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Exploring the Agreement Between Dimensional CBCL Measures and Categorical DSM-IV Diagnoses of Comorbid Psychopathology in Children with Autism Spectrum Disorders

Saturday, 4 May 2013: 09:00-13:00
Banquet Hall (Kursaal Centre)
E. Gjevik, Institute of Clinical Medicine, University of Oslo, Oslo, Norway

Autism spectrum disorders (ASD) are often comorbid with other psychiatric symptoms and disorders. However, identifying and describing psychiatric comorbidity in children and adolescents with ASD is challenging.


To explore how a dimensional questionnaire, The Child Behaviour Check List (CBCL), agreed to a DSM-IV based standardized interview, The schedule of Affective Disorders and Schizophrenia (Kiddie-SADS), in identifying comorbid psychiatric symptoms and disorders, and explore the usefulness of combining these two diagnostic tools in clinical practice.  


The study sample included a clinically representative group of 55 children and adolescents with ASD,  ranging in age from 6 to 18 years,  including the three main ASD subgroups and the broad range of cognitive and language functioning. Questionnaire and interview assessment were based on parent information


High rate of psychopathology was found both through questionnaire and interview assessment. Thirty-eight children (69% of the sample) had elevated scores on the CBCL Thought problem scale, 35 (65%) on the Attention Problems scale and 34 (62%) on the Affective Problems scale. Forty children (73%) were diagnosed with at least one comorbid DSM-IV disorder. ADHD (17 children, 31%) and anxiety disorders (24 children, 40%) were the most prevalent. We found good agreement between the CBCL and the Kiddie-SADS for identifying children with comorbid ADHD, depressive disorder and OCD. However, a high number of children had elevated CBCL scores, but no interview identified ADHD, depressive disorder or ODD/CD. There was poor agreement between the CBCL and the Kiddie- SADS for identifying children with anxiety disorders.


This explorative study is one of very few directly comparing dimensional questionnaire information and categorical DSM-IV diagnoses of comorbid psychopathology in children and adolescents with ASD. Our findings support the use the CBCL for identifying children with comorbid DSM-IV defined ADHD, depressive disorder and ODD/CD, but not for identifying children with anxiety disorders. The CBCL questionnaire seems to capture core symptoms of ASD as well as comorbid psychopathology, and clinicians should be aware that the CBCL may be unspecific when used in children with ASD.

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