHD and presenting aggressive behaviors since their childhood, present many characteristics encountered in delinquents suffering from juvenile BPD in clinical researches. In addition, those characteristics are also often recognized in juvenile delinquents diagnosed with an ADHD (DSM-IV), suggesting that (typical and atypical)BPD is under-diagnosed in juveniles and that behavioral disturbances, aggressiveness and irritability are considered as symptoms of an ADHD and/or a CD.

Keyphrases: adolescent, CBCL, DSM