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     

Psychiatric adjustment in adolescents with a history of chronic fatigue syndrome

OBJECTIVE: To ascertain psychiatric adjustment in youngsters with a history of childhood chronic fatigue syndrome (CFS). METHOD: Subjects were 25 children and adolescents with CFS who were seen in tertiary pediatric/psychiatric clinics (mean age 15.6 years, seen a mean of 45.5 months after illness onset; 17 subjects had recovered and 8 were still ill) and 15 healthy matched controls. Youngsters and their parents (usually mothers) were interviewed and completed questionnaires. Instruments used included the Schedule for Affective Disorders and Schizophrenia for School-Age Children (K-SADS), the Child Behavior Checklist (CBCL), and the Harter Self-Esteem Questionnaire. RESULTS: At assessment, psychiatric disorders (mainly anxiety and depressive disorders) were present in half the subjects with a history of CFS, a rate significantly higher than in healthy controls. On the CBCL youngsters with a history of CFS had an excess of psychological symptoms and decreased social competence. On the Harter Self-Esteem Questionnaire they reported reduced self-esteem, especially in social competence. Anxiety disorders were significantly more common in recovered subjects than in those with active CFS illness status. CONCLUSIONS: Psychiatric disorders were found to be increased in adolescents with a history of severe CFS; CFS may enhance the risk for or share common predisposing factors with anxiety disorders.     

Exploring ADHD age-of-onset criterion in Brazilian adolescents

 Objective: To explore age-of-onset criterion for the diagnosis of attention–deficit hyperactivity disorder (ADHD) in a school sample of young Brazilian adolescents. Methods: 191 students aged 12 to 14 years were evaluated using DSM-IV ADHD criteria, measures of ADHD symptoms and global impairment. Results: Both adolescents with ADHD (n=30) and adolescents who fulfilled all DSM-IV ADHD criteria, except age of onset of impairment criterion (ADHD w/o age-of-onset, n=27) had significantly higher scores on Attention Problems, Delinquent and Aggressive Behavior scales of the Child Behavior Checklist (CBCL) and lower scores on the Child Global Assessment scale (CGAS) than non-ADHD adolescents (n=134). Adolescents with ADHD and youths with ADHD w/o age-of-onset did not differ significantly in any measure assessed. Conclusion: These results concur with recent literature proposing revision of the age-of-onset criterion for the diagnosis of ADHD. Accepted: 22 February 2000     

The Conners-28 teacher questionnaire in clinical and nonclinical samples of Greek children 6 –12 years old

It is accepted practice in child psychiatry to use more than one source of information in assessing behavioural problems in children and adolescents. Employing standardized tools for these assessments allows cross-cultural comparisons and better interchange of the findings. Achenbach's Child Behavior Checklist (CBCL) and Teacher's Report Form (TRF) are two widely accepted instruments that were standardized in Greece within the framework of the European Network for the Study of Hyperkinetic Disorder. We studied the Conners-28 teacher questionnaire in a Greek community sample of primary schoolchildren aged 6–12 years. The factor structure showed to be similar to that originally reported from the USA. Discrimination between the referred and nonreferred sample was high, especially for the Inattentive-passive scale. Conners-28 scores were highly correlated with the TRF (scored by the same informant), much less so with the CBCL (scored by a different informant). Our study demonstrates the usefulness and applicability of the Conners-28 item questionnaire. Accepted: 9 December 1998     

Personality disorders in former child psychiatric patients

The present case-control study was undertaken in order to investigate the long-term outcome with respect to personality disorder (PD) symptomatology in former child psychiatric in-patients as compared to matched controls from the general population. Altogether 359 former patients and 359 controls were invited to participate in the study. Of these, 164 (46 %) former patients and 193 (54 %) controls approved participation. From these, 137 age and sex-matched pairs with a mean age of 30.7 (SD = 6.8) years were constructed. Adult PD symptomatology was assessed by means of the DSM-IV and ICD-10 Personality Questionnaire (DIP-Q). There were 52 former patients (38 %) and 15 controls (10.9 %) who fulfilled criteria for at least one DSM-IV self-reported PD. There was a significantly higher prevalence for all specific self-reported PDs in former patients compared to controls. The mean number of disorders was 1.7 (SD = 2.6) in former patients and 0.3 (SD = 0.8) in controls. Moreover, former patients fulfilled more PD criteria than controls (23 vs. 11; median numbers). The former patients had significantly lower global functioning and more psychosocial problems than the controls. These problems were related to personality pathology. The results of this study indicate that child psychiatric morbidity seems to increase the risk for adult PD symptomatology. However, the results may be biased by the low participation rate. Accepted: 11 September 2002 Correspondence to Lisa Ekselius, MD, PhD     

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. Accepted: 22 February 2000     

Validity of the Child Behaviour Checklist in a Norwegian sample

The purpose of the study was to test the applicability of the Child Behaviour Checklist for assessing behaviour problems and competencies in Norwegian children and adolescents. Information was obtained by mailing checklists to parents of random sampled children and adolescents in a mixed rural/semirural area and the urban Oslo area. High-scoring children and random samples of normal-scoring children in two different age groups were clinically assessed in the second part of the study. The results support the predictive validity of the CBCL as judged by its ability to distinguish between children with psychiatric disorders and psychiatrically nondisordered children. Differences pertaining to sex, age, SES, and degree of urbanisation confirm findings of earlier studies across cultures. Accepted: 17 September 1998     

Trichotillomania and related disorders in children and adolescents

Eleven chronic hair pullers, 11 subjects with obsessive-compulsive disorder (OCD), and 11 subjects with a non-OCD anxiety disorder were assessed with structured interviews and the Child Behavior Checklist (CBCL). Only 4 hair pullers (36%) reported both rising tension and relief with hair pulling. Each group had significantly more internalizing than externalizing symptoms on the CBCL. Seven hair pullers (64%) had a lifetime history of at least one other axis I diagnosis. The results provide further evidence that trichotillomania in referred children and adolescents is usually a chronic disorder often associated with internalizing symptoms and psychiatric comorbidity. Rising tension followed by relief with hair pulling may be an unnecessary restriction in the diagnosis of childhood trichotillomania.     

The German version of the "Screen for Child Anxiety Related Emotional Disorders" (SCARED): parent- and self report in a clinical sample

The psychometric properties and cross-informant agreement of the German version of the "Screen for Child Anxiety Related Emotional Disorders" (SCARED) were assessed in a clinical sample. 77 children and adolescents aged 11 to 18 years in outpatient psychotherapy and 66 parents filled out the SCARED and Youth Self Report (YSR) or Child Behavior Checklist (CBCL), respectively. In n = 57 cases both parent and self-report was available. The German SCARED is shown to have good convergent and divergent validity compared with YSR/CBCL scales. The total score discriminated between children with an anxiety disorder and children with another psychiatric disorder. Cross-informant agreement was moderate with children reporting more and more severe anxiety symptoms than their parents. In conclusion, both the parent and the child version of the German SCARED proved valid. In clinical settings the integration of data from both perspectives seems important.     

Psychiatric comorbidity in attention deficit disorder: impact on the interpretation of Child Behavior Checklist results.

Studies have investigated associations between the Child Behavior Checklist (CBCL) and clinical diagnoses without assessing the impact of comorbidity on these results. This study evaluates associations between parental reports from the CBCL and a structured diagnostic interview in children with attention deficit disorder with hyperactivity (ADDH) stratified by the presence (ADDH+) or absence (ADDH-) of psychiatric comorbidity. Interview-defined ADDH children scored significantly worse on all scales of the CBCL compared with scores from interview-defined non-ill comparisons. However, these findings were accounted for by the subgroup of children with ADDH+. The results indicate a good correspondence between CBCL-based ratings and interview-defined diagnoses. These findings also suggest that the CBCL may be a good screening instrument, not only for ADDH but also for comorbid psychiatric disorders.     

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.     

Personality and Psychopathology in Flemish Referred Children: Five Perspectives of Continuity

The present study investigates five types of continuity of personality and internalizing and externalizing problems (i.e., structural, differential, mean-level, individual-level and ipsative continuity) in a sample of referred children and adolescents (N = 114) with a broad variety of psychological problems. Mothers were administered a child personality and psychopathology measure, i.e., the Hierarchical Personality Inventory for Children [Handleiding hiërarchische persoonlijkheidsvragenlijst voor kinderen (manual hierarchical personality inventory for children). Ghent University, Department of Developmental, Personality, and Social Psychology, Ghent, 2005] and the Child Behavior Checklist [Handleiding voor de cbcl/4–18: (Manual of the CBCL/4–18), Afdeling Kinder- en Jeugdpsychiatrie. Erasmus Universiteit Rotterdam, The Netherlands, 1996] at two measurement occasions, with a 26-months interval. Personality was substantially stable, paralleling findings for non-referred peers. Internalizing and Externalizing Problem Behavior were almost as stable as personality traits, suggesting that childhood psychopathology is more persistent than generally assumed. Strengths and limitations of the present study and implications for further research are discussed.     

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     

Manic symptoms and behavioral dysregulation in youth with velocardiofacial syndrome (22q11.2 deletion syndrome)

Mania and bipolar disorder have been reported in adolescents and adults with velocardiofacial syndrome (VCFS; also known as 22q11.2 deletion syndrome). Children with VCFS have a high prevalence of attention-deficit/hyperactivity disorder (ADHD), which may constitute a risk factor for the eventual development of bipolar disorder in this population. Therefore, we sought to determine whether children with VCFS exhibit more manic symptoms than community controls that also may have learning disorders and ADHD. The study population consisted of 86 children with VCFS and 36 community controls from ages 9 to 15 years, using measures of Young Mania Rating Scale-Parent Version, Schedule for Affective Disorders and Schizophrenia for School-Age Children-Present and Lifetime Version (K-SADS-PL), Child Behavior Checklist (CBCL), and Wechsler Intelligence Scale for Children-3rd edition (WISC-III). The results indicate that manic symptoms were not more prevalent in VCFS than in a community sample of children with learning disorders and ADHD. However, after accounting for symptoms of depression and ADHD, we found that manic symptoms in VCFS predicted uniquely to scores on four Child Behavior Checklist (CBCL) subscales, including anxiety, somatization, thought, and conduct problems. In contrast, manic symptoms in controls predicted uniquely to conduct problems only. Accordingly, our findings of severe behavioral impairment in youth with VCFS and manic symptoms suggest that these children may warrant more intensive monitoring and treatment relative to youth with VCFS and ADHD only.     

Disruptive Behavior Disorders in Adolescents With ASD: Comparisons to Youth With Intellectual Disability or Typical Cognitive Development

Dual diagnosis of autism spectrum disorder (ASD) and behavior problems and/or mental disorders has become increasingly recognized and studied. Reported rates in samples of mixed-age youth with ASD are often above 70%, making this comorbidity more the rule than the exception. The present study compared rates of disruptive behavior disorder diagnosis in a sample of 13-year-old adolescents with ASD (n = 58), intellectual disability (ID; n = 40), or typical cognitive development (TD; n = 100). In youth without ASD, there was a high negative correlation between IQ and disruptive behavior disorders, assessed with the Child Behavior Checklist (CBCL) and the Diagnostic Interview Schedule for Children (DISC). In youth with ASD, however, the presence of a comorbid disruptive behavior disorder was unrelated to IQ, indicating that higher intelligence was not a protective factor for disruptive behavior disorders (DBDs) in ASD. On four CBCL scales and two DISC scales examined, youth with ASD had significantly higher rates than TD youth, though not generally higher than youth with ID. The most commonly diagnosed comorbid disorder in the early adolescents with ASD was attention-deficit/hyperactivity disorder. This has implications for planning school-based interventions, particularly for high-functioning children with ASD who are more likely to be fully included in general education.     

Behavioural and emotional problems in children of alcoholic mothers and fathers

 The Child Behavior Check List (CBCL) was used to compare a sample of 103 Danish children of alcoholics (CoA) to a Danish population-based sample (N = 780). The CoA had a significantly greater incidence of symptoms on 17 of the 118 CBCL items. Compared to the reference population, daughters of alcoholics were more impaired than sons of alcoholics on most CBCL measures. In families with maternal alcoholism daughters had higher internalising and depression scores than sons, and in families with paternal alcoholism, sons had higher internalising and depression scores than daughters. The CoA also had a significantly greater risk of scoring above the 95th percentile on internalising behaviour, depression symptoms and socially deviant behaviour. On all CBCL dimensions, almost half of the CoA samples functioned as well as the average of the reference population. The results from this study suggest that CoA should be regarded as a risk group but with very heterogeneous consequences in response to parental alcoholism. Accepted: 29 November 1999     

Cross-gender behavior and psychopathology in boy psychiatric outpatients

One hundred 5- to 12-year-old boys referred for outpatient psychiatric evaluation were assessed for cross-gender behavior using the Child Behavior and Attitude Questionnaire (CBAQ) and the Child Game Participation Questionnaire (CGPQ), and for possible associated psychopathology using the Child Behavior Checklist (CBCL) and clinical psychiatric (DSM-III) diagnoses. On the two feminine scales of the CBAQ and CGPQ, 30 to 50% scored within defined clinical ranges. High feminine scale scorers did not have higher Total CBCL scores than lower feminine scale scorers, and scores on the feminine scales correlated minimally with scores on the CBCL broad and narrow-band behavior problem scales, except for a significant positive correlation with the Delinquent subscale. No particular clinical psychiatric diagnoses were significantly associated with high feminine scorers: however, high feminine behavior scorers tended to have more conduct problems and mixed adjustment disorders and less anxious and depressive psychopathology. Clinicians were not alert to the degree of cross-gender behavior found, perhaps due to the concomitant externalizing psychopathology and masculine behavior in these same patients.     

A quick and reliable screening measure for OCD in youth: reliability and validity of the obsessive compulsive scale of the Child Behavior Checklist

BACKGROUND: The high prevalence and morbidity of obsessive compulsive disorder (OCD) in youth, the secretive nature of the disorder leading to under-recognition, and the lack of specialized child psychiatry services in many areas suggest that a simple, quick, and reliable screening tool to identify cases could be very useful to clinicians who work with children. METHOD: We used 8 items from the Child Behavior Checklist (CBCL), an empirically derived instrument free of clinician bias, to investigate the usefulness of a previously reported CBCL-based obsessive compulsive scale (OCS) by Nelson et al [Nelson EC, Hanna GL, Hudziak JJ, Botteron KN, Heath AC, Todd RD. Obsessive-compulsive scale of the Child Behavior Checklist: Specificity, sensitivity, and predictive power. Pediatrics 2001;108(1):E14] in a separate cohort of youth with OCD. We computed the psychometric properties of the OCS in our sample of youth with OCD and in psychiatric and normal controls, and compared these to the published values. RESULTS: Using the recommended cutoff between the 60th and 70th percentiles of the OCS to best predict the presence of OCD, we found very high sensitivity (92%-78%), specificity (86%-94%), negative predictive value (96%-90%), and positive predictive value (77%-86%). CONCLUSIONS: The OC scale of the CBCL shows good reliability and validity and acceptable psychometric properties to help discriminate youth with OCD.