Child Behavior Checklist Scales Research Articles

Migraine and behavior in children: influence of maternal headache frequency

We took advantage of a large population study in order to measure child behavior, as captured by the Child Behavior Checklist (CBCL) as a function of headache status in the children and their mothers. Of the target sample, consents and analyzable data were obtained from 1,856 families (85.4 %). Headache diagnoses were defined according to the second edition of the International Classification of Headache Disorders, and behavioral and emotional symptoms were assessed by the validated Brazilian version of the CBCL. We calculated the relative risk of abnormalities in the CBCL domains as a function of headache status in the children, after adjusting by a series of main effect models. Children with migraine were more likely to present abnormal scores in several of the CBCL scales, relative to children without migraine, and maternal migraine status contributed little to the model. However, when the mother had daily headaches, both children with and without migraine had similar CBCL scores. In multivariate analyses, migraine status in the children predicted CBCL scores (p < 0.01). Headache status and headache frequency in the mother did not predict CBCL scores in children with migraine but predicted in children without migraine (p < 0.01). The burden of migraine to the family is complex. Children with migraine are more likely to have behavioral and emotional symptoms than children without migraine. Children without migraine may be affected, in turn, by frequent headaches experienced by their mothers.

Comorbidity and Phenomenology of Bipolar Disorder in Children With ADHD

Objective: To assess the comorbidity of bipolar disorder (BPD) in children with ADHD and to study the psychopathological profile of ADHD children with and without mania. Method: A total of 100 children with ADHD were assessed with a semistructured diagnostic interview and questionnaires of mania, ADHD, and general psychopathology. Results: 8% of children met criteria for BPD and 6% for BPD–not specified. ADHD children with bipolar spectrum disorder had greater comorbidity with disruptive behavior disorders and scored higher on the Young Mania Rating Scales and on the Child Behavior Checklist (CBCL) Scales of rule-breaking behavior, externalizing problems, and total problems; however, significance on the CBCL Scales was lost when controlling for disruptive behavior disorders. Conclusion: BPD is frequently associated with ADHD; it has important implications for prognosis and choice of treatment. Differences on the CBCL Scales could be explained by the comorbidity with disruptive behavior disorders rather than by a specific manic profile.

Assessing Emotional and Behavioural Problems with the Child Behaviour Checklist: Exploring the Relevance of Adjusting the Norms for the Flemish Community

The Child Behaviour Checklist (CBCL) is one of the most frequently used dimensional instruments for screening behavioural and emotional problems in children. In this study the psychometric properties of the CBCL 2001-version and the usefulness of existing US norms within a Flemish community sample were explored. Mothers of young children ( N = 170) and school-aged children and adolescents ( N = 718) completed the CBCL and the Strengths and Difficulties Questionnaire (SDQ). Reliability of both the CBCL/1½-5 and CBCL/6-18 was excellent. There were substantial correlations between the SDQ and CBCL scales, indicating a good concurrent validity. Significant differences were found when comparing the mean CBCL raw scores of the different subsamples (for different ages and gender groups) with the US norms. Generally spoken, the mean CBCL raw scores as well as the clinical and borderline clinical cutpoints for Flemish children were mostly lower, specifically for the Total Problems score and the Externalising scales.

Examining the Criterion Validity of CBCL and TRF Problem Scales and Items in a Large Singapore Sample

This study examined the criterion validity of the Child Behavior Checklist (CBCL) and Teacher's Report Form (TRF) problem scales and items in demographically-matched Singapore samples of referred and non-referred children (840 in each sample for the CBCL and 447 in each sample for the TRF). Internal consistency estimates for both the CBCL and TRF scales were good. Almost all CBCL and TRF problem scales and items significantly discriminated between referred and non-referred children, with referred children scoring higher, as expected. The largest referral status effects were on attention problems scales and their associated items, with the TRF having larger effects than the CBCL. Effect sizes for demographic variables such as age, gender, ethnicity and SES were much smaller than effect sizes for referral status, across both the CBCL and TRF forms and at both the scale and item levels. These findings suggest that teachers can be effective partners in identifying children who need mental health services and those who do not.

The CBCL 1.5–5 and the identification of preschoolers with autism in Italy

To study the potential use of child behaviour checklist (CBCL) 1.5-5 scales for the early identification of preschoolers at risk of autism. CBCL scores of three groups of preschoolers were compared: (1) an experimental group of 101 preschoolers with autism spectrum disorder (ASD); (2) a control group of 95 preschoolers with other psychiatric disorders (OPD); (3) a control group of 117 preschoolers with typical development (TD). One-way analysis of variance (ANOVA), logistic regression with odds ratio (OR) and receiver operating characteristic (ROC) analyses were performed. ANOVA revealed that ASD and OPD had significantly higher scores in almost all CBCL scales than TD. ASD presented significantly higher scores than OPD on Withdrawn, Attention Problems and Pervasive Developmental Problems (PDP) scales. Logistic regression analysis demonstrated that these same CBCL scales have validity in predicting the presence of an ASD towards both TD and OPD. ROC analysis indicated high sensitivity and specificity for PDP (0.85 and 0.90) and Withdrawn (0.89 and 0.92) scales when ASD is compared to TD. Specificity (0.60 for PDP and 0.65 for Withdrawn) decreases when comparing ASD and OPD CONCLUSIONS: The PDP and Withdrawn scales have a good predictive validity so that they could be proposed as a first-level tool to identify preschoolers at risk of autism in primary care settings. Problems regarding the lower specificity when comparing ASD v. OPD are discussed.

Time Trends in Psychopathology

Time-trend studies are required to learn about children's mental health status in changing societies. Some international studies have already analyzed secular trends over periods of 10 to 25 years, but the results are inconsistent. Our study aims to detect German time trends of psychopathology in children aged 8-11, from the first large Child Behavior Checklist (CBCL)-based study in Marburg/Germany 1987 until the present day (2008). Parents filled in the CBCL to report psychopathological symptoms in their children. The school-based samples from the years 1987 and 2008 were matched for sex, age, and socioeconomic status. The matched samples each consists of 212 girls and boys (girls: 50.5 %, boys: 49.5 %). MANCOVAs and ANCOVAs were used to test differences in mean CBCL scale scores. Somatic symptoms showed a significant increase from 1987 to 2008. Similar trends were found for other internalizing symptoms, but did not reach significance. Externalizing symptoms showed no significant increase. Boys showed more aggressive or delinquent behavior and attention problems than girls. The children with the lowest socioeconomic status showed the highest symptom levels in both assessment years. The increase in somatic problems might be an effect of changes in expected school performance and economic aspects. The overall high rate of psychopathology in children highlights the necessity of effective prevention and intervention programs, particularly regarding families with lower socioeconomic status.

Detection of plasma autoantibodies to brain tissue in young children with and without autism spectrum disorders

Autism spectrum disorders (ASDs) are characterized by impaired language and social skills, often with restricted interests and stereotyped behaviors. A previous investigation of blood plasma from children with ASDs (mean age=5½years) demonstrated that 21% of samples contained autoantibodies that reacted intensely with GABAergic Golgi neurons of the cerebellum while no samples from non-sibling, typically developing children showed similar staining (Wills et al., 2009). In order to characterize the clinical features of children positive for these autoantibodies, we analyzed plasma samples from children enrolled in the Autism Phenome Project, a multidisciplinary project aimed at identifying subtypes of ASD. Plasma from male and female children (mean age=3.2years) was analyzed immunohistochemically for the presence of autoantibodies using histological sections of macaque monkey brain. Immunoreactivity to cerebellar Golgi neurons and other presumed interneurons was observed for some samples but there was no difference in the rate of occurrence of these autoantibodies between children with ASD and their typically developing peers. Staining of neurons, punctate profiles in the molecular layer of the dentate gyrus, and neuronal nuclei were also observed. Taken together, 42% of controls and subjects with ASD demonstrated immunoreactivity to some neural element. Interestingly, children whose plasma reacted to brain tissue had scores on the Child Behavior Checklist (CBCL) that indicated increased behavioral and emotional problems. Children whose plasma was immunoreactive with neuronal cell bodies scored higher on multiple CBCL scales. These studies indicate that additional research into the genesis and prevalence of brain-directed autoantibodies is warranted.

Development of a parent-report cognitive function item bank using item response theory and exploration of its clinical utility in computerized adaptive testing.

The purpose of this study is to report the reliability, validity, and clinical utility of a parent-report perceived cognitive function (pedsPCF) item bank. From the U.S. general population, 1,409 parents of children aged 7-17 years completed 45 pedsPCF items. Their psychometric properties were evaluated using Item Response Theory (IRT) approaches. Receiver operating characteristic (ROC) curves and discriminant function analysis were used to predict clinical problems on child behavior checklist (CBCL) scales. A computerized adaptive testing (CAT) simulation was used to evaluate clinical utility. The final 43-item pedsPCF item bank demonstrates no item bias, has acceptable IRT parameters, and provides good prediction of related clinical problems. CAT simulation resulted in correlations of 0.98 between CAT and the full-length pedsPCF. The pedsPCF has sound psychometric properties, U.S. general population norms, and a brief-yet-precise CAT version is available. Future work will evaluate pedsPCF in other clinical populations in which cognitive function is important.

P01-324 - Prevalence of behavioral and emotional problems in children at-risk for learning difficulties

IntroductionStudies have shown that children with learning difficulties are likely to demonstrate a host of shared behavioral and emotional problems that affect their daily functioning.Objectives/AimsThe goal of this study was to examine profiles of behavioral and emotional problems in children at risk for Learning Disorders (LD) and Communication Disorders (COMM), without intellectual disabilities.MethodData on the Child Behavior Checklist (CBCL) of 52 participants (4–12 years old) at-risk for LD and 52 age- and gender- matched participants at-risk for COMM were obtained from the archival records of a local outpatient child psychiatric clinic. For all CBCL scales, T scores ranging from 65 to 69 are in the borderline clinical range, whereas a T score of 70 and above are in the clinical range. T scores of below 65 are considered as non-clinical. For the purposes of this study, a T score of 65 and above for the CBCL syndromes indicated the problem to be of clinical concern.ResultsA total of 51.9% of these children had at least one problem of clinical concern, with Attention Problems (LD: 36.5% vs. COMM: 17.3%), Social Problems (LD: 21.2% vs. COMM: 30.8%), and Withdrawn/Depressed (LD: 23.1% vs. COMM: 26.9%) syndromes being commonly reported. There were no significant differences between the 2 groups on the CBCL syndromes.ConclusionsFindings from the study suggest that children with any form of learning difficulties demonstrate high prevalence of behavioral and emotional problems, suggesting possible comorbidities such as Attention Deficit Hyperactivity and Depression.

The Nature of Covariation Between Autistic Traits and Clumsiness: A Twin Study in a General Population Sample

While social impairment, difficulties with communication, and restricted repetitive behaviors are central features of Autism Spectrum Disorders, physical clumsiness is a commonly co-occuring feature. In a sample of 398 twin pairs (aged 8-17years) from the Italian Twin Registry we investigated the nature of the co-variation between a psychometric index of Clumsiness and the Child Behavior Checklist (CBCL) Autistic scale. Bivariate twin analyses showed that a genetic etiological overlap, rather than direct causation, is a plausible explanation for the association between clumsiness and autistic-like traits, as measured by indices derived from the parent-rated CBCL scale. Additive genetic influences that impinge upon clumsiness/motor problem and autistic-like traits coincided remarkably, with a genetic correlation of 0.63.

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.

Cognitive Functioning and Academic Performance in Elementary School Children with Anxious/Depressed and Withdrawn Symptoms

RATIONALE: Few studies have evaluated the relationship between depressive symptomatology and neuropsychological performance in children without symptomatic depression. OBJECTIVES: This study determined the relationship between anxious/depressed and withdrawn symptoms and performance on cognitive and academic achievement measures. METHODS: 335 Caucasian and Hispanic children aged 6 to 11 years who participated in the Tucson Children's Assessment of Sleep Apnea (TuCASA) study were administered a comprehensive neuropsychological battery measuring cognitive functioning and academic achievement. Their parents completed the Child Behavior Checklist (CBCL). Correlations between performance on the cognitive and academic achievement measures and two Internalizing scales from the CBCL were calculated. Comparisons were made between a "Clinical" referral group (using a T-score of ≥ 60 from the CBCL scales) and a "Normal" group, as well as between Caucasians and Hispanics. RESULTS: No differences were found between those participants with increased anxious/depressed or withdrawn symptoms on the CBCL and those without increased symptoms with respect to age, gender, ethnicity, or parental education level. However, significant negative correlations were found between these symptoms and general intellectual function, language, visual construction skills, attention, processing speed, executive functioning abilities, aspects of learning and memory, psychomotor speed and coordination, and basic academic skills. CONCLUSIONS: These findings support the hypothesis that depressive symptomatology negatively impacts performance on cognitive and academic achievement measures in school-aged children and these findings are not affected by ethnicity. The findings also reinforce the concept that the presence of anxious/depressed or withdrawn symptoms needs to be considered when evaluating poor neuropsychological performance in children.

Behaviour problems of patients with Moebius sequence and parental stress

Moebius sequence is a rare condition usually defined as congenital facial paralysis with congenital impairment of ocular abduction. At present, there is little information on behavioural problems, parental stress and possible relationships between these factors. To fill this gap, this study investigated these aspects relevant for counselling. Parents of 4-17 year old subjects known to the German Möbius syndrome foundation were anonymously asked to fill out several questionnaires, for example, the Child Behavior Checklist (CBCL)4-18. The primary care givers of 41/58 subjects (70.7%) sent back filled-out questionnaires. Ten subjects did not meet the inclusion criteria; 15 males and 16 females (4; 7-17; 0 years, median age: 10; 7 years) were included. Ten out of 31 subjects were rated as clinical on at least one CBCL scale; three had a total problem score in the clinical range. Social problems were the most important problems with rates of 12-17-year old subjects being about five times as high as those of younger subjects. Compared with the general population, but not with other parents of mentally and/or physically handicapped children, the primary care givers experienced higher levels of stress, which were correlated to anxious/depressed behaviour, aggressive behaviour, externalising problems and total problem score of the children. The older a child the higher the primary care giver's life satisfaction was. Social problems seem to be frequent among 4-17-year old subjects with Moebius sequence, and primary care givers show increased strain. Therefore, families with an affected child need early and adequate support.

The Reliability and Criterion Validity of the Diagnostic Infant and Preschool Assessment: A New Diagnostic Instrument for Young Children

The need to assess Diagnostic and Statistical Manual, Fourth Edition (DSM-IV) disorders in children younger than 7 years of age has intensified as clinical efforts to diagnose and treat this population have increased, and clinical research on psychopathology has advanced. A new diagnostic instrument for young children was created, the Diagnostic Infant Preschool Assessment (DIPA), and was tested for test-retest reliability and concurrent criterion validity. The caregivers of 50 outpatients aged 1-6 years were interviewed twice by trained interviewers, once by a clinician and once by a research assistant, about eight disorders. The median test-retest intraclass correlation was 0.69, mean 0.61, and values ranged from 0.24 to 0.87. The median test-retest kappa was 0.53, mean 0.52, and values ranged from 0.38 to 0.66. There were no differences by duration between interviews. Concurrent criterion validity show good agreement between the instrument and DSM-based Child Behavior Checklist scales when the DSM-based scales were matched well to the disorder (attention-deficit/hyperactivity inattentive and hyperactive and oppositional disorders). Preliminary data support the DIPA as a reliable and valid measure of symptoms in research and clinical work with very young children. This measure adds a tool that is flexible in covering both DSM-IV syndromes and empirically-validated developmental modifications that can help increase confidence in assessing young children, ensuring coverage of symptoms, and improve access to care.

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.

Effectiveness of child psychoanalytic psychotherapy in a clinical outpatient setting

The objective of this study was to evaluate the outcome of child psychoanalytic psychotherapy in a clinical outpatient setting in a city in southern Brazil. Three psychological tests (Rorschach, Bender and WISC III) were administered to 23 children, aged 6–11 years old, and the Child Behaviour Check List (CBCL) was completed by the parents. All testing was completed before the beginning of the individual psychoanalytic psychotherapy. The same measures were repeated after 12 months of intervention. The 23 children who received individual psychoanalytic psychotherapy were compared with a control group who did not receive any kind of intervention. In the clinical group, the results indicated a statistically significant reduction of anxiety symptoms (0.002) and school problems (0.031), improvement in interpersonal relationships (0.022), and positive change in the following CBCL scales: withdrawn (0.010), thought problems (0.022), anxiety and depression (0.017), internalising (0.008) and total (0.003). An effect size of 0.696 was calculated based on the CBCL total scale before and after the intervention. The results revealed that child psychoanalytical psychotherapy is mostly effective in the treatment of female children who present internalising disorders.

Behavior Problems and Subtypes of Attention-deficit Hyperactivity Disorder With Comorbidities

This study investigated the relationship between Child Behavior Checklist (CBCL) symptoms and attention-deficit hyperactivity disorder (ADHD) subtypes [inattentive (ADHD-I) and combined (ADHD-C)] with or without comorbidities. Overall, 116 ADHD children were interviewed using the Mini-International Neuropsychiatric Interview to assess ADHD subtypes and comorbidities, and were then divided into four groups according to their subtypes and comorbidities. The CBCL was completed by the parents of the ADHD children. The association between behavioral symptom severity and groups was examined by comparing the CBCL scales of the four groups. The scores for the Aggressive Behavior (p = 0.014) and Anxiety/Depression scales (p = 0.033) were higher in patients with ADHD-I with comorbidities than with ADHD-I without comorbidities. In addition, the score for the Aggressive Behavior scale was higher in patients with ADHD-C without comorbidities than in patients with ADHD-I without comorbidities (p = 0.011). The scores for the six CBCL scales were all higher in patients with ADHD-C with comorbidities than in patients with ADHD-I without comorbidities. Our findings suggest a synergistic effect of the co-occurrence of comorbidities and the ADHD-C subtype on behavioral symptom severity. Physicians could use the CBCL scales to distinguish patients with more severe symptoms from patients with less severe symptoms.

Tourette Syndrome–Associated Psychopathology: Roles of Comorbid Attention-Deficit Hyperactivity Disorder and Obsessive-Compulsive Disorder

Individuals with Tourette syndrome (TS) often display comorbid symptoms of attention-deficit hyperactivity disorder (ADHD) and obsessive-compulsive disorder (OCD), as well as externalizing and internalizing behaviors. This study was aimed to examine the impacts of tic severity, ADHD symptoms, and OCD on internalizing (e.g., anxiety) and externalizing (e.g., aggression) psychopathology. Using linear regressions, we examined how tics, ADHD, and OCD symptoms predicted the externalization and internalization behaviors measured by the Child Behavior Checklist in a clinical sample of children and adolescents with TS. In addition, Child Behavior Checklist scales were compared among children with TS without ADHD, TS and ADHD, ADHD without TS, and unaffected control group. In the TS group, externalizing behaviors were predicted by tic severity, inattention, and hyperactivity/impulsivity but not by OCD symptoms, whereas internalizing behaviors were predicted by inattention and OCD symptoms but not by tic severity or hyperactivity/impulsivity. Comparison among different clinical groups revealed main effects of TS and ADHD on both externalizing and internalizing behaviors. These findings suggest that tics, ADHD, and OCD symptoms differentially explain the variance in externalizing and internalizing behavioral problems in individuals with TS. In addition, the data support the notion that TS is itself a risk factor for behavioral problems, mandating that children with TS even without ADHD and OCD still need to be assessed and treated for psychopathology.

Do Sluggish Cognitive Tempo Symptoms Predict Response to Methylphenidate in Patients with Attention-Deficit/Hyperactivity Disorder–Inattentive Type?

In this naturalistic study, we assessed the effect of sluggish cognitive tempo (SCT) symptoms in the response to methylphenidate (MPH) in 88 children and adolescents with attention-deficit/hyperactivity disorder-Inattentive Type (ADHD-I) according to Diagnostic and Statistical Manual of Mental Disorders, 4(th) edition (DSM-IV) criteria. SCT symptoms were assessed in these subjects by means of the Child Behavior Checklist (CBCL) scale. The response to MPH after 1 month of treatment was assessed by parental scores in the Swanson, Nolan, and Pelham Questionnaire-Version IV (SNAP-IV) scale. No significant differences were found between subjects with and without SCT symptoms in the response to MPH either assessing presence of SCT symptoms categorically (at least 1 symptom) or dimensionally (p < 0.5 for both analyses; effect size [ES] = 0.24). Our findings corroborate previous phenotypic data suggesting that SCT symptoms do not define a clinically relevant type of ADHD-I.

Predicting behavioral problems in craniopharyngioma survivors after conformal radiation therapy

Although radiation therapy is a primary treatment for craniopharyngioma, it can exacerbate existing problems related to the tumor and pre-irradiation management. Survival is often marked by neurologic deficits, panhypopituitarism, diabetes insipidus, cognitive deficiencies, and behavioral and social problems. The Achenbach Child Behavior Checklist (CBCL) was used to evaluate behavioral and social problems during the first 5 years of follow-up in 27 patients with craniopharyngioma treated with conformal radiation therapy. All group averages for the CBCL scales were within the age-typical range at pre-irradiation baseline. Extent of surgical resection was implicated in baseline differences for the internalizing, externalizing, behavior problem and social scores. Significant longitudinal changes were found in internalizing, externalizing, behavior problem and school scores that correlated with tumor and treatment-related factors. The most common variables implicated in post-irradiation behavioral and social problems were CSF shunting, presence of an Ommaya reservoir, diabetes insipidus, and low pre-irradiation growth hormone levels.