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. 2016 Jan;9(1):33-42.
doi: 10.1002/aur.1515. Epub 2015 Jul 3.

Utility of the Child Behavior Checklist as a Screener for Autism Spectrum Disorder

K Alexandra Havdahl  1   2   3 , Stephen von Tetzchner  4 , Marisela Huerta  1 , Catherine Lord  1 , Somer L Bishop  5
Affiliations

Utility of the Child Behavior Checklist as a Screener for Autism Spectrum Disorder

K Alexandra Havdahl et al. Autism Res. 2016 Jan.

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.

Keywords: Child Behavior Checklist (CBCL); diagnosis; early detection; emotional/behavioral problems.

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Figures

Figure 1
Figure 1
Sensitivity and specificity (%) of the WTP scale in children with high EBP (n = 80) at cutoff 124 and 134. Abbreviation: EBP = emotional/behavioral problems.
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