CBQ
The Child/Adolescent Bipolar Questionnaire
Today's Date
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Month
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Year
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Patient Name
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First Name
Last Name
Rate the following questions to the best of your ability:
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Rows
0 Never
1 Rarely
2 Sometimes
3 Often
4 Very Often
Does your child's mood change from happy to sad instantaneously - almost like flicking a light switch?
When your child gets in trouble at school or at home, do they blame others for causing the mistake?
Does your child have long, explosive rage attacks - sometimes complete with foul language that's inappropriate for their age?
Does your child suddenly reject taking part in their favorite activities?
Does your child seek out gory films and violent, bloody games?
Does your child expect the worst at every turn? Do they panic over small, seemingly insignificant events - like a minor scrape or a crime-related news story?
Is your child much more curious about sex than other children their age? Do they bring up sex inappropriately in conversation, or have they engaged in inappropriate or risky sexual behaviors?
Does your child inconsistently have periods where they have unfocused, limitless energy that feels out of control, even to them?
Does your child masterfully lie to either avoid consequences or manipulate a situation?
Is your child sometimes precocious - charming adults with their intelligent and mature speaking style - and then at other times regress to baby-like, primitive behaviors, like crawling up in a fetal position when stressed or engaging in baby talk?
All of a sudden, is your child convinced they can be a famous singer, president of the United States, an international spy, and a millionaire - all at once?
Does your child engage in dangerous activities - like jumping out of trees or rollerblading while hanging on to the back of a car - and later say that they knew it could be dangerous, for others but that they felt immune to that danger? Do they report that they may even welcome any injury?
Does it seem like your child has given up sleeping altogether - but often doesn't seem tired the day after a sleepless night?
Does your child's brain seem powered by a motor? Do they talk a mile a minute, or say they can't seem to slow down their thoughts?
When you try to set limits on your child - asking them to shut off electronics, stop a game/task to join you at the dinner table - do they react in an extreme or violent way?
Rows
0 Never
1 Rarely
2 Sometimes
3 Often
4 Very Often
Scores:
Total Score:
Provider Notes:
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