El análisis de curvas ROC en estudios epidemiológicos de psicopatología infantil: aplicación al cuestionario CBCL

ROC analysis was applied in order to study diagnostic accuracy of the Child Behavior Checklist (CBCL) and to obtain the optimal cut-off in a sample of 196 pediatric and psychiatric patients 6 to 17 years old. The group of origin, the diagnosis in the Diagnostic lnterview for Children and Adolescents-Revised (DICA-R) and the clinician's diagnosis were used as external validators. The results indicate that the discriminant power of the CBCL for the presence or absence of psychopathology depends on the external validator used. The best results were obtained when it was considered the group of origin and the DlCA-R diagnoses. As screening test, a cut-off between 50 and 54 gave the best sensitivity.Mediante el análisis de curvas ROC se estudia la precisión diagnóstica del Child Behavior Checklist (CBCL) y se obtiene elpunto de corte óptimo en una muestra de 196 niños y adolescentes procedentes de centros de consulta pediátrica y psiquiátrica. Se utilizaron como patrones de referencia el grupo de procedencia, el diagnóstico según la entrevista diagnóstica estructurada DICA-R y el diagnóstico del clínico. Los resultados indican que la capacidad del CBCL para discriminar entre sujetos con y sin psicopatología depende en gran medida del patrón de referencia utilizado, siendo mejor el rendimiento de la prueba cuando se contrasta con el grupo de procedencia o con la entrevista diagnóstica estructurada. Como prueba de cribado, el punto de corte de la puntuación total del CBCL se situada entre los valores 50 y 54 para optimizar la sensibilidad

El análisis de curvas ROC en estudios epidemiológicos de psicopatología infantil: aplicación al cuestionario CBCL

ROC analysis was applied in order to study diagnostic accuracy of the Child Behavior Checklist (CBCL) and to obtain the optimal cut-off in a sample of 196 pediatric and psychiatric patients 6 to 17 years old. The group of origin, the diagnosis in the Diagnostic lnterview for Children and Adolescents-Revised (DICA-R) and the clinician's diagnosis were used as external validators. The results indicate that the discriminant power of the CBCL for the presence or absence of psychopathology depends on the external validator used. The best results were obtained when it was considered the group of origin and the DlCA-R diagnoses. As screening test, a cut-off between 50 and 54 gave the best sensitivity.Mediante el análisis de curvas ROC se estudia la precisión diagnóstica del Child Behavior Checklist (CBCL) y se obtiene elpunto de corte óptimo en una muestra de 196 niños y adolescentes procedentes de centros de consulta pediátrica y psiquiátrica. Se utilizaron como patrones de referencia el grupo de procedencia, el diagnóstico según la entrevista diagnóstica estructurada DICA-R y el diagnóstico del clínico. Los resultados indican que la capacidad del CBCL para discriminar entre sujetos con y sin psicopatología depende en gran medida del patrón de referencia utilizado, siendo mejor el rendimiento de la prueba cuando se contrasta con el grupo de procedencia o con la entrevista diagnóstica estructurada. Como prueba de cribado, el punto de corte de la puntuación total del CBCL se situada entre los valores 50 y 54 para optimizar la sensibilidad

Functional impairment associated with symptoms of oppositional defiant disorder in preschool and early school boys and girls from the general population

Objetivo: Explorar si los síntomas y el diagnóstico de Trastorno Negativista Desafiante (TND), según los criterios diagnósticos DSM-IV, se asocian al mismo nivel de deterioro funcional en niños y niñas de la población general en los primeros años escolares. Método: Se aplicó un cuestionario de cribado a una muestra de 852 escolares de tres a siete años de edad. Un total de 251 familias fueron evaluadas con entrevista diagnóstica y con las medidas de deterioro funcional. Resultados: Los síntomas de TND y el diagnóstico son igualmente prevalentes en los niños y en las niñas, pero las niñas de entre 3 y 5 años presentaron una mayor prevalencia de diagnóstico subumbral de TND. No hubo diferencias significativas entre niños y niñas en el uso de servicios de salud, ni en el tratamiento recibido, ni en la carga familiar asociada a los síntomas o al diagnóstico de TND. Aunque el diagnóstico de TND no se asoció a un mayor deterioro funcional por sexo, los síntomas individuales y el diagnóstico subumbral se asociaban con mayor deterioro funcional en los niños que en las niñas. Conclusión: La “oposicionalidad” pueden estar midiendo variables diferentes en niños y en niñas, y esta posibilidad se debe tener en cuenta para identificar correctamente este problema en cada sexo.Objective: To explore whether the symptoms and diagnosis of Oppositional Defiant Disorder (ODD), as defined in the DSM-IV, are equally impairing for girls and boys from the general population in the early school years. Method: A sample of 852 three to seven-year-old schoolchildren were screened out for a double-phase design. A total of 251 families were assessed with a diagnostic interview and with measures of functional impairment. Results: ODD symptoms and diagnosis were equally prevalent in boys and girls, but three- to five-year-old girls had a higher prevalence of subthreshold ODD. There were no significant differences between boys and girls in the impact on use of services, treatment received and family burden associated with ODD symptoms and diagnosis. Although diagnosis of ODD was not associated with higher functional impairment by sex, individual symptoms and subthreshold diagnosis were more impairing for boys than for girls. Conclusion: Oppositionality may be measuring different things for boys and girls, and this possibility must be taken into account with a view to the correct identification of this problem in each sex

Prevalence of mental disorders in children and adolescents from a Spanish slum

This paper reports rates of psychopathology in a population of 9- and 13-yr olds from a Spanish slum. Two cohorts of all the children born in 1989 and in 1993 and registered in the census of a municipality in 2001 were assessed over a 3-yr period with structured diagnostic interviews and functional measures. In the first year of the study 79 (53.7%) children of the adolescent 13-yr-old population and 72 (59.5%) of the pre-adolescent 9-yr-old population participated. Between 30% and 60% of preadolescents and between 30% and 50% of adolescents presented some mental disorder. Anxiety and disruptive behavior disorders were the most frequent disorders in both cohorts. For both genders, the highest risk for any psychopathology was at 10 yr. We found that, psychopathology and functional impairment decreased with age, and that the psychopathology of children in a peripheral slum of a big city is 3 times higher than the median of the general population. This information should be useful for administrators providing services for children from the most disadvantaged segment of the population.Spain Developmental psychopathology Functional impairment Children Adolescents Comorbidity

Developmental trajectories for ODB in the different instruments, children's age on X-axis and raw score on Y-axis (broken line represents the cut-off of diagnosis for DSM-IV definition and percentile 90 at baseline in the sample for dimensional measures; triangle represents observed empirical values).

<p><i>S = slope (in brackets, p-value)</i>.</p

Demographic Characteristics of the Sample (<i>N</i> = 622).

<p>Demographic Characteristics of the Sample (<i>N</i> = 622).</p