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Latent class analysis of Child Behavior Checklist attention problems.

OBJECTIVE: To test whether attention problems in children are continuously distributed or categorically discrete, the authors performed latent class analyses (LCA) of items from the Attention Problems scale of the Child Behavior Checklist (CBCL) using data from the clinical and nonclinical samples used in the derivation of the CBCL syndromes. METHOD: A CBCL was completed by a parent or guardian of each of 2,100 nonreferred children selected to be representative of U.S. nonreferred children and a demographically matched sample of 2,100 clinically referred children. Attention problems symptoms were subjected to LCA. RESULTS: LCAs were consistent with the presence of 3 levels of symptom presentation in both samples. Children in the nonclinical sample were classified as having no symptoms, mild symptoms, or moderate symptoms. Children in the clinical group had mild, moderate, or severe symptoms. CONCLUSIONS: These results suggest that child and adolescent psychiatric symptoms such as attention problems can be thought of as continuously distributed phenomena rather than discrete disease entities, lending support for an empirical approach to both clinical work and research. In addition, high prevalence rates of attention problems in both clinical and nonclinical samples suggest the need for careful screening of attention problems in clinic and academic settings.

Adolescent↗

Latent class analysis of child behavior checklist anxiety/depression in children and adolescents.

OBJECTIVE: Comorbidity of psychiatric problems such as anxiety and depression poses challenges to treatment and research. This study tested whether problem items from the Anxious/Depressed scale of the Child Behavior Checklist (CBCL) can be separated into distinct anxiety and depression classes or are continuously distributed throughout a population. METHOD: A CBCL was completed by a parent or guardian of each of 1,987 children and adolescents selected to represent nonreferred children in the United States, as well as by a parent or guardian of each of a demographically matched sample of 1,987 clinically referred children and adolescents. Problem items from the Anxious/Depressed scale of the CBCL were subjected to latent class analysis. RESULTS: Analyses revealed three levels of problem presentation in both samples. Children in the nonreferred sample were classified as having no problems, mild problems, or moderate anxiety/depression problems. Children and adolescents in the referred group were classified as having mild, moderate, or severe levels of problems. No pure anxiety or depression classes were found, only classes containing a mixture of both anxiety and depressive problems. Age, gender, and sample differences were found in class groupings, with nonreferred adolescent girls showing elevated levels of problems. CONCLUSIONS: Results suggest that the comorbid conditions of anxiety and depression, as assessed by the CBCL anxiety/depression problem items, can be thought of as part of the same continuum of problems. Implications for assessment and treatment utilization are discussed.

Adolescent↗

Use of a child behavior checklist in the psychosocial assessment of children with epilepsy.

Children with epilepsy are faced with many of the same psychosocial stressors as other chronically ill children, and a proper assessment is vital. The purpose of this study was to determine whether the Child Behavior Checklist of Achenbach and Edelbrock could be used as a practical and objective tool for evaluating the psychosocial needs of children with epilepsy. Thirty-eight children were randomly selected from the Neurology outpatient clinic at the Children's Hospital of Eastern Ontario. Questionnaires were completed by the mothers during their waiting period. Results demonstrated the highest risk of maladjustment was within social functioning. As children reach adolescence, adjustment problems are mostly related to school. Although as a group, our sample did not differ from norms for behavior problems, there was evidence to suggest behavioral maladjustment for individual children. The checklist appears to be a good screening tool for maladjustment that could be included as part of the pediatrician's comprehensive assessment of children with epilepsy.

Adolescent↗

The Child Behavior Checklist as an indicator of posttraumatic stress disorder and dissociation in normative, psychiatric, and sexually abused children.

Expert ratings and confirmatory factor analyses were used to derive a posttraumatic stress disorder (PTSD), dissociation, and a combined PTSD/dissociation scale from the Child Behavior Checklist (CBCL). Validity was established by examining the relationship of these scales to features of sexual abuse thought to relate to severity and chronicity, as well as to self-report scales of PTSD and dissociation. In addition, this study examined differences between normative, psychiatric, and sexually abused children on the new scales. Both the sexual abuse and psychiatric sample differed significantly from the normative sample on all scales, but not from each other. Despite correlations of the dissociation and PTSD/dissociation combined scale with features of trauma and child self-report of PTSD and dissociation, the absence of differences between the clinical groups on the derived scales suggests that the scales measure generic, as opposed to trauma-related, distress.

Child↗

Behavioural problems and psychiatric symptoms in 5-13 year-old Swedish children-a comparison of parent ratings on the FTF (Five to Fifteen) with the ratings on CBCL (Child Behavior Checklist).

As part of the validation procedure of a new parent questionnaire ("Five to Fifteen" or the FTF) a random sample of 1500 children aged 5-13 years from the Swedish Population Register (SPAR) was approached. The FTF and the Child Behavior Checklist (CBCL) were sent to the parents of the children together with questions about background conditions. After two reminders the response rate was 55.6%. The final sample had a mean age of 9.12 years (SD=1.89) and a sex distribution with 55% boys and 45% girls. Analysis of attrition did not support overrepresentation of foreigners/immigrants in the attrition population. FTF like CBCL showed sensitivity to sociodemographic variables. On the FTF fewer problems were indicated for girls in all domain scales, whereas this was true for the summary scale Externalizing and Mixed problems of the CBCL. The effects of age and area of residence were slight, but parental education was negatively related to all domain scales of the FTF and to all the CBCL scales. The intercorrelations of the FTF and CBCL scales with common content showed substantial overlap supporting the validity of the FTF scales. The correlation between scales within the FTF however also indicates a substantial comorbidity. This is also supported by the substantial correlation between problem score of the FTF domains perception, language, motor skills and the CBCL scale scores Attention, Social problems as well as the summary scale Mixed problems. These findings indicate that problems with inattention and social relations are shared across the various problem domains. Factor analysis of the FTF subdomain scores resulted in two factors, one representing learning problems and the other behavioural/emotional problems. Despite the low response rate the representativity of the sample was supported by the fact that the total problem score of CBCL was very similar to that of another Swedish sample with a relatively high response rate. The finding of a frequency of AD/HD symptoms in the FTF rating corresponding to the figures of prevalence of AD/HD in several international epidemiological studies could also be seen as support for the relevance of the findings. Thus, the results give support to the usefulness of the FTF questionnaire as an instrument that can help in delineating specific problem areas within the field of child neuropsychiatry. Through the comparison with the CBCL the validity of the FTF for the parts that the two instruments share could be ascertained and the value of tapping a broader problem area could be elucidated.

Adolescent↗

Is it prudent to administer all items for each Child Behavior Checklist cross-informant syndrome? Evaluating the psychometric properties of the Youth Self-Report dimensions with confirmatory factor analysis and item response theory.

Through surveying of children in 10 nations with parent, teacher, and Youth Self-Report (YSR) forms of the Child Behavior Checklist (CBCL), cross-informant syndromes (CISs) were derived and cross-validated by sample-dependent methodology. Generalizing CBCL syndromes and norms to nations excluded from its normative sample is problematic. This study used confirmatory factor analyses (CFAs) to test factor model fit for CISs on the YSR responses of 625 Jamaican children ages 11 to 18 years. Item response theory (IRT), a sample-independent methodology, was used to estimate the psychometric properties of individual items on each dimension. CFAs indicated poor to moderate model-to-data fit. Across all syndromes, IRT analyses revealed that more than 3/4 of the cross-informant items yielded little information. Eliminating such items could be cost effective in terms of administration time yet improve the measures discrimination across syndrome severity levels.

Adolescent↗

Evaluation of emotional and behavioral problems in language impaired children using the Child Behavior Checklist.

Speech and language impaired children are at special risk for developing psychiatric disorders. Attention deficit, aggressive behaviour as well as overanxiety and excessive shyness have been reported in speech and language impaired children. The purpose of this study was to determine how the Child Behavior Checklist (CBCL) could be used as a screening instrument in language impaired children. In a sample of 83 language impaired children, emotional and behavioural problems were evaluated using the CBCL. Independent of this assessment, DSM-IV diagnoses were established for all children. Sixty-six of the 83 children had a psychiatric diagnosis. The use of the Total Behavior Problem score (TBP) as a global measure of behavioural disturbance showed that children with a psychiatric diagnosis had significantly higher scores on the TBP score than children without a psychiatric diagnosis. The specificity of the TBP was 88.2%, the sensitivity 75.8%, and the false classification rate 21.6%. The most frequently reported behavioural disturbances were problems on scale VI ("Attention Problems"-39 children) and on scale I ("Withdrawn"-32 children). A small group of children with a receptive language disorder and pronounced compulsive behavioural problems had elevated scores on scale V ("Thought Problems").

Affect↗

Comparing the German versions of the Strengths and Difficulties Questionnaire (SDQ-Deu) and the Child Behavior Checklist.

The Strengths and Difficulties Questionnaire (SDQ) is a brief behavioural screening questionnaire that can be completed in about 5 minutes by the parents and teachers of 4-16 year olds. The scores of the English version correlate well with those of the considerably longer Child Behavior Checklist (CBCL). The present study compares the German versions of the questionnaires. Both SDQ and CBCL were completed by the parents of 273 children drawn from psychiatric clinics (N = 163) and from a community sample (N = 110). The children from the community sample also filled in the SDQ self-report and the Youth Self Report (YSR). The children from the clinic sample received an ICD-10 diagnosis if applicable. Scores from the parent and self-rated SDQ and CBCL/YSR were highly correlated and equally able to distinguish between the community and clinic samples, with the SDQ showing significantly better results regarding the total scores. They were also equally able to distinguish between disorders within the clinic sample, the only significant difference being that the SDQ was better able to differentiate between children with and without hyperactivity-inattention. The study shows that like the English originals, the SDQ-Deu and the German CBCL are equally valid for most clinical and research purposes.

Adolescent↗

Behavioral correlates of television viewing in primary school children evaluated by the child behavior checklist.

BACKGROUND: Television is a source from which children gain information about life and experience different types of behavior. The Child Behavior Checklist (CBCL) has not been used thoroughly to evaluate the behavioral effects of television viewing on children. OBJECTIVE: To examine the competency and problem behavior correlates of television viewing in school-aged children using the CBCL. DESIGN: Cross-sectional survey. SETTING: Two randomly selected grade schools, one from a high-income district and the other from a low-income district. PARTICIPANTS: Students in grades 2 and 3 and their parents. MAIN OUTCOME MEASURES: A questionnaire on children's time spent watching television and engaging in other daily activities and the CBCL were sent to the parents of 888 second- and third-grade students. RESULTS: Results of the questionnaire reported that the overall mean +/- SD daily television viewing time was 2.5 +/- 1.3 hours. Overall television viewing time had a negative correlation with social and school achievement (r = -0.17, P<.001 and r = 0.11, P =.03, respectively) subscale scores. Withdrawn (r = 0.11, P =.004), social problem (r = 0.14, P =.001), thought problem (r = 0.11, P =.03), attention problem (r = 0.20, P<.001), delinquent behavior (r = 0.12, P<.001), aggressive behavior (r = 0.22, P<.001), and externalization (r = 0.19, P<.001) subscales and total problem (r = 0.15, P<.001) scores were positively correlated with time spent watching television. Stepwise logistic regression analysis revealed that the only significant variables associated with a risk of watching television for more than 2 hours were age, gender, social subscale, and attention problem subscale scores of the CBCL. CONCLUSION: As evaluated by the CBCL, television viewing time is positively associated with social problems, delinquent behavior, aggressive behavior, externalization, and total problem scores. Older age, male gender, and decreasing social subscale and increasing attention problem subscale scores on the CBCL increases the risk of watching television for more than 2 hours.

Analysis of Variance↗

Diagnosing attention deficit disorders with the Behavioral Assessment System for Children and the Child Behavior Checklist: test and construct validity analyses using optimal discriminant classification trees.

The usefulness of the Behavioral Assessment System for Children (BASC) and Child Behavior Checklist (CBCL) Parent scales was examined with respect to (a) differentiating students with attention deficit-hyperactivity disorder (ADHD) from non-ADHD students and (b) discriminating between the predominantly inattentive-type and combined-type ADHD-afflicted students. For both the BASC and the CBCL, a different optimal discriminant classification tree analysis (CTA) model was developed for each of the 2 diagnostic predictions. For distinguishing ADHD students from non-ADHD students, the BASC model was more parsimonious and accurate than the CBCL model. Toward the goal of differentiating between primarily inattentive and combined types, the CBCL's model was superior for predicting primarily inattentive students. The results demonstrate the diagnostic utility of the BASC and CBCL and describe salient behavioral dimensions associated with subtypes of ADHD.

Attention Deficit Disorder with Hyperactivity↗

[Methodological coomparison between the Child Behavior Checklist and the Strengths and Difficulties Questionnaires].

Few instruments have been developed to screen emotional and behavioural problems and mental disorders using questionnaire methods in a broad study, as will be done in the Health Survey for Children and Adolescents. In the context of this survey's pretest, two questionnaires--the Child Behavior Checklist (CBCL) and the Strengths and Difficulties Questionnaire (SDQ)--were compared regarding their psychometric properties, their diagnostic power, and the study participants' acceptance of the instruments. With this comparison, the question was addressed concerning which of the two questionnaires mentioned above is more reliable, valid and acceptable to the participants in describing mental health problems and psychiatric disorders in a population-based survey intended for a target age group of 6 to 17-year olds. The results of this methodical comparison show that both instruments are comparably useful for screening purposes. Both instruments detected mental disorders that were established in a clinical interview with equal probability. In this regard, the self-report tends to be superior to the parents' report in the age group from 11 to 17 years. The SDQ displays a slightly higher acceptance and--in comparison to the CBCL--a considerably lower number of items. It can therefore be recommended for use in the survey.

Adolescent↗

PTSD scale of the Child Behavior Checklist: concurrent and discriminant validity with non-clinic-referred sexually abused children.

Several assessment instruments include measures that are purported to assess characteristics of posttraumatic stress disorder (PTSD). Although these measures are used often by researchers and clinicians, few are supported by extensive validity data. The PTSD scale of the Child Behavior Checklist (CBCL) is one that has not yet encountered significant challenges to its validity. We examine the concurrent and discriminant validity of the CBCL-PTSD scale. Participants included 63 non-clinic-referred sexually abused (SA) children, 60 non-SA psychiatric outpatient children, and 61 non-SA, non-clinic-referred schoolchildren. Results revealed questionable concurrent validity for this scale, and suggest poor discriminant validity between SA children and non-SA psychiatric outpatients.

Adolescent↗

The mediating effect of age on the relationship between Child Behavior Checklist hyperactivity scores and neuropsychological test performance.

The relationship between hyperactivity and neuropsychological test performance at different age levels was examined. It was found that for young children (6 to 8 years of age, n = 90), there was no significant association between hyperactivity/attentional problems (as measured by the Hyperactivity scale of the Child Behavior Checklist) and performance on neuropsychological tasks thought to contain an attentional component (WISC-R Coding, Arithmetic, and Digit Span; WRAT Arithmetic; and the Benton Visual Retention Test). However, for older children (9 to 12 years of age, n = 92), there were significant and large negative correlations between CBC Hyperactivity scores and Coding, WRAT Arithmetic, and Benton VRT scores. Multiple regression analyses supported the above results (for Coding and WRAT Arithmetic), indicating that hyperactivity/inattention has a particularly deleterious effect on test performance (relative to same-age peers) as age increases.

Age Factors↗

A longitudinal community study: do psychosocial risk factors and child behavior checklist scores at 5 years of age predict psychiatric diagnoses at a later age?

OBJECTIVE: To examine the extent to which certain risk factors in 5- to 6-year-old children predict later psychopathology in a population-based sample of children from the province of Limburg in the south of the Netherlands. METHOD: Of the 2,290 children of interest, 1,317 children were screened with the Child Behavior Checklist (CBCL) and psychosocial risk factors for these children were collected. On the basis of the CBCL ratings, 403 children participated in the second stage in which, 1.5 years later, standardized child psychiatric information was obtained. Weighted logistic regression analyses were used to investigate predictors of psychopathology. RESULTS: In separate analyses of specific types of child psychopathology, different risk factors emerged as significant. Low-level parental occupation and having foreign-born parents were predictive of conduct disorders, and living in a single-parent family and a having a life event were the most important predictors of mood and anxiety disorders. Furthermore, CBCL-based ratings at 5 to 6 years of age corresponded well with interview-defined diagnoses 1.5 years later. CONCLUSIONS: Investigation of psychosocial risk factors and CBCL scores at the age of 5 to 6 years could be helpful in predicting child psychopathology and could help identify children at risk, in order to provide them with timely attention.

Adolescent↗

Child Behavior Checklist findings further support comorbidity between ADHD and major depression in a referred sample.

OBJECTIVE: To examine the convergence of categorical and empirical diagnostic systems to evaluate whether psychiatric comorbidity of juvenile major depression with attention-deficit hyperactivity disorder (ADHD) is due to assessment bias. METHOD: Using total predictive value and the odds ratio, the authors evaluated the convergence of Child Behavior Checklist (CBCL) scales with structured interview-derived diagnoses in 94 children with major depression, 97 with ADHD, and 115 normal control children with neither diagnosis. RESULTS: The CBCL Anxious/Depressed scale discriminated depressed from nondepressed children irrespective of comorbidity with ADHD, and the Attention Problems scale discriminated ADHD from non-ADHD children irrespective of comorbidity with major depression. Children with major depression comorbid with ADHD had CBCL correlates of both syndromes. CONCLUSIONS: Since the CBCL is an empirically derived taxonomic system, the correspondence between the content-congruent CBCL scales and DSM-III-R categorical diagnoses of major depression and of ADHD indicates that previously reported findings of high overlap between these two disorders using structured diagnostic interview methodology and trained raters were not due to rater biases.

Adolescent↗

Bipolar diagnoses in community mental health: Achenbach Child Behavior Checklist profiles and patterns of comorbidity.

BACKGROUND: There are converging findings about pediatric bipolar disorder (PBD) in terms of associated comorbidity and behavior problem profiles on the Achenbach Child Behavior Checklist (CBCL). However, no study has examined clinical or demographic characteristics of youths clinically diagnosed with bipolar disorder in a low-income, diverse community clinical sample. METHODS: Archival data (N = 3086 cases) from six urban community mental health centers (CMHC) were reviewed to determine the base rate of bipolar disorder and the demographic and clinical characteristics (comorbidity and CBCL profiles) associated with the diagnosis. RESULTS: Roughly 6% of the sample received clinical diagnoses of PBD. Patterns of comorbidity and CBCL profiles were highly similar to published samples. However, elevated CBCL scores were not specific to bipolar disorder, since they were also frequently high for nonbipolar cases. CONCLUSIONS: There appears to be substantial convergence between the demographic and clinical characteristics of cases clinically diagnosed with PBD versus those diagnosed with semistructured research interviews, strengthening the validity of both sets of diagnoses. At the same time, the CBCL appears to do poorly discriminating clinical diagnoses of PBD, due to the pervasive externalizing behavior problems in CMHC samples and the variable presentation of PBD cases.

Bipolar Disorder↗

Confirmation that Child Behavior Checklist clinical scales discriminate juvenile mania from attention deficit hyperactivity disorder.

OBJECTIVE: To determine whether boys meeting diagnostic criteria for juvenile mania and attention deficit hyperactivity disorder (mania-ADHD) may be distinguished from boys with ADHD alone on a range of clinical and family variables. METHODOLOGY: Boys aged 9-13 years with mania-ADHD (n = 25), ADHD alone (n = 99), or no psychiatric diagnosis (n = 27) were compared on parent and teacher report Child Behavior Checklists (CBCL) and Conners Questionnaires, self-report CBCLs, patterns of comorbidity, intellectual functioning, and family variables. RESULTS: Mania-ADHD subjects had significantly higher mean ratings than ADHD only subjects on the parent CBCL for the Withdrawn, Thought Problems, Delinquent Behavior and Aggressive Behavior scales and significantly higher rates of comorbid depression, anxiety and psychotic symptoms. Other variables did not distinguish the mania-ADHD and ADHD only groups. CONCLUSIONS: These data confirm previous research indicating that the CBCL may be used to assist in the clinical identification of manic children.

Adolescent↗

[Behavioral symptoms of children and adolescents in Germany, the Netherlands and USA. A cross-cultural study with the Child Behavior Checklist].

The goal of the study was a cross-cultural comparison of the parent ratings of behavior problems of children and adolescents aged 4-18 years in Germany, The Netherlands and the United States using the Child Behavior Checklist (CBCL). The analyses were undertaken in a German community sample (n = 1622) and a Dutch community sample (n = 2076). The results were compared with the data published by Achenbach for the national US sample. The analyses were based on the scales of the 1991 CBCL version and were performed for four age and sex groups (4- to 11-year-old boys/girls and 12- to 18-year-old boys/girls). In general, relatively minor differences could be detected between the three random samples. The range in the different samples was between -0.04 and 0.35, which is in line with other cross-cultural analyses using the CBCL. As long as no representative norms for Germany are available, the American norms can serve as an orientation for German studies using the CBCL.

Adolescent↗