Objective: To evaluate the diagnostic performance of the Attention Problem Scale of the Child Behavior Checklist (CBCL-APS) for the screening of Attention-Deficit/Hyperactivity Disorder (ADHD) in a sample of Brazilian children and adolescents.
Methods: The CBCL-APS was given to 763 children and adolescents. Child psychiatrists using DSM-IV criteria confirmed the clinical diagnoses. Diagnostic performance was evaluated through Receiver-Operating Characteristic (ROC) curves.
Results: Only moderate areas under the curve (AUC) were found for the general sample (AUC = 0.79; 95%CI = 0.76-0.82), and for the subsample of referred patients (AUC = 0.78; 95%CI = 0.74-0.82). The subsample of patients with ADHD of the combined type presented the largest AUC (AUC = 0.85; 95%CI = 0.82-0.88).
Conclusion: Our findings concur with previous studies of different cultures demonstrating adequate diagnostic performance of the CBCL-APS for the screening of ADHD, especially of the combined type.
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References
1.
Achenbach, T. M. (1991a). Manual for the Child Behavior Checklist. Burlington: University of Vermont, Department of Psychiatry.
2.
Achenbach, T. M. (1991b). Manual for the Child Behavior Checklist - Teacher Report Form. Burlington: University of Vermont, Department of Psychiatry.
3.
American Psychiatric Association. (1994). Diagnostic and statistical manual of mental disorders (4th ed.). Washington, DC: Author.
4.
Applegate, B., Lahey, B. B., Hart, E. L., Biederman, J., Hynd, G. W., Barkley, R. A., et al. (1997). Validity of age-of-onset criterion for ADHD: A report from the DSM-IV field trials. Journal of the American Academy of Child and Adolescent Psychiatry, 36, 1211-1221.
5.
Barbosa, G. A., Dias, M. R., & Gaião, A. A. (1997). Validación factorial de los índices de hiperactividad del cuestionário de Conners en escolares de João Pessoa-Brasil. Infanto, 5, 118-125.
6.
Barkley, R. A., & Biederman, J. (1997). Toward a broader definition of the age-of-onset criterion for attention-deficit hyperactivity disorder. Journal of the American Academy of Child and Adolescent Psychiatry, 36, 1204-1210.
7.
Barkley, R. A., Fischer, M., Edelbrock, C. S., & Smallish, L. (1990). The adolescent outcome of hyperactive children diagnosed by research criteria: An 8-year prospective follow-up study. Journal of the American Academy of Child and Adolescent Psychiatry, 29, 546-557.
8.
Biederman, J., Faraone, S. V., Doyle, A., Lehman, B. K., Kraus, I., Perrin, J., et al. (1993). Convergence of the Child Behavior Checklist with structured interview-based psychiatric diagnoses of ADHD children with and without comorbidity. Journal of Child Psychology and Psychiatry and Allied Disciplines, 34, 1241-1251.
9.
Biederman, J., Faraone, S. V., Mick, E., Moore, P., & Lelon, E. (1996). Child behavior checklist findings further support comorbidity between ADHD and major depression in a referred sample. Journal of the American Academy of Child and Adolescent Psychiatry, 35, 734-742.
10.
Bordin, I. A., Mari, J. J., & Caeiro, M. F. (1995). Validação da versão brasileira do “Child Behavior Checklist” (CBCL) (Inventário de Comportamentos da Infância e Adolescência): Dados preliminares. Revista da Associação Brasileira de Psiquiatria e da Associação de Psiquiatria da America Latina, 17, 55-66.
11.
Brito, G., Pinto, R. C., & Lins, M. F. (1995). A behavioral assessment scale for attention deficit disorder in Brazilian children based on DSM-III-R criteria. Journal of Abnormal Child Psychology, 23, 509-520.
12.
Brown, T. (1995). Brown Attention Deficit Disorder Scales. San Antonio: The Psychological Corporation.
13.
Bussing, R., Schuhmann, E., Belin, T. R., Widawski, M., & Perwien, A. R. (1998). Diagnostic utility of two commonly used ADHD screening measures among special education students. Journal of the American Academy of Child and Adolescent Psychiatry, 37, 74-82.
14.
Carson, J. L., Eisenberg, J. M., Shaw, L. M., Kundel, H. L., & Soper, K. A. (1985). Diagnostic accuracy of four assays of prostatic acid phosphatase. Comparison using receiver operating characteristic curve analysis. The Journal of the American Medical Association, 253, 665-669.
15.
Chen, W. J., Faraone, S. V., Biederman, J., & Tsuang, M. T. (1994). Diagnostic accuracy of the child behavior checklist scales for attention-deficit hyperactivity disorder: A receiver-operating characteristic analysis. Journal of Consulting and Clinical Psychology, 62, 1017-1025.
16.
Conners, C. K. (2000). Conners’ Rating Scales-Revised (CRS-R). Toronto, Canada: Multi-Health Systems.
17.
Conners, C. K. (1990). Conners’ Abbreviated Symptom Questionnaire (ASQ). Toronto, Canada: Multi-Health Systems.
18.
Conners, C. K., Sitarenios, G., Parker, J. D., & Epstein, J. N. (1998). The revised Conners’ Parent Rating Scale (CPRS-R): Factor structure, reliability, and criterion validity. Journal of Abnormal Child Psychology, 26, 257-268.
19.
Conners, C. K., Wells, K. C., Parker, J. D., Sitarenios, G., Diamond, J. M., & Powell, J. W. (1997). A new self-report scale for assessment of adolescent psychopathology: Factor structure, reliability, validity, and diagnostic sensitivity. Journal of Abnormal Child Psychology, 25, 487-497.
20.
Crijnen, A. A., Achenbach, T. M., & Verhulst, F. C. (1997). Comparisons of problems reported by parents of children in 12 cultures: Total problems, externalizing, and internalizing. Journal of the American Academy of Child and Adolescent Psychiatry, 36, 1269-1277.
21.
Dulcan, M. (1997). Practice parameters for the assessment and treatment of children, adolescents, and adults with Attention-Deficit/Hyperactivity Disorder. Journal of the American Academy of Child and Adolescent Psychiatry, 36(Suppl.), 85S-121S.
22.
Hanley, J. A., & McNeil, B. J. (1982). The meaning and use of the area under a receiver-operating characteristic (ROC) curve. Radiology, 143, 29-36.
23.
Holmes, W. C. (1998). A short, psychiatric, case-finding measure for HIV seropositive outpatients: Performance characteristics of the 5-item mental health subscale of the SF-20 in a male, seropositive sample. Medical Care, 36, 237-243.
24.
Jellinek, M., Little, M., Murphy, J. M., & Pagano, M. (1995). The Pediatric Symptom Checklist: Support for a role in a managed care environment. Archives of Pediatrics and Adolescent Medicine, 149, 740-746.
25.
Kasius, M. C., Ferdinand, R. F., van den Berg, H., & Verhulst, F. C. (1997). Associations between different diagnostic approaches for child and adolescent psychopathology. Journal of Child Psychology and Psychiatry and Allied Disciplines, 38, 625-632.
26.
Livingston, R. (1999). Cultural issues in diagnosis and treatment of ADHD. Journal of the American Academy of Child and Adolescent Psychiatry, 38, 1591-1594.
27.
McCarney, S. B. (1989). Attention Deficit Disorders Evaluation Scale-Home Version. Columbia: Hawthorne Educational Services.
28.
Mehringer, A. M., Downey, K. K., Schuh, L. M., Pomerleau, C. S., Snedecor, S. M., & Schubiner, H. (2002). The Assessment of Hyperactivity and Attention (AHA): Development and preliminary validation of a brief self-assessment of adult ADHD. Journal of Attention Disorders, 5, 223-231.
29.
Orvaschel, H. (1985). Psychiatric interviews suitable for use in research with children and adolescents. Psychopharmacology Bulletin, 21, 737-745.
30.
Polanczyk, G., Eizirik, M., Aranovich, V., Denardin, D., Silva, T. L., Conceição, T.V., et al. (2003). Interrater reliability for the schedule for Affective Disorders and Schizophrenia, Epidemiological version for School age children (KSADS-E). Revisita Brasiliera de Psiquiatria, 25, 87-90.
31.
Reid, R. (1995). Assessment of ADHD with culturally different groups: The use of behavioral rating scales. School Psychology Review, 24, 537-560.
32.
Reid, R., DuPaul, G. J., Power, T. J., Anastopoulos, A. D., Rogers-Adkinson, D., Noll, M. B., et al. (1998). Assessing culturally different students for attention deficit hyperactivity disorder using behavior rating scales. Journal of Abnormal Child Psychology, 26, 187-198.
33.
Rey, J. M., Morris-Yates, A., & Stainslaw, H. (1992). Measuring the accuracy of diagnostic tests using receiver operating characteristics (ROC) analysis. International Journal of Methods in Psychiatric Research, 2, 39-50.
34.
Rohde, L. A. (2002). ADHD in Brazil: The DSM-IV criteria in culturally different populations. Journal of the American Academy of Child and Adolescent Psychiatry, 41, 1131-1133.
35.
Rohde, L. A., Barbosa, G., Polanczyk, G., Eizirik, M., Rasmussen, E. R., Neuman, R. J., et al. (2001). Factor and latent class analysis of DSM-IV ADHD symptoms in a school sample of Brazilian adolescents. Journal of the American Academy of Child and Adolescent Psychiatry, 40, 711-718.
36.
Rohde, L. A., Biederman, J., Busnello, E., Zimmermann, H., Schmitz, M., Martins, S., et al. (1999). ADHD in a school sample of Brazilian adolescents: A study of prevalence, comorbid conditions, and impairments. Journal of the American Academy of Child and Adolescent Psychiatry, 38, 716-722.
37.
Rohde, L. A., Biederman, J., Zimmermann, H., Schmitz, M., Martins, S., & Tramontina, S. (2000). Exploring ADHD age-of-onset criterion in Brazilian adolescents. European Child and Adolescent Psychiatry, 9, 212-218.
38.
Roman, T., Schmitz, M., Polanczyk, G., Eizirik, M., Rohde, L. A., & Hutz, M. (2001). Attention-deficit hyperactivity disorder: A study of association with both dopamine transporter gene and the dopamine D4 receptor gene. American Journal of Medical Genetics, 105, 471-478.
39.
Rothenberger, A., Banaschewski, T., & Woerner, W. (2002, July). Screening for ADHD: Usefulness of the parent SDQ. Paper presented at the ADHD Forum, Prague.
40.
Shaffer, D., Fisher, P., Dulcan, M. K., Davies, M., Piacentini, J., Schwab-Stone, M.E., et al. (1996). The NIMH Diagnostic Interview Schedule for Children Version 2.3 (DISC-2.3): Description, acceptability, prevalence rates, and performance in the MECA study. Methods for epidemiology of child and adolescent mental disorders study. Journal of the American Academy of Child and Adolescent Psychiatry, 35, 865-877.
41.
Shaffer, D., Gould, M. S., Brasic, J., Abrosini, P., Fisher, P., Bird, H., et al. (1983). A children’s global assessment scale (CGAS). Archives of General Psychiatry, 40, 1228-1231.
42.
Swanson, J. M., Kraemer, H. C., Hinshaw, S. P., Arnold, L. E., Conners, C. K., Abikoff, H. B., et al. (2001). Clinical relevance of the primary findings of the MTA: Success rates based on severity of ADHD and ODD symptoms at the end of treatment. Journal of the American Academy of Child and Adolescent Psychiatry, 40, 168-179.
43.
Ullman, R. K., Sleator, E. K., & Spragre, R. L. (1991). ADD H: Comprehensive Teacher’s Rating Scale-2nd Edition (ACTeRS). Odessa, FL: Psychological Assessment Resources.
44.
Wender, P. H. (1995). Attention-Deficit Disorder in Adults. New York: Oxford University Press.
