An Analysis of the Child Behavior Checklist Anxiety Problems Scale’s Predictive Capabilities
The Child Behavior Checklist (CBCL) is widely used to assess behavioral and emotional problems in youth. The CBCL Diagnostic and Statistical Manual (DSM)-Oriented Anxiety Problems subscale (CBCL-AP) was developed for the identification of DSM-IV anxiety disorders. Using data from 298 youth aged 6- to 18, the CBCL-AP scale was examined to determine its ability to differentially predict, via Receiver Operating Characteristics (ROC) analysis, the presence of (a) generalized anxiety disorder (GAD), (b) separation anxiety disorder (SAD), (c) specific phobia (SPPH), or (d) the presence of any of these disorders. Independent Evaluators (IEs) administered the Anxiety Disorders Interview Schedule for Children (ADIS-C/P) to determine the presence of an anxiety disorder. The ability of the CBCL-AP to predict to anxiety disorders was compared to the ability of the CBCL Anxious/Depressed (CBCL-A/D) scale and the seven empirically derived CBCL syndrome subscales and five DSM-Oriented subscales to predict anxiety disorder diagnoses. Results revealed that CBCL-AP scores significantly predicted all diagnoses. CBCL-A/D scores significantly predicted SAD (AUC = 0.67), GAD (AUC = 0.69), and the presence of any of the three disorders (AUC = 0.72), but not the presence of SPPH (AUC = 0.52). Although the CBCL-AP scale may not be a substitute for extensive diagnostics, it has demonstrated utility as an instrument for assessing anxiety and can serve to identify anxious youth in need of mental health services.
KeywordsChild anxiety Adolescent anxiety Anxiety treatment Anxiety
The preparation of this manuscript was facilitated by support from the National Institute of Health (Child Health and Human Development) grant (R01HD080097) to Philip C. Kendall.
Compliance with Ethical Standards
Conflict of Interest
M. J. Knepley, P. C. Kendall, and M. M. Carper declare they have no conflicts of interest.
All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional and/or national research committee and with the 1964 Helsinki declaration and its later amendments or comparable ethical standards.
Informed consent was obtained from all individual participants included in the study.
- 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., & Edelbrock, C. (1987). Manual for the Youth Self-Report and 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. 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(8), 957–964. https://doi.org/10.1097/01.CHI.0000046898.27264.A2.Google Scholar
- Connolly, S. D., & Bernstein, G. A. (2007). Practice parameter for the assessment and treatment of children and adolescents with anxiety disorders. Journal of the American Academy of Child & Adolescent Psychiatry, 46(2), 267–283. https://doi.org/10.1097/01.chi.0000246070.23695.06.
- Ebesutani, C., Bernstein, A., Nakamura, B. J., Chorpita, B. F., Higa-McMillan, C. K., Weisz, J. R., & & Research Network on Youth Mental Health. (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(3), 373–384. https://doi.org/10.1007/s10862-009-9174-9.
- Kendall, P. C., Chu, B. C., Pimentel, S. S., & Choudhury, M. (2000). Treating anxiety disorders in youth. In P. C. Kendall (Ed.), Child and adolescent therapy: Cognitive-behavioral procedures (2nd ed., pp. 235–287). New York: Guilford Press.Google Scholar
- Kendall, P. C., Panichelli-Mindel, S. M., Sugarman, A., & Callahan, S. A. (1997). Exposure to child anxiety: theory, research, and practice. Clinical Psychology: Science and Practice, 4(1), 29–39Google Scholar
- Kim-Cohen, J., Caspi, A., Moffitt, T. E., Harrington, H., Milne, B. J., & Poulton, R. (2003). Prior juvenile diagnoses in adults with mental disorder: Developmental follow-back of a prospective-longitudinal cohort. Archives of General Psychiatry, 60(7), 709–717. https://doi.org/10.1001/archpsyc.60.7.709.Google Scholar
- Lacalle, M., Ezpeleta, L., & Doménech, J. M. (2012). DSM-oriented scales of the child behavior checklist and youth self-report in clinically referred Spanish children. The Spanish Journal of Psychology, 15(1), 377387. https://doi.org/10.5209/rev_SJOP.2012.v15.nl.37344. Google Scholar
- March, J. S. (1998). Multidimensional Anxiety Scale for Children. North Tonawanda: Multi-Health Systems.Google Scholar
- Merikangas, K., Nakamura, E., & Kessler, R. (2009). Epidemiology of mental disorders in children and adolescents. Dialogues in Clinical Neuroscience, 11(1), 7–20.Google Scholar
- Merikangas, K. R., He, J. P., Burstein, M., Swanson, S. A., Avenevoli, S., Cui, L., Benjet, C., Goergiades, K., & Swendsen, J. (2010). Lifetime prevalence of mental disorders in US adolescents: Results from the National Comorbidity Survey Replication–Adolescent Supplement (NCS-A). Journal of the American Academy of Child & Adolescent Psychiatry, 49(10), 980–989. https://doi.org/10.1016/j.jaac.2010.05.017.Google Scholar
- 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(3), 557–565. https://doi.org/10.1207/s15374424jccp3303_13.
- Silverman, W., & Nelles, W. (1988). The anxiety disorders interview schedule for children. Journal of the American Academy of Child and Adolescent Psychiatry, 27(6), 772–778.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(8), 937–944. https://doi.org/10.1097/00004583-200108000-00016.
- Silverman, W., & Albano, A. M. (1996). The anxiety disorders interview schedule for DSM-IV: child and parent versions. San Antonio: Graywind.Google Scholar
- Weller, E., Weller, R., Teare, M., & Fristad, M. (1999). Parent version-Children’s interview for psychiatric syndromes (P-ChIPS). Washington: American Psychiatric Press.Google Scholar
- 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(3), 335–342. https://doi.org/10.1207/153744202760082595.Google Scholar
- World Health Organization. (2008). Multiaxial classification of child and adolescent psychiatric disorders: The ICD-10 classification of mental and Behavioural disorders in children and adolescents. Cambridge: University Press.Google Scholar
- Wren, F. J., Scholle, S. H., Heo, J., & Comer, D. M. (2016). Pediatric mood and anxiety syndromes in primary care: who gets identified?. The International Journal of Psychiatry in Medicine, 33(1), 1–16Google Scholar