Have the Cross-Informant Syndromes of the CBCL any practical value in identifying grouped ICD10 diagnoses?

Utility of the Child Behavior Checklist in screening depressive disorders within clinical samples

BACKGROUND

Previous studies analyzed the clinical validity of the Child Behavior Checklist (CBCL) for screening primary depressive disorders (major depression and dysthymia). Other psychiatric disorders with depressive symptomatology (e.g. adjustment disorders with depressive reaction) have not been a research focus to date. This study aims to examine the utility of the CBCL scales Anxious/Depressed and Affective Problems in screening both primary depressive disorders and other disorders with depressive symptomatology.

METHODS

The two samples consisted of 1445 outpatients and 698 inpatients aged 11-18 who were referred for child and adolescent psychiatric services. The predictive power of the CBCL scales was examined using ROC-analysis.

RESULTS

Both CBCL scales showed small to medium predictive power when screening for primary and other depressive disorders in clinically referred outpatients (AUCs=.694-.780). Within the inpatient sample, only primary depressive disorders were detected with small predictive power different from chance level (AUCs=.625-.673). Both CBCL scales did not differ significantly with regards to predicting depressive disorders.

LIMITATIONS

A limitation of this study is the lack of reliability checks for consensus classification process of the ICD-10 diagnoses. However, comparable prior work using structured interviews resulted in similar AUC values, supporting our findings.

CONCLUSIONS

In outpatient samples, the CBCL is suitable for screening other depressive disorders in addition to primary depressive disorders. This is not the case for inpatients due to a misclassification number of 40%; thus using CBCL scales screen for depressive disorders in such populations warrants caution.

The Autism--Tics, AD/HD and other Comorbidities (A-TAC) telephone interview: convergence with the Child Behavior Checklist (CBCL)

OBJECTIVE

To compare telephone interview screening for child psychiatric/neuropsychiatric disorders using the inventory of Autism-Tics, Attention deficit/hyperactivity disorder (AD/HD) and other Comorbidities (A-TAC) with results from the Child Behavior Checklist (CBCL).

BACKGROUND

The A-TAC is a parent telephone interview focusing on autism spectrum disorders (ASDs) and co-existing problems, developed for lay interviewers.

SUBJECTS AND METHODS

A-TAC telephone interviews and CBCL questionnaires were obtained from parents of 106 Swedish twin pairs aged 9 and 12 years.

RESULTS

Correlations between A-TAC modules and CBCL scales aimed at measuring similar concepts were generally significant albeit modest, with correlation coefficients ranging from 0.30 through 0.55.

CONCLUSION

The A-TAC has convergent validity with the CBCL in several problem areas, but the A-TAC also provides more detailed and specific assessments of ASD symptoms and related neuropsychiatric problems.

The autism--tics, AD/HD and other comorbidities inventory (A-TAC): further validation of a telephone interview for epidemiological research

BACKGROUND

Reliable, valid, and easy-to-administer instruments to identify possible caseness and to provide proxies for clinical diagnoses are needed in epidemiological research on child and adolescent mental health.The aim of this study is to provide further validity data for a parent telephone interview focused on Autism--Tics, Attention-deficit/hyperactivity disorder (AD/HD), and other Comorbidities (A-TAC), for which reliability and preliminary validation data have been previously reported.

METHODS

Parents of 91 children clinically diagnosed at a specialized Child Neuropsychiatric Clinic, 366 control children and 319 children for whom clinical diagnoses had been previously assigned were interviewed by the A-TAC over the phone. Interviewers were blind to clinical information. Different scores from the A-TAC were compared to the diagnostic outcome.

RESULTS

Areas under ROC curves for interview scores as predictors of clinical diagnoses were around 0.95 for most disorders, including autism spectrum disorders (ASDs), attention deficit/hyperactivity disorder (AD/HD), tic disorders, developmental coordination disorders (DCD) and learning disorders, indicating excellent screening properties. Screening cut-off scores with sensitivities above 0.90 (0.95 for ASD and AD/HD) were established for most conditions, as well as cut-off scores to identify proxies to clinical diagnoses with specificities above 0.90 (0.95 for ASD and AD/HD).

CONCLUSIONS

The previously reported validity of the A-TAC was supported by this larger replication study using broader scales from the A-TAC-items and a larger number of diagnostic categories. Short versions of algorithms worked as well as larger. Different cut-off levels for screening versus identifying proxies for clinical diagnoses are warranted. Data on the validity for mood problems and oppositional defiant/conduct problems are still lacking. Although the A-TAC is principally intended for epidemiological research and general investigations, the instrument may be useful as a tool to collect information in clinical practice as well.

Behavioural equivalents of anxiety in children with fragile X syndrome: parent and teacher report

BACKGROUND

Identifying many of the diagnostic criteria for anxiety and depression in individuals with intellectual disability (ID) can be challenging because they may be unable to recognize and communicate their emotional experiences accurately. The purpose of this study is to identify behavioural equivalents of anxiety in children with fragile X syndrome (FXS), the leading inherited cause of ID.

METHODS

Parents and teachers of 43 children (aged 6-14 years) with full mutation FXS completed two standardized questionnaires on children's problem behaviour and psychiatric symptoms. Items from the questionnaires thought to be possible behavioural equivalents of anxiety were identified and grouped into four domains: Avoidance Behaviours - Confrontational; Avoidance Behaviours - Non-confrontational; Anxiety Continuum Behaviours; and Behavioural Dysregulation. The mean rating for the four groups of items was used to predict the children's status for exhibiting significant problems with anxiety as defined by the Diagnostic and Statistical Manual of Mental Disorders-oriented Anxiety Subscale from the problem behaviour scale.

RESULTS

The predictor variables classified 81% (parent rating) and 86% (teacher rating) of the children correctly. Avoidance Behaviours - Confrontational and Avoidance Behaviours - Non-confrontational (teacher rating) and Anxiety Continuum Behaviours (parent and teacher rating) made unique contributions to the models.

CONCLUSIONS

Children who are unable to identify and communicate that they worry about general day-to-day events may exhibit more observable behaviours resembling active and passive avoidance (e.g. arguing, avoiding difficult tasks, staring off) or have specific phobias and compulsions. These findings suggest that there are behavioural equivalents for anxiety disorder in children with FXS and, more generally, support the notion of behavioural equivalents in ID.