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.     

The Obsessive-Compulsive Symptom (OCS) scale of the Child Behavior Checklist: a comparison between Swedish children with Obsessive-Compulsive Disorder from a specialized unit, regular outpatients and a school sample

To evaluate the discriminative power of various items as reported by parents in the OCS-scale extracted from the Child Behavior Checklist (CBCL) problem scale and to compare findings with outcomes of previous validation studies. Children referred to a specialized child psychiatric Obsessive-Compulsive Disorder (OCD) clinic (OCD group) (n=185) receiving a formal OCD diagnosis according to DSM IV criteria based on interviews with the Children's Yale-Brown Obsessive-Compulsive Scale (CY-BOCS) were compared to a sample recruited from regular child and adolescent psychiatric outpatient clinics (CPO group) (n=177). Both samples were compared to a normative school sample (SS group) and all three groups were matched for age and gender. Thirty seven CBCL items, mostly representing core internalizing symptoms and parts of the thought problem scale as well as physical and sleep problems, were first identified. Ten of these items (including all discriminative items in previous validation studies) could distinguish children with OCD from CPO patients. In a subsequent analysis, the results of a logistic regression showed that four CBCL items, "Obsessions," "Fearful and Anxious," "Compulsions," and "Worries" remained significant predictors. These four OCS items and previously used CBCL OCS-scales were further examined by means of ROC-analysis showing that the "Obsessions" and "Compulsions" CBCL items were the strongest predictors. These two CBCL items performed well as screens for OCS symptoms in children and adolescents and the addition of similar CBCL items did not further increase sensitivity or specificity. It is suggested that parental responses on these two items could preferably be used as screen for OCD in children and adolescents in regular child psychiatric clinics.     

Continuity and change of psychopathology from childhood into adulthood: a 14-year follow-up study

OBJECTIVE: To test the 14-year continuity and change of behavioral and emotional problems from childhood into adulthood. METHOD: For 1,615 children and adolescents aged 4 to 16 years from the general population, parents completed the Child Behavior Checklist (CBCL) at initial assessment. At follow-up 14 years later, subjects completed the Young Adult Self-Report (YASR), and their parents completed the Young Adult Behavior Checklist (YABCL). RESULTS: Of the subjects who were initially classified as deviant, 14 years later 41% were classified as deviant according to their YABCL Total Problem score, and 29% according to their YASR Total Problem score. Intrainformant (CBCL/YABCL) Withdrawn, Social Problems, Delinquent Behavior, and Aggressive Behavior scores, and cross-informant (CBCL/YASR) Anxious/Depressed, Thought Problems, and Delinquent Behavior scores were independent predictors of general levels of problem behavior. CONCLUSIONS: Childhood and adolescent problems persisted to a considerable degree into adulthood, although the majority of children who were deviant at initial assessment could not be regarded as deviant 14 years later. Children who were adolescents at initial assessment (12-16 years) showed higher stability of problem behaviors than subjects who were children at initial assessment (4-11 years).     

Child-reported depression and anxiety in preadolescence: II. Preschool predictors

OBJECTIVE: To examine the predictive association of parent- and teacher-reported behaviors at age 2 to 3 years in relation to child-reported depression and anxiety at age 10 to 11 years. METHOD: Subjects were participants in a longitudinal study of 420 children aged 2 to 3 years from the general population first assessed in 1989 and again in 1991 (n = 397) and 1997 (n = 358). For the present study, 249 children were included for whom all relevant measures were obtained. These measures include the Child Behavior Checklist (CBCL) for 2- to 3-year-olds at time 1, the CBCL for 4- to 18-year-olds and the Teacher's Report Form at time 2, and the Dimensions of Depression Profile for Children and the State-Trait Anxiety Inventory for Children at time 3. RESULTS: Only 5 and 8 of 220 parent-reported preschool problem items were significantly related to later child-reported depression and anxiety, respectively, and only 3 of 120 teacher-reported problem items were related to later anxiety. Of 120 teacher-reported preschool problem items, 21 were significantly related to later depression, including items referring to early signs of depression and social and academic problems. CONCLUSIONS: Teachers, but not parents, can provide valuable information regarding preschool signals of preadolescent depression, but not anxiety. These signals include early social and academic problems.     

Child-reported depression and anxiety in preadolescence: I. Associations with parent- and teacher-reported problems

OBJECTIVE: To examine a wide range of parent- and teacher-reported behaviors in relation to child-reported depression and anxiety in preadolescence. METHOD: Subjects were participants in a longitudinal study of 420 preschool children from the general population that started in 1989. At second follow-up 8 years later (ages 10-11 years), usable parent information was obtained for 358 children. For this study, 274 children for whom complete child, parent, and teacher reports were obtained at age 10 to 11 years were included. Measures included the Dimensions of Depression Profile for Children, the State-Trait Anxiety Inventory for Children, the Child Behavior Checklist/4-18, and the Teacher's Report Form. RESULTS: Of 120 parent-reported problem items, only 11 and 9 were associated with child-reported depression and anxiety, respectively. For teachers, 33 and 20 items (of 120) were significantly associated with child-reported depression and anxiety, respectively, including items referring to withdrawal, anxiety, depression, social problems, and academic problems. CONCLUSIONS: Teachers are more likely than parents to notice internalizing problems and related problems such as social and academic problems in children reporting depression or anxiety.     

Validity Study of the CBCL 6–18 for the Assessment of Emotional Problems in Youth With ASD

Youth with autism spectrum disorder (ASD) often present with emotional problems such as anxiety and depression (American Psychiatric Association, 2013). A recent study of the Child Behavior Checklist 6-18 (CBCL; Achenbach & Rescorla, 2001) indicated good sensitivity but relatively low specificity for identifying emotional problems in youth with ASD. The current study examined the extent to which variance in the CBCL’s Anxious/Depressed, Withdrawn/Depressed, Internalizing Domain, and Total Problems scales was accounted for by symptoms of emotional problems relative to ASD symptoms. Correlation and multiple regression analyses indicated that these scales measured anxiety and depression but a small statistically significant proportion of variance in Total Problems scores was also accounted for by ASD symptoms. Results contribute to the emerging evidence base for the inclusion of the CBCL in assessment protocols for assessing emotional and behavioral problems in youth with ASD.     

Understanding childhood (problem) behaviors from a cultural perspective: comparison of problem behaviors and competencies in Turkish immigrant, Turkish and Dutch children

Parents' reports of problem behaviors in 2,081 Dutch children, 3,127 Turkish children in Ankara and 833 Turkish immigrant children living in The Netherlands, aged 4–18 years, were compared. Dutch and Turkish versions of the Child Behavior Checklist (CBCL) were used. Immigrant children were scored higher than Dutch children on 6 of the 11 CBCL scales, most markedly on the Anxious/Depressed scale. Immigrant children were scored higher than Ankara children on five CBCL scales. However, these differences were much smaller than those found between immigrant and Dutch children. Furthermore, immigrant children's Total Problem scores did not differ from those for Ankara children. Turkish immigrant children have very similar patterns of parent-reported problem behaviors to children living in Turkey, although both groups of Turkish children showed higher levels of parent-reported problem behaviors than Dutch children. The higher scores for Turkish children on the Anxious/Depressed scale compared with their Dutch peers may be explained by cultural differences in parental perception of children's problem behaviors, as well as the threshold for reporting them, or by cultural differences in the prevalence of problems, for instance as the result of cross-cultural differences in child-rearing practice. More research is needed to test the degree to which Turkish immigrant parents tend to preserve their cultural characteristics and child-rearing practices in Dutch society.     

Characterization of children of bipolar parents by parent report CBCL

In past research the Child Behavior Checklist (CBCL) has differentiated among various diagnostic categories for children and adolescents. However, research has not been conducted on whether the CBCL differentiates among diagnostic categories for children at high risk for development of psychopathology. This study compares four diagnostic groups [bipolar disorder (BD), attention/deficit-hyperactivity disorder (ADHD), Depressed/Anxious and No Diagnosis] within a cohort of 58 children of bipolar parents to determine whether their CBCL scores will replicate the scores of children not at high risk for bipolar disorder. The cohort of children of bipolar parents received elevated scores on the CBCL scales in comparison with non-clinical populations. In addition, the CBCL distinguished between children of bipolar parents with and without clinical disorders. Finally the BD group differed from the ADHD group only on the Aggressive Behaviors, Withdrawn and Anxious/Depressed subscales of the CBCL. Therefore the CBCL did not discriminate between the BD and ADHD groups as it had in previous studies of children with BD and unspecified family history. It is possible that this discrepancy is due to a group of children of bipolar parents with ADHD who are currently prodromal for bipolar disorder and therefore received higher scores on the CBCL based on prodromal symptomatology. A longitudinal follow-up of this cohort is necessary to ascertain whether this is the case.     

Parent reports of sleep/alertness problems and ADHD symptoms in a sample of obese adolescents

OBJECTIVE: Recent evidence suggests an association between obesity and Attention Deficit/Hyperactivity Disorder (ADHD) or ADHD traits. The characteristics of obese subjects with a higher probability of ADHD symptoms are still unclear. We explore the hypothesis that obese adolescents with sleep/alertness problems represent a subgroup at high risk for ADHD traits, independently from associated symptoms of anxiety/depression. The aim of this study was to assess the relationship between parent reports of sleep/alertness problems and ADHD traits in a clinical sample of obese adolescents, controlling for symptoms of anxiety/depression. METHODS: Seventy obese subjects (age range, 10-16 years) were included. The parents filled out the Sleep Disturbance Scale for Children (SDSC), the Conners Parents Rating Scale-Revised (Short Version) (CPRS-R:S), and the Child Behavior Checklist (CBCL). The ADHD Rating Scale (ADHD-RS) was completed by a child psychiatrist. RESULTS: Using multiple regression models controlling for symptoms of anxiety/depression, scores of excessive daytime sleepiness on the SDSC were significantly associated with ADHD traits on the CPRS-R:S as well as on the ADHD-RS. CONCLUSIONS: Obese adolescents described as excessively sleepy by their parents may be at higher risk of ADHD symptoms, independently from symptoms of anxiety/depression. Although the clinician may overlook a potential diagnosis of ADHD in obese adolescents described as sleepy, the results of this study suggest to systematically look for symptoms of ADHD in this subgroup of obese patients. Further studies using objective methods to assess sleep/alertness disturbances are needed to gain insight into the relationship between sleep/alertness disturbances and ADHD in obese individuals.     

Psychopathological problems in children affected by tic disorders

AIM: The aim of this study was to assess the psychopathological and behavioural problems in patients affected by any tic disorder and their relationship with the severity of tic symptomatology. METHODS: A cross-sectional assessment was made of 125 children and adolescents affected by any tic disorder, all at their first neuropsychiatric evaluation and all drug na?ve. Tic disorder diagnoses were established by using The Tourette Syndrome Classification Study Group criteria; the procedures included the administration of Yale Global Tic Severity Scale (YGTSS), Children Yale-Brown-Obsessive-Compulsive Scale (CY-BOCS) and Child Behaviour Checklist (CBCL). RESULTS: The patients showed a mild to moderate tic disorder (mean YGTSS score = 27). Of the patients, 19% had Obsessive-Compulsive Disorder (OCD), but another 46% showed Obsessive-Compulsive (OC) symptoms. CBCL T total was pathologic in 17% of the children, with higher percentages in the Internalization and Attention Problems subscales. Statistical analysis pointed out a significant relationship between YGTSS and CY-BOCS scores as well as a significant relationship between the duration of tic symptomatology and several CBCL subscales (Internalization, Depressed/Anxious, Thought and Attention Problems). CONCLUSION: Our data can be summarized in three main points: a large number of patients have milder tics without any psychopathological comorbidity; OC symptoms are frequently associated with tics, mainly in children with more severe symptomatology; psychopathological problems, in particular internalizing difficulties, are present in children with long standing tic disorders.     

Screen for Child Anxiety-Related Emotional Disorders (SCARED): convergent and divergent validity

The purpose of this study was to examine the Screen for Child Anxiety-Related Emotional Disorders' (SCARED) divergent and convergent validity and its ability to identify anxious children. The SCARED, the Child Behaviour Checklist (CBCL), and the State-Trait Anxiety Inventory for Children (STAIC) were administered to children, adolescents (n = 295), and their parents attending an outpatient mood and anxiety disorders clinic. DSM-IIIR/IV diagnoses were made using a semistructured interview (n = 130) or a symptom checklist (n = 165). The Multi-Trait Multi-Method Matrix was used to assess construct validity, and Receiver Operating Curve analysis was used to assess the sensitivity and specificity of the SCARED, CBCL, and STAIC. The SCARED correlated significantly better with the CBCL's internalizing factors than with the externalizing factors. In addition, parent and child forms of the SCARED correlated significantly with the trait and state subscales of the STAIC. Children with an anxiety disorder scored significantly higher on the SCARED than children with depression only or disruptive disorders only (P < 0.05), thus demonstrating the discriminant validity of the SCARED. The SCARED is a reliable and valid screening tool for clinically referred children and adolescents with anxiety disorders.     

Social competence and emotional/behaviour problems in 6–16 year-old Swedish school children

Social competence and emotional/behavioural problems as reported by parents on a Swedish version of the Child Behaviour Checklist (CBCL) were examined in 1308 Swedish school-aged children/adolescents recruited from a stratified, random sample of schools in urban, semirural, and rural areas in Uppsala County, Sweden, and from Stockholm, the capital city of Sweden. The overall response rate was 80.6%. Few gender differences were found, but adolescents received higher problem scores and higher social competence scores than the younger children. Children from the middle SES groups were regarded as having higher social competence levels, and children from the lower SES groups had higher emotional/behaviour problem scores. Children from the larger cities consistently obtained higher problem scores. Those who had received help during the previous year because of psychological problems (2%) had much higher problems scores than those who had not received help. The levels of emotional/behavioural problems in children and adolescents in the present sample seem to be comparable to those reported in similar Scandinavian studies where the CBCL has been used. However, they were considerably lower than those commonly reported in epidemiological studies of children/adolescents from other countries and cultures. Accepted: 26 August 1998     

Behavioural disorders in adolescents with early-treated congenital hypothyroidism

This study analyses the possible risk factors for the on-set of behavioural disorders and psychiatric disturbances in a group of 30 early-treated congenital hypothyroidism (CH) subjects (12 children and 18 adolescents) compared with a control group of 116 age-matched normal subjects (58 children and 58 adolescents). The study also allowed us to evaluate the possible age at onset of behavioural disorders. Both the sample's and the controls' behaviours were assessed using a specific diagnostic instrument: Achenbach's and Edelbrock's Child Behaviour Checklist (CBCL). A clinical structured interview, the Diagnostic Interview for Children and Adolescents--Revised (DICA-R) was also administered to 18 adolescents with early-treated CH, in order to determine the presence of psychopathological disturbances. In accordance with literature data, the children and adolescents with early-treated CH showed more behavioural problems than age-matched, normal controls. In the children, a statistically significant difference versus the controls emerged only in their higher delinquent behaviour score, while the adolescents gave, on the CBCL, significantly higher scores compared with controls in the withdrawal, anxiety/depression, thought problems, attention problems and aggressive behaviour scales. In the DICA-R, 44% of adolescents with early-treated CH showed symptoms of anxiety disorder, in particular, separation anxiety disorder with phobic components; 16% showed mood disorder and depression and 11% showed behavioural disorders with attention deficit.     

Child Behavior Checklist item scores in Norwegian children

In an epidemiological study of children aged four to 16, 1170 parents responded to the Child Behavior Checklist (CBCL). Similar effects of age and socio-economic status (SES) on item scores as those reported in several international studies with the CBCL were found in the total sample. Contrary to the results of other studies, differences related to gender were found for only a few items. A subgroup of 41 children and 36 adolescents and their parents were interviewed with psychiatric interviews. Several CBCL problem items were good predictors of psychiatric disorder in the interviewed children and adolescents. High positive and negative predictive values were found for the items clumsy and the item unhappy, sad or depressed in this sample. Accepted: 7 May 1999     

The Youth Self-Report (YSR) and the Depression Self-Rating Scale (DSRS) as measures of depression and suicidality among adolescents

Two hundred and thirty-seven adolescents from a junior high school in a small community outside G?teborg, Sweden, completed the Youth Self Report (YSR) and the Depression Self Rating Scale (DSRS). Self-reported suicidality and biographical data were also recorded. The school doctor and nurse assessed the adolescents' somatic, psychological and behavioural problems using school health-records. The convergent validity of the YSR total problems scale and syndrome scales were tested against the DSRS. Discriminant validity was assessed by the two measures' ability to predict suicidality and school health problems. The Internalising (r = 0.65**) and Anxious/Depressed (r= 0.61**) syndrome scales of the YSR had the highest correlations with the DSRS. However, all YSR syndrome scales were significantly, though more modestly, correlated with the DSRS. Using stepwise logistic regression analysis, four YSR sub-scales [Social Withdrawal, Anxious/Depressed, Attention problems and Delinquency] predicted mild-severe self-reported depression (DSRS scores 12 and above). The YSR syndrome scales Anxious/Depressed and Delinquency predicted suicide ideation whereas the Self-destructive/Identity problem and Social Withdrawal (low scores) scales predicted Suicide attempts. The YSR Anxious/Depressed sub-scale and the DSRS total score seem to measure a similar dimension. However, the Anxious/Depressed and Selfdestructive/Identity problem scales were superior in predicting suicidality.     

The prevalence of specific phobia and associated co-morbid features in children and adolescents

ObjectiveThe aims of this study were to investigate the prevalence, associated co-morbid psychiatric disorders and behavioral/emotional problems associated with the subtypes of specific phobia in children and adolescents.MethodsA total of 2673 randomly selected children and adolescents from Seoul, Korea were assessed using the parent version of the Diagnostic Interview Schedule for Children (DISC-IV) and Children's Behavior Checklist (CBCL). We analyzed differences in psychiatric co-morbidities and CBCL profiles among the subtypes of specific phobia.ResultsThe 1-year prevalence of specific phobia was 7.9% (95% CI 7.63–8.17). Animal phobia was associated with anxiety disorder (OR 8.68, 95% CI 1.91–39.51) and oppositional defiant disorder (OR 2.55, 95% CI 1.27–5.12). Nature–environment phobia was associated with anxiety disorder (OR 25.70, 95% CI 6.16–107.10). Blood–injection–injury phobia showed associations with attention-deficit/hyperactivity disorder (ADHD: OR 6.74, 95% CI 2.81–16.15). Subjects with nature–environment phobia scored higher than did controls on the anxious/depressed, social problems, attention problems, and total behavioral problem profiles of the CBCL. Subjects with blood–injection–injury phobia scored significantly higher than did controls on the attention problems, aggressive behaviors, and externalizing problem profiles.ConclusionsContrary to animal phobias, nature–environment and blood–injection–injury phobias were associated with various behavioral and emotional problems and approximately correlated to their co-morbid psychiatric disorders. Among these subtypes, significant differences were found in demographic characteristics, co-morbid psychiatric disorders, and emotional/behavioral problems. These findings suggest that distinctive clinical characteristics might be related with different subtypes of specific phobia and clinician must consider psychiatric co-morbidities when treating children & adolescents with specific phobia.     

Does oppositional defiant disorder have temperament and psychopathological profiles independent of attention deficit/hyperactivity disorder?

Background

Most studies on temperamental and behavioral/emotional characteristics of oppositional defiant disorder (ODD) did not rule out the effect of comorbid attention-deficit/hyperactivity disorder (ADHD). The main objective of this study was to identify the temperamental and psychopathological patterns of ODD independent of comorbid ADHD. We also aimed to compare the patterns of temperament and psychopathology between ODD with and without ADHD.

Method

Parents of 2673 students, randomly selected from 19 representative schools in Seoul, Korea, completed the Diagnostic Interview Schedule for Children Version IV. Among 118 children and adolescents with ODD diagnosed by the Diagnostic Interview Schedule for Children Version IV, the parents of 94 subjects (mean age, 10.4 ± 3.0 years) and the parents of a random sample of 94 age- and gender-matched non-ODD/non-ADHD children and adolescents completed the parent's version of the Child Behavior Checklist (CBCL) and the Junior Temperament and Character Inventory.

Results

Subjects with ODD showed temperament and character profiles of high Novelty Seeking, low Self-directedness, and low Cooperativeness, a distinct pattern on the CBCL, and were at increased risk for anxiety and mood disorders compared to the controls after controlling for the effect of comorbid ADHD. The children and adolescents with both ODD and ADHD showed decreased levels of Persistence and Self-directedness and higher scores on 4 subscales of the CBCL (Anxious/Depressed, Attention Problems, Delinquent Behaviors, and Aggressive Behaviors) compared to those with ODD only.

Conclusions

Oppositional defiant disorder is associated with specific temperamental and behavioral/emotional characteristics, independent of ADHD. Moreover, the results of this study support that co-occurring ADHD and ODD have differentially higher levels of behavioral and emotional difficulties.     

Social competence and emotional/behavioural problems in children of psychiatric inpatients

The social competence and emotional/behavioural problems among 80 5–16-year-old children of 46 inpatients with various psychiatric disorders were assessed by the parents using a Swedish version of the Child Behavior Checklist (CBCL). The ratings of these children were compared to a normative sample of school children, but also whether type of psychiatric disorder among the parents was related to psychosocial functioning in their children. Fifty percent of the parents had a psychotic disorder; other common diagnoses were depressive, neurosis or personality disorders. Overall, children of psychiatric inpatients were perceived by the parents to be less socially competent and to have more emotional/behavioural problems than school children in the same age groups. However, 25% of the children of psychiatric parents were rated as having more severe problems (corresponding to the 90th percentile of the normative sample). About 15% of the children had total problem levels comparable to child psychiatric samples, but only 5% did actually receive ongoing help from the child psychiatric service. Parents with a depressive disorder or a crisis reaction also regarded their children to be more anxious/depressed, and to have more social problems than those of parents with other psychiatric disorders. Four CBCL items were found to be strong predictors of being a child of a psychiatric parent or parent in the normative sample. We suggest that the CBCL might be a valuable clinical tool in the screening and identification of those children of psychiatrically ill parents, who show more extreme problem scores and therefore might need help because of psychological problems. Accepted: 11 November 1999     

Persistence of Sleep Problems in Children with Anxiety and Attention Deficit Hyperactivity Disorders

This study examines the persistence of sleep problems over 18 months in 76 referred children with anxiety disorders and/or attention deficit hyperactivity disorders (ADHD) and 31 nonreferred controls, and explores predictors of sleep problems at follow-up (T2) in the referred children. Diagnoses were assessed at initial assessment (T1) using the semi-structured interview Kaufman Schedule for Affective Disorders and Schizophrenia. Sleep problems were assessed using the Children’s Sleep Habit Questionnaire at T1 and at T2. Persistence rate of total sleep problems in the clinical range was 72.4 % in referred children, and did not differ significantly between children with a T1 diagnosis of anxiety disorder (76.0 %), ADHD (70.6 %), anxiety disorder and ADHD (68.8 %) or nonreferred controls (50.0 %) The total sleep problems score at T1 significantly predicted the total sleep problems score at T2, whereas age, sex, parent education level and total number of life events did not.     

Executive Function Deficits in Psychiatric Outpatients in Australia

This study compared deficits in executive functioning in psychiatric outpatients with anxiety and depression to neurologically impaired patients and a community sample using a cross-sectional design. Anxious, depressed and neurologically impaired patients were compared for executive dysfunction using the revised Dysexecutive Questionnaire. A large sample of 663 community individuals, 39 mood disordered, 121 anxiety disordered and 120 neurologically impaired outpatients participated. Anxious and depressed patients exhibited significantly greater executive dysfunction than neurological patients and healthy controls. Anxiety patients reported the greatest executive dysfunction than all other groups including greater total problems and specific deficits in inhibiting responses and in acting with volition. Problems with inhibition reflect difficulties of anxiety patients in preventing automatic responses. Problems with volition reported by anxiety patients were attributed to comorbid depression, consistent with anxiety patients reporting the highest levels of depressive as well as anxious symptomology. Depressed patients reported greater problems with volition than community members, reflecting problems with planning and motivation. Neurologically impaired individuals reported a comparable level of executive dysfunction to the general community. This was attributed mainly to the poor ability of neurologically impaired individuals to report their own deficits. We discuss the relevance of executive functioning to anxiety and depression, and the implications of using the DEX-R with clinical samples.