Title

Validating the child behavior checklist for ages 1.5-5 years in Karachi, Pakistan

Date of Award

2013

Document Type

Thesis

Degree Name

Master of Science in Epidemiology & Biostatistics (MSc Epidemiology & Biostats)

Department

Community Health Sciences

Abstract

Background: Emotional/behavioral (EB) problems in young children tend to track into school age and adolescence, and are predictive of adult psychopathology and suicidal tendencies. It is imperative to detect and treat EB problems in early childhood. Limited research in Pakistan exists related to EB problems in children, and is virtually non-existent for children under 5 years old. This is due to the unavailability of validated measurement tools. The Child Behavior Checklist for ages 11/2 to 5 years (CBCL/1.5-5) is an inexpensive, easy to administer behavior rating scale. It is widely used worldwide to facilitate clinical assessment of child behavior, and to conduct research into the field. Thus, the objective of this study was to assess the criterion validity of the CBCL/1.5-5 DSM1-oriented scales (DOS), and to assess the 1-month test-retest reliability of the CBCL/1.5-5. Methodology: The study was conducted in two low-income communities located in the South of Karachi, namely Pakistan Chowk and Sultanabad. The Urdu version of CBCL/1.5-5 was administered in a face to face interview with mothers of the selected children. This was followed by the child's assessment pertaining to psychological problems common in early childhood; this was conducted within 1-3 days of CBCL/1.5-5 interview. The CBCL/1.5-5 was re-administered one month later to study the test-retest reliability. The data from this tool was scored by the Assessment Data Manager (ADM) software; SPSS version 19 was used to conduct all statistical analyses. Results: CBCL/1.5-5 data was collected on 453 children, and DSM-based clinical assessment of 378 children was conducted; test-retest reliability interviews were conducted on 220 children. The mean age of the children enrolled in the study was 40 months (SD: 13 Diagnostic & Statistical Manual of Mental Disorders Emotional/behavioral (EB) problems in young children tend to track into school age and adolescence, and are predictive of adult psychopathology and suicidal tendencies. It is imperative to detect and treat EB problems in early childhood. Limited research in Pakistan exists related to EB problems in children, and is virtually non-existent for children under 5 years old. This is due to the unavailability of validated measurement tools. The Child Behavior Checklist for ages 11/2 to 5 years (CBCL/1.5-5) is an inexpensive, easy to administer behavior rating scale. It is widely used worldwide to facilitate clinical assessment of child behavior, and to conduct research into the field. Thus, the objective of this study was to assess the criterion validity of the CBCL/1.5-5 DSM1-oriented scales (DOS), and to assess the 1-month test-retest reliability of the CBCL/1.5-5. Methodology The study was conducted in two low-income communities located in the South of Karachi, namely Pakistan Chowk and Sultanabad. The Urdu version of CBCL/1.5-5 was administered in a face to face interview with mothers of the selected children. This was followed by the child's assessment pertaining to psychological problems common in early childhood; this was conducted within 1-3 days of CBCL/1.5-5 interview. The CBCL/1.5-5 was re-administered one month later to study the test-retest reliability. The data from this tool was scored by the Assessment Data Manager (ADM) software; SPSS version 19 was used to conduct all statistical analyses. Results CBCL/1.5-5 data was collected on 453 children, and DSM-based clinical assessment of 378 children was conducted; test-retest reliability interviews were conducted on 220 children. The mean age of the children enrolled in the study was 40 months (SD: 13 Diagnostic & Statistical Manual of Mental Disorders months); about half of them were boys. The mean Total Problems score was 50.32 (SD: 22.67).About 83% children had at least one mental health problem upon psychological assessment (95% CI: 79 — 87%); the most common was anxiety. CBCL/1.5-5 DOS were found to have low to moderate discriminative ability (AUC range 0.63 — 0.78).Moderate to strong test-retest reliability was observed (r = 0.38 — 0.74). Conclusion The CBCL/1.5-5 DOS have adequate discriminative ability (sensitivity and specificity) when compared to psychological assessment. One-month test-retest reliability is also adequate. Thus, CBCL/1.5-5 is a suitable screening instrument for early childhood EB problems in the community. The mean total problems score and the score on CBCL/1.5-5 scales were higher than the highest reported in the world. Mental health services should be developed to identify and treat children with EB problems, and primary prevention strategies should be implemented.

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