An Analysis of the Child Behavior Checklist Anxiety Problems Scale’s Predictive Capabilities

  • Mark J. KnepleyEmail author
  • Philip C. KendallEmail author
  • Matthew M. Carper


The Child Behavior Checklist (CBCL) is widely used to assess behavioral and emotional problems in youth. The CBCL Diagnostic and Statistical Manual (DSM)-Oriented Anxiety Problems subscale (CBCL-AP) was developed for the identification of DSM-IV anxiety disorders. Using data from 298 youth aged 6- to 18, the CBCL-AP scale was examined to determine its ability to differentially predict, via Receiver Operating Characteristics (ROC) analysis, the presence of (a) generalized anxiety disorder (GAD), (b) separation anxiety disorder (SAD), (c) specific phobia (SPPH), or (d) the presence of any of these disorders. Independent Evaluators (IEs) administered the Anxiety Disorders Interview Schedule for Children (ADIS-C/P) to determine the presence of an anxiety disorder. The ability of the CBCL-AP to predict to anxiety disorders was compared to the ability of the CBCL Anxious/Depressed (CBCL-A/D) scale and the seven empirically derived CBCL syndrome subscales and five DSM-Oriented subscales to predict anxiety disorder diagnoses. Results revealed that CBCL-AP scores significantly predicted all diagnoses. CBCL-A/D scores significantly predicted SAD (AUC = 0.67), GAD (AUC = 0.69), and the presence of any of the three disorders (AUC = 0.72), but not the presence of SPPH (AUC = 0.52). Although the CBCL-AP scale may not be a substitute for extensive diagnostics, it has demonstrated utility as an instrument for assessing anxiety and can serve to identify anxious youth in need of mental health services.


Child anxiety Adolescent anxiety Anxiety treatment Anxiety 



The preparation of this manuscript was facilitated by support from the National Institute of Health (Child Health and Human Development) grant (R01HD080097) to Philip C. Kendall.

Compliance with Ethical Standards

Conflict of Interest

M. J. Knepley, P. C. Kendall, and M. M. Carper declare they have no conflicts of interest.

Ethical Approval

All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional and/or national research committee and with the 1964 Helsinki declaration and its later amendments or comparable ethical standards.

Experiment Participants

Informed consent was obtained from all individual participants included in the study.


  1. Achenbach, T. M. (1991). Manual for the child behavior checklist 4–18 and 1991 profile. Burlington: Department of Psychiatry, University of Vermont.Google Scholar
  2. Achenbach, T. M. (1995). Empirically based assessment and taxonomy: Applications to clinical research. Psychological Assessment, 7(3), 261–274. Scholar
  3. Achenbach, T. M., & Edelbrock, C. (1987). Manual for the Youth Self-Report and Profile. Burlington: University of Vermont, Department of Psychiatry.Google Scholar
  4. Achenbach, T.M., & Rescorla, L.A. (2001). Manual for the ASEBA School-age Forms & Profiles. Google Scholar
  5. Achenbach, T. M., Dumenci, L., & Rescorla, L. A. (2003). DSM oriented and empirically based approaches to constructing scales from the same item pools. Journal of Clinical Child and Adolescent Psychology, 32(3), 328–340. Scholar
  6. Aschenbrand, S. G., Angelosante, A. G., & Kendall, P. C. (2005). Discriminant validity and clinical utility of the CBCL with anxiety disordered youth. Journal of Clinical Child and Adolescent Psychology, 34(4), 735–746. Scholar
  7. Chavira, D. A., Stein, M. B., Bailey, K., & Stein, M. T. (2004). Child anxiety in primary care: Prevalent but untreated. Depression and Anxiety, 20(4), 155–164. Scholar
  8. Choudhury, M. S., Pimentel, S. S., & Kendall, P. C. (2003). Childhood anxiety disorders: Parent–child (dis)agreement using a structured interview for the DSM-IV. Journal of the American Academy of Child and Adolescent Psychiatry, 42(8), 957–964. Scholar
  9. Connolly, S. D., & Bernstein, G. A. (2007). Practice parameter for the assessment and treatment of children and adolescents with anxiety disorders. Journal of the American Academy of Child & Adolescent Psychiatry, 46(2), 267–283.
  10. Ebesutani, C., Bernstein, A., Nakamura, B. J., Chorpita, B. F., Higa-McMillan, C. K., Weisz, J. R., & & Research Network on Youth Mental Health. (2010). Concurrent validity of the child behavior checklist DSM-oriented scales: Correspondence with DSM diagnoses and comparison to syndrome scales. Journal of Psychopathology and Behavioral Assessment, 32(3), 373–384.
  11. Essau, C. A., Conradt, J., & Petermann, F. (2000). Frequency, comorbidity, and psychosocial impairment of anxiety disorders in adolescents. Journal of Anxiety Disorders, 14(3), 263–279. Scholar
  12. Ferdinand, R. F. (2008). Validity of the CBCL/YSR DSM-IV scales anxiety problems and affective problems. Journal of Anxiety Disorders, 22(1), 126–134. Scholar
  13. Kazdin, A. E., & Weisz, J. R. (1998). Identifying and developing empirically supported child and adolescent treatments. Journal of Consulting and Clinical Psychology, 66(1), 19–36. Scholar
  14. Kendall, P. C., Chu, B. C., Pimentel, S. S., & Choudhury, M. (2000). Treating anxiety disorders in youth. In P. C. Kendall (Ed.), Child and adolescent therapy: Cognitive-behavioral procedures (2nd ed., pp. 235–287). New York: Guilford Press.Google Scholar
  15. Kendall, P. C., Panichelli-Mindel, S. M., Sugarman, A., & Callahan, S. A. (1997). Exposure to child anxiety: theory, research, and practice. Clinical Psychology: Science and Practice, 4(1), 29–39Google Scholar
  16. Kendall, P. C., Puliafico, A., Barmish, A., Choudhury, M. S., Henin, A., & Treadwell, K. (2007). Assessing anxiety with the child behavior checklist and the teacher report form. Journal of Anxiety Disorders, 21(8), 1004–1015. Scholar
  17. Kim-Cohen, J., Caspi, A., Moffitt, T. E., Harrington, H., Milne, B. J., & Poulton, R. (2003). Prior juvenile diagnoses in adults with mental disorder: Developmental follow-back of a prospective-longitudinal cohort. Archives of General Psychiatry, 60(7), 709–717. Scholar
  18. Lacalle, M., Ezpeleta, L., & Doménech, J. M. (2012). DSM-oriented scales of the child behavior checklist and youth self-report in clinically referred Spanish children. The Spanish Journal of Psychology, 15(1), 377387. Google Scholar
  19. Langley, A. K., Bergman, L., & Piacentini, J. C. (2002). Assessment of childhood anxiety. International Review of Psychiatry, 14(2), 102–113. Scholar
  20. March, J. S. (1998). Multidimensional Anxiety Scale for Children. North Tonawanda: Multi-Health Systems.Google Scholar
  21. Merikangas, K., Nakamura, E., & Kessler, R. (2009). Epidemiology of mental disorders in children and adolescents. Dialogues in Clinical Neuroscience, 11(1), 7–20.Google Scholar
  22. Merikangas, K. R., He, J. P., Burstein, M., Swanson, S. A., Avenevoli, S., Cui, L., Benjet, C., Goergiades, K., & Swendsen, J. (2010). Lifetime prevalence of mental disorders in US adolescents: Results from the National Comorbidity Survey Replication–Adolescent Supplement (NCS-A). Journal of the American Academy of Child & Adolescent Psychiatry, 49(10), 980–989. Scholar
  23. Nakamura, B., Ebesutani, C., Bernstein, A., & Chorpita, B. (2009). A psychometric analysis of the child behavior checklist DSM oriented scales. Journal of Psychopathology and Behavioral Assessment, 31(3), 178–189. Scholar
  24. Pauschardt, J., Remschmidt, H., & Mattejat, F. (2010). Assessing child and adolescent anxiety in psychiatric samples with the child behavior checklist. Journal of Anxiety Disorders, 24(5), 461–467. Scholar
  25. Pine, D. S., Cohen, P., Gurley, D., Brook, J., & Ma, Y. (1998). The risk for early-adulthood anxiety and depressive disorders in adolescents with anxiety and depressive disorders. Archives of General Psychiatry, 55(1), 56–64. Scholar
  26. Puleo, C., Conner, B., Benjamin, C., & Kendall, P. C. (2011). CBT for childhood anxiety and substance use at 7.4-year follow-up: A reassessment controlling for known predictors. Journal of Anxiety Disorders, 25(5), 690–696. Scholar
  27. Reich, W. (2000). Diagnostic interview for children and adolescents (DICA). Journal of the American Academy of Child and Adolescent Psychiatry, 39, 59–66. Scholar
  28. Schuckit, M. A., & Hesselbrock, V. (1994). Alcohol dependence and anxiety disorders: What is the relationship? American Journal of Psychiatry, 151(12), 1723–1734. Scholar
  29. Seligman, L. D., Ollendick, T. H., Langley, A. K., & Baldacci, H. B. (2004). The utility of measures of child and adolescent anxiety: A meta-analytic review of the revised children’s manifest anxiety scale, the state-trait anxiety inventory for children, and the child behavior checklist. Journal of Clinical Child and Adolescent Psychology, 33(3), 557–565.
  30. Silverman, W., & Nelles, W. (1988). The anxiety disorders interview schedule for children. Journal of the American Academy of Child and Adolescent Psychiatry, 27(6), 772–778.Google Scholar
  31. Silverman, W. K., Saaverda, L. L., & Pina, A. A. (2001). Test-retest reliability of anxiety symptoms and diagnoses with anxiety disorders interview schedule for DSM-IV: Child and parent versions. Journal of the American Academy of Child and Adolescent Psychiatry, 40(8), 937–944.
  32. Swan, A., & Kendall, P. C. (2016). Fear and missing out: Youth anxiety and functional outcomes. Clinical Psychology: Science and Practice, 23, 417–435. Scholar
  33. Silverman, W., & Albano, A. M. (1996). The anxiety disorders interview schedule for DSM-IV: child and parent versions. San Antonio: Graywind.Google Scholar
  34. Weller, E., Weller, R., Teare, M., & Fristad, M. (1999). Parent version-Children’s interview for psychiatric syndromes (P-ChIPS). Washington: American Psychiatric Press.Google Scholar
  35. Wolk, C. B., Kendall, P. C., & Beidas, R. (2015). Cognitive-behavioral therapy for child anxiety confers long-term protection from suicidality. Journal of the American Academy of Child and Adolescent Psychiatry, 54(3), 175–179. Scholar
  36. Wood, J. J., Piacentini, J. C., Bergman, R. L., McCracken, J., & Barrios, V. (2002). Concurrent validity of the anxiety disorders section of the anxiety disorders interview schedule for DSM-IV: Child and parent versions. Journal of Clinical Child Adolescent Psychology, 31(3), 335–342. Scholar
  37. World Health Organization. (2008). Multiaxial classification of child and adolescent psychiatric disorders: The ICD-10 classification of mental and Behavioural disorders in children and adolescents. Cambridge: University Press.Google Scholar
  38. Wren, F. J., Scholle, S. H., Heo, J., & Comer, D. M. (2016). Pediatric mood and anxiety syndromes in primary care: who gets identified?. The International Journal of Psychiatry in Medicine, 33(1), 1–16Google Scholar
  39. Yates, B. T., & Taub, J. (2003). Assessing the costs, benefits, cost effectiveness, and cost-benefit of psychological assessment: We should, we can, and here’s how. Psychological Assessment, 15(4), 478–495. Google Scholar

Copyright information

© Springer Science+Business Media, LLC, part of Springer Nature 2019

Authors and Affiliations

  1. 1.Department of PsychologyTemple UniversityPhiladelphiaUSA

Personalised recommendations