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Predicting Anxiety Diagnoses and Severity with the CBCL-A: Improvement Relative to Other CBCL Scales?

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Abstract

The Child Behavior Checklist (CBCL) is a widely used parent-report of child and adolescent behavior. We examined the ability of the CBCL-A scale, a previously published subset of CBCL items, to predict the presence of generalized anxiety disorder (GAD), separation anxiety disorder (SAD), and social phobia (SoP), as well as anxiety severity, among 488 youth randomized in the Child Anxiety Multimodal Study (CAMS). We predicted that the CBCL-A’s unique inclusion of items related to somatic symptoms would better identify anxiety disorder and severity than other CBCL scales, given that somatic complaints are often key features of anxiety among youth. Results support the use of the anxiety-based CBCL subscales as first-line screeners for generally elevated symptoms of anxiety, rather than tools to identify specific anxiety disorders. Although somatic symptoms are often reported and included in diagnostic criteria for certain anxiety disorders (e.g., SAD, GAD), the unique combination of somatic and non-somatic symptoms for the CBCL-A subscale did not increase its ability to consistently predict the presence of specific anxiety disorders.

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Notes

  1. Age and sex were considered as potential control variables. No sex differences were found for any of the CBCL subscales examined. Initial analyses indicated age differences for only the INT and the AP subscales (ps <. 05). As such, all regression analyses were also run including age as a covariate. No differences in statistical interpretation were found when age was included as a covariate. As such, analyses presented include only comorbidity as a covariate in the regression models.

References

  • Achenbach, T. M. (1991). Manual for the Child Behavior Checklist 4–18 and 1991 profile. Burlington: Department of Psychiatry, University of Vermont.

    Google Scholar 

  • Achenbach, T. M. (1995). Empirically based assessment and taxonomy: Applications to clinical research. Psychological Assessment, 7, 261–274. doi:10.1037//1040-3590.7.3.261.

    Article  Google Scholar 

  • Achenbach, T. M., & Dumenci, L. (2001). Advances in empirically based assessment: revised cross-informant syndromes and new DSM-oriented scales for the CBCL, YSR, and TRF: Comment on Lengua, Sadowski, Friedrich, and Fisher (2001). Journal of Consulting and Clinical Psychology, 69, 699–702. doi:10.1037//0022-006X.69.4.699.

    Article  PubMed  Google Scholar 

  • Achenbach, T. M., Dumenci, L., & Rescorla, L. A. (2003). DSM oriented and empirically based approaches to constructing scales from the same item pools. Journal of Clinical Child and Adolescent Psychology, 32, 328–340. doi:10.1207/S15374424JCCP3203_02.

    Article  PubMed  Google Scholar 

  • Achenbach, T. M., & Edelbrock, C. (1983). Manual for the Child Behavior Checklist and revised behavior profile. Burlington: University of Vermont, Department of Psychiatry.

    Google Scholar 

  • Achenbach, T. M., & Rescorla, L. A. (2001). Manual for the ASEBA School-Age Forms & Profiles. Burlington: University of Vermont, Research Center for Children, Youth, & Families.

    Google Scholar 

  • Albano, A. M., Chorpita, B. F., & Barlow, D. H. (2003). Childhood anxiety disorders. In E. J. Mash & R. A. Barkley (Eds.), Child psychopathology (2nd ed., pp. 279–329). New York: Guilford Press.

    Google Scholar 

  • Association, A. P. (2000). Diagnostic and Statistical Manual of Mental Disorders, (4th ed., text rev.). Washington: American Psychiatric Association.

    Google Scholar 

  • Aschenbrand, S. G., Angelosante, A. G., & Kendall, P. C. (2005). Discriminant validity and clinical utility of the CBCL with anxiety-disordered youth. Journal of Clinical Child And Adolescent Psychology, 34, 735–746. doi:10.1207/s15374424jccp3404_15.

    Article  PubMed  Google Scholar 

  • Beidel, D. C., Turner, S. M., & Morris, T. L. (1995). A new inventory to assess childhood social anxiety and phobia: The social phobia and anxiety inventory for children. Psychological Assessment, 7, 73–79. doi:10.1037//1040-3590.7.1.73.

    Article  Google Scholar 

  • Biederman, J., Faraone, S. V., Doyle, A., Lehman, B. K., Kraus, I., Perrin, J., & Tsuang, M. T. (1993). Convergence of the Child Behavior Checklist with structured interview-based psychiatric diagnoses of ADHD children with and without hyperactivity. Journal of Child Psychology and Psychiatry, 34, 1241–1251. doi:10.1097/00004583-199303000-00011.

    Article  PubMed  Google Scholar 

  • Biederman, J., Faraone, S., Mick, E., & Moore, P. (1996). Child Behavior Checklist findings further support comorbidity between ADHD and major depression in a referred sample. Journal of the American Academy of Child and Adolescent Psychiatry, 35, 734–742. doi:10.1097/00004583-199606000-00013.

    Article  PubMed  Google Scholar 

  • Borkovec, T. D., Ray, W. J., & Stöber, J. (1998). Worry: A cognitive phenomenon intimately linked to affective, physiological, and interpersonal behavioral processes. Cognitive Therapy And Research, 22, 561–576. doi:10.1023/A:1018790003416.

    Article  Google Scholar 

  • Brasil, H. H. A., & Bordin, I. A. (2010). Convergent validity of K-SADS-PL by comparison with BCL in a Portuguese speaking outpatient population. BMC Psychiatry, 10, 1–11. doi:10.1186/1471-244X-10-83.

    Article  Google Scholar 

  • Chavira, D. A., Stein, M. B., Bailey, K., & Stein, M. T. (2004). Child anxiety in primary care: Prevalent but untreated. Depression and Anxiety, 20, 155–164. doi:10.1002/da.20039.

    Article  PubMed  Google Scholar 

  • Choudhury, M. S., Pimentel, S. S., & Kendall, P. C. (2003). Childhood anxiety disorders: Parent–child (dis)agreement using a structured interview for the DSM-IV. Journal of the American Academy of Child and Adolescent Psychiatry, 42, 957–964. doi:10.1097/01.CHI.0000046898.27264.A2.

    Article  PubMed  Google Scholar 

  • Compton, S., Walkup, J., Albano, A. M., Piacentini, J., Birmaher, B., Sherrill, J., & March, J. (2010). Child/Adolescent Anxiety Multimodal Study (CAMS): Rationale, design, and methods. Child and Adolescent Psychiatry and Mental Health, 4, 1–15. doi:10.1186/1753-2000-4-1.

    Article  PubMed Central  PubMed  Google Scholar 

  • Crawley, S., Caporino, N., Birmaher, B., Ginsburg, G., Piacentini, J., Albano, A.M.… & Kendall, P. C. (in press). Somatic complaints in anxious youth. Child Psychiatry and Human Development. Doi: 10.1007/s10578/s1057-013-0410-x

  • Doucette, A. (2002). Child and adolescent diagnosis: The need for a model-based approach. In L. E. Beutler & M. L. Malik (Eds.), Rethinking the DSM. A psychological perspective (pp. 201–220). Washington: American Psychological Association.

    Google Scholar 

  • Ebesutani, C., Bernstein, A., Nakamura, B. J., Chorpita, B., Higa-McMillan, C., & Weisz, J. (2010). Concurrent validity of the Child Behavior Checklist DSM-oriented scales: Correspondence with DSM diagnoses and comparison to syndrome scales. Journal of Psychopathology and Behavioral Assessment, 32, 373–384. doi:10.1007/s10862-009-9174-9.

    Article  PubMed Central  PubMed  Google Scholar 

  • Edelbrock, C., & Costello, A. J. (1988). Convergence between statistically derived behavior problem syndromes and child psychiatric diagnoses. Journal of Abnormal Child Psychology, 16, 219–231. doi:10.1007/BF00913597.

    Article  PubMed  Google Scholar 

  • Emslie, G., Kratochvil, C., Vitiello, B., Silva, S., Mayes, T., & McNulty, S. (2006). Treatment for Adolescents with Depression Study (TADS): Safety results. Journal of the American Academy of Child and Adolescent Psychiatry, 45, 1440–1455. doi:10.1097/01.chi.0000240840.63737.1d.

    Article  PubMed Central  PubMed  Google Scholar 

  • Essau, C. A., Conradt, J., & Petermann, F. (2000). Frequency, comorbidity, and psychosocial impairment of anxiety disorders in adolescents. Journal of Anxiety Disorders, 14, 263–279. doi:10.1016/S0887-6185(99)00039-0.

    Article  PubMed  Google Scholar 

  • Ferdinand, R. F. (2008). Validity of the CBCL/YSR DSM-IV scales anxiety problems and affective problems. Journal of Anxiety Disorders, 22(1), 126–134. doi:10.1016/j.janxdis.2007.01.008.

    Article  PubMed  Google Scholar 

  • Ginsburg, G. S., Riddle, M. A., & Davies, M. (2006). Somatic symptoms in children and adolescents with anxiety disorders. Journal of the American Academy of Child and Adolescent Psychiatry, 45, 1179–1187. doi:10.1097/01.chi.0000231974.43966.6e.

    Article  PubMed  Google Scholar 

  • Grant, B., Hasin, D., Stinson, F., Dawson, D., Ruan, W., Goldstein, R., & Huang, B. (2005). Prevalence, correlates, co-morbidity, and comparative disability of DSM-IV generalized anxiety disorder in the USA: Results from the National Epidemiologic Survey on alcohol and related conditions. Psychological Medicine, 35, 1747–1759.

    Article  PubMed  Google Scholar 

  • Hofflich, S. A., Hughes, A. A., & Kendall, P. C. (2006). Somatic complaints and childhood anxiety disorders. International Journal of Clinical and Health Psychology, 6, 229–242.

    Google Scholar 

  • Kendall, P. C., Compton, S. N., Walkup, J. T., Birmaher, B., Albano, A., Sherrill, J., & Piacentini, J. (2010). Clinical characteristics of anxiety disordered youth. Journal of Anxiety Disorders, 24, 360–365. doi:10.1116/j.jahxdis.2010.01.009.

    Article  PubMed Central  PubMed  Google Scholar 

  • Kendall, P. C., Hudson, J. L., Gosch, E., FlannerySchroeder, E., & Suveg, C. (2008). Cognitive-behavioral therapy for anxiety disordered youth: A randomized clinical trial evaluating child and family modalities. Journal of Consulting and Clinical Psychology, 76, 282–297.doi:10.1037/0022-006X.76.2.282.

  • Kendall, P. C., Panichelli-Mindel, S., Sugarman, A., & Callahan, S. (1997). Exposure to child anxiety: Theory, research, and practice. Clinical Psychology: Science and Practice, 4, 29–39. doi:10.1111/j.1468-2850.1997.tb00096.x.

    Google Scholar 

  • Kendall, P. C., Puliafico, A., Barmish, A., Choudhury, M. S., Henin, A., & Treadwell, K. (2007). Assessing anxiety with the Child Behavior Checklist and the Teacher Report Form. Journal of Anxiety Disorders, 21, 1004–1015. doi:10.1016/j.janxdis.2006.10.012.

    Article  PubMed  Google Scholar 

  • Kessler, R., Berglund, P., Demler, O., Jin, R., Merikangas, K., & Walters, E. (2005). Lifetime prevalence and age-of-onset distributions of DSM-IV disorders in the national comorbidity survey replication. Archives of General Psychiatry, 62, 593–602. doi:10.1001/archpsyc.62.6.593.

    Article  PubMed  Google Scholar 

  • Kley, H., Heinrichs, N., Bender, C., & Tuschen-Caffier, B. (2012). Predictors of outcome in a cognitive-behavioral group program for children and adolescents with social anxiety disorder. Journal of Anxiety Disorders, 26, 79–87. doi:10.1016/j.janxdis.2011.09.002.

    Article  PubMed  Google Scholar 

  • Langley, A. K., Bergman, L., & Piacentini, J. C. (2002). Assessment of childhood anxiety. International review of Psychiatry, 14, 102–113. doi:10.1080/09540260220132626.

    Article  Google Scholar 

  • Mennin, D., Heimberg, R., Fresco, D., & Ritter, M. (2008). Is generalized anxiety disorder and anxiety or mood disorder? Considering multiple factors as we ponder the fate of GAD. Depression and Anxiety, 25, 289–299. doi:10.1002/da.20493.

    Article  PubMed  Google Scholar 

  • Nakamura, B., Ebesutani, C., Bernstein, A., & Chorpita, B. (2009). A psychometric analysis of the Child Behavior Checklist DSM-Oriented Scales. Journal of Psychopathology And Behavioral Assessment, 31, 178–189. doi:10.1007/s10862-008-9119-8.

    Article  Google Scholar 

  • Pauschardt, J., Remschmidt, H., & Mattejat, F. (2010). Assessing child and adolescent anxiety in psychiatric samples with the Child Behavior Checklist. Journal of Anxiety Disorders, 24, 461–467. doi:10.1016/j.janxdis.2010.03.002.

    Article  PubMed  Google Scholar 

  • Pine, D. S., Cohen, P., Gurley, D., Brook, J., & Ma, Y. (1998). The risk for early-adulthood anxiety and depressive disorders in adolescents with anxiety and depressive disorders. Archives of General Psychiatry, 55, 56–64. doi:10.1001/archpsyc.55.1.56.

    Article  PubMed  Google Scholar 

  • Puleo, C., Conner, B., Benjamin, C., & Kendall, P. C. (2011). CBT for childhood anxiety and substance use at 7.4-year follow-up: A reassessment controlling for known predictors. Journal of Anxiety Disorders, 25, 690–696. doi:10.1016/j.janxdis.2011.03.005.

  • Seligman, L. D., Ollendick, T. H., Langley, A. K., & Baldacci, H. B. (2004). The utility of measures of child and adolescent anxiety: a meta-analytic review of the revised children’s manifest anxiety scale, the state-trait anxiety inventory for children, and the child behavior checklist. Journal of Clinical Child and Adolescent Psychology, 33, 557–565. doi:10.1207/s15374424jccp3303_13.

    Article  PubMed  Google Scholar 

  • Silverman, W. K., & Albano, A. M. (1996). The Anxiety Disorders Interview Schedule for Children for DSM-IV: Child and parent versions. San Antonio: Psychological Corporation.

    Google Scholar 

  • Silverman, W., & Nelles, W. (1988). The Anxiety Disorders Interview Schedule for Children. Journal of the American Academy of Child and Adolescent Psychiatry, 27, 772–778.

    Article  PubMed  Google Scholar 

  • Silverman, W. K., Saaverda, L. L., & Pina, A. A. (2001). Test-retest reliability of anxiety symptoms and diagnoses with Anxiety Disorders Interview Schedule for DSM-IV: Child and parent versions. Journal of the American Academy of Child and Adolescent Psychiatry, 40, 937–944. doi:10.1097/00004583-200108000-00016.

    Article  PubMed  Google Scholar 

  • Velting, O. N., Setzer, N. J., & Albano, A. M. (2004). Update on and Advances in Assessment and Cognitive-Behavioral Treatment of Anxiety Disorders in Children and Adolescents. Professional Psychology: Research and Practice, 35, 42–54. doi:10.1037/0735-7028.35.1.42.

    Article  Google Scholar 

  • Wadsworth, M. E., Hudziak, J. J., Heath, A. C., & Achenbach, T. M. (2001). Latent class analysis of Child Behavior Checklist anxiety/depression in children and adolescents. Journal of the American Academy of Child and Adolescent Psychiatry, 40, 106–114.

    Article  PubMed  Google Scholar 

  • Walkup, J., Albano, A. M., Piacentini, J., Birmaher, B., Compton, S., & Kendall, P. C. (2008). Cognitive behavioral therapy, sertraline, or a combination in childhood anxiety. The New England Journal of Medicine, 359, 2753–2766. doi:10.1056/NEJMoa0804633.

    Article  PubMed Central  PubMed  Google Scholar 

  • Weems, C. F. (2008). Developmental trajectories of childhood anxiety: Identifying continuity and change in anxious emotion. Developmental Review, 28, 488–502. doi: 10.1016/j.dr.2008.01.001 DOI:10.1016/j.dr.2008.01.001#doilink

  • Wood, J. J., Piacentini, J. C., Bergman, R. L., McCracken, J., & Barrios, V. (2002). Concurrent validity of the anxiety disorders section of the Anxiety Disorders Interview Schedule for DSM-IV: Child and Parent Versions. Journal of Clinical Child Adolescent Psychology, 31, 335–342. doi:10.1207/153744202760082595.

    Article  PubMed  Google Scholar 

  • Wren, F. J., Scholle, S. H., Heo, J., & Comer, D. M. (2003). Pediatric mood and anxiety syndromes in primary care: Who gets identified? The International Journal of Psychiatry in Medicine, 33, 1–16.

    Article  Google Scholar 

  • Yates, B. T., & Taub, J. (2003). Assessing the costs, benefits, cost-effectiveness, and cost-benefit of psychological assessment: We should, we can, and here’s how. Psychological Assessment, 15, 478–495. doi:10.1037/1040-3590.15.4.478.

    Article  PubMed  Google Scholar 

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Acknowledgments

This research was supported by grants (U01 MH064089, to Dr. Walkup; U01 MH64092, to Dr. Albano; U01 MH64003, to Dr. Birmaher; U01 MH63747, to Dr. Kendall; U01 MH64107, to Dr. March; U01 MH64088, to Dr. Piacentini; and U01 MH064003, to Dr. Compton) from the National Institute of Mental Health.Views expressed within this article represent those of the authors and are not intended to represent the position of NIMH, NIH, or DHHS.

Conflict of Interest

Dr. Compton is currently receiving funding from NIH and has in the past receivedfunding from Shire and Tourette’s Syndrome Association. He is also an associate editorfor Journal of Consulting and Clinical Psychology, Journal of Child and AdolescentPsychopharmacology (JCAP), and BMC Psychiatry. Dr. Piacentini receives grant or research support from the National Institute of MentalHealth, the Tourette Syndrome Foundation, and Pfizer Pharmaceuticals through theDuke University Clinical Research Institute; consultant fees from the Coleman ResearchGroup; book royalties from Guilford Press and Oxford University Press; and speakinghonoraria/travel support from the International OCD Foundation and the TouretteSyndrome Association. He is a co-author of assessment tools, none of which arecommercially published and therefore no royalties are received. Dr. Walkup receives grant/research support from the Tourette Syndrome Association andthe Hartwell Foundation. He serves the speakers’ bureau of the Tourette SyndromeAssociation. He receives royalties from Guilford Press and Oxford University Press. Dr. Birmaher receives research support from NIMH. He has or will receive royaltiesfrom Random House, Inc., Lippincott Willaims & Wilkins, and UpToDate. Dr. Sakolsky receives research support from NIMH and the National Alliance forResearch on Schizophrenia and Depression (NARSAD). She received an honorariumfrom the American Academy of Child & Adolescent Psychiatry for participation at the37th Annual Review Coruse in Child and Adolescent Psychiatry in 2012. She serves asan editorial board member of Child & Adolescent Psychopharmacology News andspecialty consultant for the Prescriber’s Letter. Her husband is a computer programmerfor Thermo Fisher Scientific. Dr. Keeton receives research support from NIMH and the Institute of EducationSciences. Dr. Albano receives research support from NIMH. She receives honoraria from theAmerican Psychological Association. She receives royalties from Oxford UniversityPress and Lynn Sonberg Book Associates. Dr. Kendall receives research support from the National Institute of Mental Health(NIMH). He has received honoraria from professional societies for speaking atconventions. He receives royalties from Guildford Press, Ericsson, Workbook Publishing(his spouse’s employment), and Oxford University Press. Dr. Caporino, Dr. Sherrill, Dr. Ginsburg, Dr. Gosch, Ms. Read, Mr. Peterman, and Ms.Settipani report no biomedical financial interests or potential conflicts of interest.

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All procedures were approved by the Institutional Review Board at each study site.

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Authors and Affiliations

  1. Department of Psychology, Temple University, 1701 N. 13th Street, Philadelphia, PA, 19122, USA

    Kendra L. Read, Cara A. Settipani, Jeremy Peterman & Philip C. Kendall

  2. Department of Psychology, Duke University, 1701 N. 13th Street, Philadelphia, PA, 19122, USA

    Scott Compton & John March

  3. Department of Psychology, University of California, Los Angeles, 1701 N. 13th Street, Philadelphia, PA, 19122, USA

    John Piacentini, James McCracken & Lindsey Bergman

  4. Department of Psychology, Cornell University, 1701 N. 13th Street, Philadelphia, PA, 19122, USA

    John Walkup

  5. Department of Psychology, University of Pittsburgh, 1701 N. 13th Street, Philadelphia, PA, 19122, USA

    Dara Sakolsky & Boris Birmaher

  6. Department of Psychology, Columbia University, 1701 N. 13th Street, Philadelphia, PA, 19122, USA

    Anne Marie Albano & Moira Rynn

  7. Department of Psychology, The John Hopkins University, School of Medicine, 1701 N. 13th Street, Philadelphia, PA, 19122, USA

    Golda Ginsburg & Courtney Keeton

  8. Department of Psychology, Philadelphia College of Osteopathic Medicine, 1701 N. 13th Street, Philadelphia, PA, 19122, USA

    Elizabeth Gosch

  9. Department of Psychology, University of Georgia, 1701 N. 13th Street, Philadelphia, PA, 19122, USA

    Cynthia Suveg

  10. Department of Psychology, The National Institute of Mental Health, 1701 N. 13th Street, Philadelphia, PA, 19122, USA

    Joel Sherrill

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  1. Kendra L. Read
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  2. Cara A. Settipani
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  3. Jeremy Peterman
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  4. Philip C. Kendall
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  5. Scott Compton
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  8. Lindsey Bergman
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  9. John Walkup
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  11. Boris Birmaher
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  12. Anne Marie Albano
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  15. Courtney Keeton
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  16. Elizabeth Gosch
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  17. Cynthia Suveg
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  18. Joel Sherrill
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  19. John March
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Corresponding authors

Correspondence to Kendra L. Read or Philip C. Kendall.

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This research was supported by National Institute of Mental Health Grants (MH063747).

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Read, K.L., Settipani, C.A., Peterman, J. et al. Predicting Anxiety Diagnoses and Severity with the CBCL-A: Improvement Relative to Other CBCL Scales?. J Psychopathol Behav Assess 37, 100–111 (2015). https://doi.org/10.1007/s10862-014-9439-9

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