Assessing child and adolescent anxiety in psychiatric samples with the Child Behavior Checklist

The Child Behavior Checklist's (CBCL) is often used as a screening instrument at first contact in standard child and adolescent psychiatric settings adding valuable information to the diagnostic process. However, its correspondence to clinical, in particular anxiety, diagnoses has not always been clear. Using parent reports from 2763 outpatients and 888 inpatients referred for psychiatric services, CBCL-anxiety scales were examined regarding their predictive validity and potential use as screening devices for anxiety disorders. Symptom scores across four diagnostic groups (anxiety disorder, emotional disorder, other psychiatric disorder and no psychiatric disorder) were calculated and compared; in addition ROC-analyses for the anxiety-disordered group were performed. Support for the validity of the "Anxiety Problems" scale (Achenbach et al., 2003) was found. However, AUC-values were only in the medium range (.71-.72) with substantial misclassification numbers proposing a limited utility of the scale as a screening instrument in our samples. Adding valuable information to the diagnostic process, the CBCL's associations with clinical anxiety diagnoses seem only moderate suggesting the additional use of other anxiety-specific instruments in clinical routine.