title: A primer on receiver operating characteristic analysis and diagnostic efficiency statistics for pediatric psychology: we are ready to ROC.
abstract: OBJECTIVE
  To offer a practical demonstration of receiver operating characteristic (ROC) analyses, diagnostic efficiency statistics, and their application to clinical decision making using a popular parent checklist to assess for potential mood disorder.
  
  
  METHODS
  Secondary analyses of data from 589 families seeking outpatient mental health services, completing the Child Behavior Checklist and semi-structured diagnostic interviews.
  
  
  RESULTS
  Internalizing Problems raw scores discriminated mood disorders significantly better than did age- and gender-normed T scores, or an Affective Problems score. Internalizing scores <8 had a diagnostic likelihood ratio <0.3, and scores >30 had a diagnostic likelihood ratio of 7.4.
  
  
  CONCLUSIONS
  This study illustrates a series of steps in defining a clinical problem, operationalizing it, selecting a valid study design, and using ROC analyses to generate statistics that support clinical decisions. The ROC framework offers important advantages for clinical interpretation. Appendices include sample scripts using SPSS and R to check assumptions and conduct ROC analyses.
authors: PhD, Department of Psychology, University of North Carolina at Chapel Hill, Davie Hall CB 3270, Chapel Hill, NC 27599-3270, USA. eay@unc.edu.
authors: Eric A
authors: EA
authors: Youngstrom
mesh_terms: D057189:Checklist; D002648:Child; D003627:Data Interpretation, Statistical; D006801:Humans; D019964:Mood Disorders / Q000175:diagnosis*; D010290:Parents; D011569:Psychiatric Status Rating Scales; D002666:Psychology, Child / Q000379:methods*; D012372:ROC Curve
keywords: diagnostic efficiency; evidence-based medicine; receiver operating characteristic analysis; sensitivity and specificity
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