The Child Behavior Checklist-Obsessive-Compulsive Subscale Detects Severe Psychopathology and Behavioral Problems Among School-Aged Children.
OBJECTIVE
The aims of this study were (1) to assess obsessive-compulsive symptoms (OCS) dimensionally in a school-aged community sample and to correlate them with clinical and demographical variables; (2) to determine a subgroup with significant OCS ("at-risk for OCD") using the Child Behavior Checklist (CBCL-OCS) and (3) to compare it with the rest of the sample; (4) To review the CBCL-OCS subscale properties as a screening tool for pediatric OCD.


METHODS
Data from the Brazilian High Risk Cohort were analyzed. The presence and severity of OCS were assessed through the CBCL-OCS subscale. DSM-IV psychiatric diagnoses were obtained by the Developmental and Well-Being Assessment. Behavioral problems were assessed using the Strengths and Difficulties Questionnaire, the Youth Strengths Inventory, and the CBCL internalizing and externalizing behavior subscales.


RESULTS
A total of 2512 (mean age: 8.86 ± 1.84 years; 55.0% male) children were included. Moderate correlations were found between OCS severity and functional impairment (r = 0.36, p < 0.001). Children with higher levels of OCS had higher rates of psychiatric comorbidity and behavioral problems (p < 0.001). A score of 5 or higher in the CBCL-OCS scale determined an "at-risk for OCD" subgroup, comprising 9.7% of the sample (n = 244), with behavioral patterns and psychiatric comorbidities (e.g., tics [odds ratios, OR = 6.41, p < 0.001]), anxiety disorders grouped [OR = 3.68, p < 0.001] and depressive disorders [OR = 3.0, p < 0.001] very similar to those described in OCD. Sensitivity, specificity, positive predictive value, and negative predictive value of the CBCL-OCS for OCD diagnosis were, respectively, 48%, 91.5%; 15.1%, and 98.2%.


CONCLUSIONS
The dimensional approach suggests that the presence of OCS in children is associated with higher rates of comorbidity, behavioral problems, and impairment. The "at-risk for OCD" group defined by the CBCL revealed a group of patients phenotypically similar to full blown OCD.
1 Department of Psychiatry, University of São Paulo Medical School (USP) , São Paulo, Brazil .|2 National Institute of Developmental Psychiatry for Children and Adolescents , São Paulo, Brazil .
Laura O
LO
Saad
2 National Institute of Developmental Psychiatry for Children and Adolescents , São Paulo, Brazil .|3 Child and Adolescent Psychiatry Unit (UPIA), Department of Psychiatry, Federal University of São Paulo (UNIFESP) , São Paulo, Brazil .
Maria C
MC
do Rosario
1 Department of Psychiatry, University of São Paulo Medical School (USP) , São Paulo, Brazil .
Raony C
RC
Cesar
1 Department of Psychiatry, University of São Paulo Medical School (USP) , São Paulo, Brazil .|2 National Institute of Developmental Psychiatry for Children and Adolescents , São Paulo, Brazil .
Marcelo C
MC
Batistuzzo
1 Department of Psychiatry, University of São Paulo Medical School (USP) , São Paulo, Brazil .|2 National Institute of Developmental Psychiatry for Children and Adolescents , São Paulo, Brazil .
Marcelo Q
MQ
Hoexter
2 National Institute of Developmental Psychiatry for Children and Adolescents , São Paulo, Brazil .|4 Hospital de Clinicas de Porto Alegre, Federal University of Rio Grande do Sul (UFRGS) , Porto Alegre, Brazil .
Gisele G
GG
Manfro
1 Department of Psychiatry, University of São Paulo Medical School (USP) , São Paulo, Brazil .
Roseli G
RG
Shavitt
1 Department of Psychiatry, University of São Paulo Medical School (USP) , São Paulo, Brazil .|5 Child Study Center , Yale School of Medicine, New Haven, Connecticut.
James F
JF
Leckman
1 Department of Psychiatry, University of São Paulo Medical School (USP) , São Paulo, Brazil .|2 National Institute of Developmental Psychiatry for Children and Adolescents , São Paulo, Brazil .
Eurípedes C
EC
Miguel
1 Department of Psychiatry, University of São Paulo Medical School (USP) , São Paulo, Brazil .|2 National Institute of Developmental Psychiatry for Children and Adolescents , São Paulo, Brazil .
Pedro G
PG
Alvarenga
D001008:Anxiety Disorders / Q000175:diagnosis; D001938:Brazil; D057189:Checklist / Q000706:statistics & numerical data*; D002648:Child; D002653:Child Behavior Disorders / Q000453:epidemiology / Q000503:physiopathology*; D015897:Comorbidity; D039721:Diagnostic and Statistical Manual of Mental Disorders; D005260:Female; D006801:Humans; D008297:Male; D009771:Obsessive-Compulsive Disorder / Q000175:diagnosis* / Q000453:epidemiology / Q000503:physiopathology; D000066553:Problem Behavior / Q000523:psychology*; D011569:Psychiatric Status Rating Scales / Q000706:statistics & numerical data
child and adolescent psychiatry; child behavior checklist; dimensional obsessive-compulsive symptoms; epidemiology; school-aged children