Examining the Child Behavior Checklist (CBCL) Utility in a Native American Population

To examine Child Behavior Checklist for Ages 1.5-5 (CBCL) validity for externalizing, internalizing, and total problems T scores when screening for clinically significant behavioral problems in a Navajo (Diné) sample that was not included in CBCL norming.

Mothers were recruited during pregnancy through the Navajo Birth Cohort Study/Environmental influences on Child Health Outcomes (NBCS/ECHO). Families completed in-person clinical assessments when children were 42 to 72 months old. Caregivers completed the CBCL and provided histories. Best estimate clinical diagnoses were established by experienced clinician-researchers using records along with comprehensive neuropsychological, psychiatric, and physical examinations.

The CBCL was completed by caregivers for 192 children (98 boys [51.0%]; mean [SD] age 4.0 [0.61] years, range 3-6 years). Of children, 125 (65.1%) received at least 1 diagnosis, with language disorder being the most common followed by speech sound disorder. Every group with a DSM-5 diagnosis had T scores within the normal range when they were derived according to the CBCL manual. T scores obtained by normalization within the study population yielded higher scores for the diagnosed group; however, area under the curve values still ranged from 0.6 to 0.7, displaying poor CBCL discriminative power. Externalizing problems T scores for children with any DSM-5 diagnosis were most discriminative (area under the curve = 0.70).

The CBCL was an ineffective single screening tool in the Diné population compared with in-person clinician evaluations, possibly because the Diné were not included in CBCL validation or cross-cultural adaptations. These findings may be relevant to other minority populations not included in CBCL norming.