title: Performance of clinician versus self-report measures to identify obsessive-compulsive disorder in children and adolescents.
abstract: OBJECTIVE
  The aim of this study was to study agreement between clinician-rated measures and self-report measures previously used in epidemiologic studies to identify obsessive-compulsive disorder (OCD) in youth and to determine the adequacy of self-report measures as screening instruments.
  
  
  METHODS
  Leyton Obsessional Inventory-Child Version (LOI-CV) survey form self-report and Children's Yale-Brown Obsessive Compulsive Scale (CY-BOCS) clinician-report measures were compared in a sample of 81 OCD-affected youths diagnosed using structured diagnostic interviews and the best-estimate method. Sensitivities and agreement between tests are determined for different cutoff scores.
  
  
  RESULTS
  The LOI-CV survey form total (item+interference) score is correlated with KSADS-E OCD severity (r=0.37, p=0.001) but not clinician-rated GAF scores (r=-0.18, p=0.12). LOI-CV survey form sensitivities at cutoff scores of 15, 20, 25, and 30 are 55%, 36%, 28%, and 19%, respectively. CY-BOCS scores are correlated with subject-rated interview severity (p<0.001) and clinician-rated GAF scores (p<or=0.05). CY-BOCS sensitivities at cutoff scores of 8, 10, 12, and 14 are 100%, 99%, 98%, and 90%. The cutoff scores required for greater than 95% sensitivity of the LOI-CV survey form and the CY-BOCS, respectively, are 2 and 12. LOI-CV survey form total scores do not correlate with CY-BOCS total or obsession subscores (p>or=0.03), but correlate with the CY-BOCS compulsion subscore.
  
  
  CONCLUSIONS
  The clinician-rated CY-BOCS measure using parent and child reporting performs superiorly to the subject-rated LOI-CV measure using child reporting to identify pediatric OCD in a clinically referred population. Because self-report measures have been used in epidemiological studies, youth OCD prevalence rates may be higher than previously reported.
authors.affiliation: Massachusetts General Hospital, and Harvard Medical School, Boston, Massachusetts, USA.
authors.forename: S Evelyn
authors.initials: SE
authors.lastname: Stewart
authors.forename: T Atilla
authors.initials: TA
authors.lastname: Ceranoglu
authors.forename: Tara
authors.initials: T
authors.lastname: O'Hanley
authors.forename: Daniel A
authors.initials: DA
authors.lastname: Geller
mesh_terms: D000293:Adolescent; D002648:Child; D005260:Female; D006801:Humans; D008297:Male; D009771:Obsessive-Compulsive Disorder / Q000175:diagnosis* / Q000469:parasitology; D010552:Personality Assessment / Q000706:statistics & numerical data*; D010555:Personality Inventory / Q000706:statistics & numerical data*; D011594:Psychometrics / Q000706:statistics & numerical data; D015203:Reproducibility of Results; D013223:Statistics as Topic