title: Utility of the Child Behavior Checklist as a Screener for Autism Spectrum Disorder.
abstract: The Child Behavior Checklist (CBCL) has been proposed for screening of autism spectrum disorders (ASD) in clinical settings. Given the already widespread use of the CBCL, this could have great implications for clinical practice. This study examined the utility of CBCL profiles in differentiating children with ASD from children with other clinical disorders. Participants were 226 children with ASD and 163 children with attention-deficit/hyperactivity disorder, intellectual disability, language disorders, or emotional disorders, aged 2-13 years. Diagnosis was based on comprehensive clinical evaluation including well-validated diagnostic instruments for ASD and cognitive testing. Discriminative validity of CBCL profiles proposed for ASD screening was examined with area under the curve (AUC) scores, sensitivity, and specificity. The CBCL profiles showed low discriminative accuracy for ASD (AUC 0.59-0.70). Meeting cutoffs proposed for ASD was associated with general emotional/behavioral problems (EBP; mood problems/aggressive behavior), both in children with and without ASD. Cutoff adjustment depending on EBP-level was associated with improved discriminative accuracy for school-age children. However, the rate of false positives remained high in children with clinical levels of EBP. The results indicate that use of the CBCL profiles for ASD-specific screening would likely result in a large number of misclassifications. Although taking EBP-level into account was associated with improved discriminative accuracy for ASD, acceptable specificity could only be achieved for school-age children with below clinical levels of EBP. Further research should explore the potential of using the EBP adjustment strategy to improve the screening efficiency of other more ASD-specific instruments.
authors.affiliation: Center for Autism and the Developing Brain, Weill Cornell Medical College, White Plains, New York.|Lovisenberg Diaconal Hospital, Oslo, Norway.|Norwegian Institute of Public Health, Oslo, Norway.
authors.forename: K Alexandra
authors.initials: KA
authors.lastname: Havdahl
authors.affiliation: Department of Psychology, University of Oslo, Oslo, Norway.
authors.forename: Stephen
authors.initials: S
authors.lastname: von Tetzchner
authors.affiliation: Center for Autism and the Developing Brain, Weill Cornell Medical College, White Plains, New York.
authors.forename: Marisela
authors.initials: M
authors.lastname: Huerta
authors.affiliation: Center for Autism and the Developing Brain, Weill Cornell Medical College, White Plains, New York.
authors.forename: Catherine
authors.initials: C
authors.lastname: Lord
authors.affiliation: Department of Psychiatry, University of California San Francisco, California.
authors.forename: Somer L
authors.initials: SL
authors.lastname: Bishop
mesh_terms: D000293:Adolescent; D000067877:Autism Spectrum Disorder / Q000175:diagnosis*; D057189:Checklist / Q000379:methods*; D002648:Child; D002652:Child Behavior; D002675:Child, Preschool; D003937:Diagnosis, Differential; D005260:Female; D006801:Humans; D008297:Male; D015203:Reproducibility of Results; D012680:Sensitivity and Specificity
keywords: Child Behavior Checklist (CBCL); diagnosis; early detection; emotional/behavioral problems