The Child Bipolar Questionnaire - Version 2.0
©2002 Demitri F. Papolos, M.D. All rights reserved.

Please complete the following survey. All fields are required except where noted.

My child has and/or had the following symptoms and/or behaviors. You may have noticed a behavior as far back as early childhood or you may have observed it more recently. In either case, estimate how frequently the behavior has occurred since you first noticed it. In other words, please rate these symptoms and/or behaviors as they were at their most severe and/or prior to your child starting medication. Then select a number in the “Frequency” column using the following key, to represent the frequency of occurrence:

Never or hardly ever Sometimes Often Very often or
almost constantly
1 2 3 4
  1 2 3 4
1) displays excessive distress when separated from family
2) exhibits excessive anxiety or worry
3) has difficulty arising in the AM
4) is hyperactive and easily excited in the PM
5) has difficulty settling at night
6) has difficulty getting to sleep
7) sleeps fitfully and/or awakens in the middle of the night
8) has night terrors and/or nightmares
9) wets bed
10) craves sweet-tasting foods
11) is easily distracted by extraneous stimuli
12) is easily distracted during repetitive chores & lessons
13) demonstrates inability to concentrate at school
14) attempts to avoid homework assignments
15) able to focus intently on subjects of interest and yet at times is easily distractible
16) has poor handwriting
17) has difficulty organizing tasks
18) has dfficulty making transitions
19) has difficulty estimating time
20) has auditory processing or short-term memory deficit
21) is extremely sensitive to textures of clothes, labels, and tightness of fit of socks or shoes
22) exhibits extreme sensitivity to sound and noise
23) complains of body temperature extremes or feeling hot despite neutral ambient temperature
24) is easily excitable
25) has periods of high, frenetic energy and motor activation
26) has many ideas at once
27) interrupts or intrudes on others
28) has periods of excessive and rapid speech
29) has exaggerated ideas about self or abilities
30) tells tall tales; embellishes or exaggerates
31) displays abrupt, rapid mood swings
32) has irritable mood states
33) has elated or silly, goofy, giddy mood states
34) displays precocious sexual curiousty
35) exhibits inappropriate sexual behaviors, e.g. openly touches self or others’ private parts
36) takes excessive risks
37) complains of being bored
38) has periods of low energy and/or withdraws or isolates self
39) has decreased initiative
40) experiences periods of self doubt and poor self-esteem
41) feels easily criticized and/or rejected
42) feels easily humiliated or shamed
43) fidgets with hands or feet
44) is intolerant of delays
45) relentlessly pursues own needs and is demanding of others
46) is willful and refuses to be subordinated by others
47) argues with adults
48) is bossy towards others
49) defies or refuses to comply with rules
50) blames others for his/her mistakes
51) is easily angered in response to limit setting
52) lies to avoid consequences of his/her actions
53) has protracted, explosive temper tantrums
54) has difficulty maintaining friendships
55) displays aggressive behavior towards others
56) has destroyed property intentionally
57) curses viciously, uses foul language in anger
58) makes moderate threats to others or self
59) makes clear threats of violence to others or self
60) has made clear threats of suicide
61) is fascinated with gore, blood, or violent imagery
62) has acknowledged experiencing auditory and/or visual hallucinations
63) hoards or avidly seeks to collect objects or food
64) has concern with dirt, germs, or contamination
65) is very intuitive and/or very creative

The Child Bipolar Questionnaire may be found online at the Web site of the Juvenile Bipolar Research Foundation