Concurrent validity of the DSM-IV scales Affective Problems and Anxiety Problems of the Youth Self-Report

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Abstract

This study investigated the concurrent validity of the DSM-IV scales Anxiety Problems and Affective Problems of the Youth Self-Report (YSR) in a community sample of Dutch young adolescents aged 10–12 years. We first examined the extent to which the YSR/DSM-IV scales reflect symptoms of DSM-IV anxiety disorders and DSM-IV Major Depressive Disorder, assessed with the Revised Child Anxiety and Depression Scale (RCADS). Second, we examined whether the association between the YSR/DSM-IV scales and the RCADS scales was stronger than the association between the empirically derived YSR narrow-band scales Anxious/Depressed and Withdrawn and the same RCADS scales. Results showed that the YSR/DSM-IV scale Affective Problems had a stronger association with symptoms of DSM-IV Major Depressive Disorder than the YSR narrow-band scales Withdrawn and Anxious/Depressed. However, the YSR/DSM-IV scale Anxiety Problems had a weaker association with symptoms of DSM-IV anxiety disorders, compared to the YSR narrow-band scale Anxious/Depressed. It was concluded that the construction of the DSM-IV scales improved the correspondence with DSM-IV Major Depressive Disorder, but not with DSM-IV anxiety disorders.

Introduction

Two main taxonomic approaches are widely used to describe psychopathology in children and adolescents: the clinical-diagnostic approach and the empirical-quantitative approach. The clinical-diagnostic approach is represented by the Diagnostic and Statistical Manual of Mental Disorders (DSM; American Psychiatric Association, 2000), and yields diagnostic categories that are based on pre-defined sets of criteria. The approach is characterised as “top down”, indicating that the set of criteria is derived from experts’ judgements. Conversely, the empirical-quantitative approach, represented by the Achenbach System of Empirically Based Assessment, yields empirical syndrome scales that are derived from multivariate statistical analyses of symptoms that tend to co-occur in large samples of children (Achenbach, Dumenci, & Rescorla, 2003). This approach is characterised as “bottom up”, because it is based on statistical analyses of children's scores on problem items, instead of relying on experts’ judgements.

Several studies examined associations between the clinical-diagnostic approach and the empirical-quantitative approach (Connor-Smith & Compas, 2003; Edelbrock & Costello, 1988; Gould, Bird, & Jaramillo, 1993; Kasius, Ferdinand, van den Berg, & Verhulst, 1997; Lengua, Sadowski, Friedrich, & Fisher, 2001). In these studies, information regarding DSM diagnoses was obtained with standardised interviews, whereas empirical-quantitative information was obtained with standardised questionnaires, such as the Youth Self-Report (YSR; Achenbach, 1991), a self-report questionnaire, and the Child Behaviour Checklist (CBCL; Achenbach, 1991), a parent questionnaire. These questionnaires yield scores on two externalising narrow-band syndrome scales (Delinquent Behaviour and Aggressive Behaviour), and three internalising narrow-band syndrome scales (Anxious/Depressed, Withdrawn, and Somatic Complaints). In general, it was found that the externalising narrow-band scales correspond strongly with their DSM counterparts. Specific associations were found between the CBCL scale Delinquent Behaviour and DSM Conduct Disorder, and between the CBCL scale Aggressive Behaviour and DSM Oppositional Defiant Disorder. For instance, Edelbrock and Costello (1988) examined the association between CBCL scales and DSM-III (American Psychiatric Association, 1980) diagnoses, obtained with the Diagnostic Interview Schedule for Children (DISC; Costello, Edelbrock, Dulcan, Kalas, & Klaric, 1984), in 270 clinically referred children aged 6–16 years. They found a strong association between the CBCL scale Delinquent Behaviour and a diagnosis of Conduct Disorder. This finding was confirmed by Gould et al. (1993), who found a firm relationship between the Delinquent Behaviour scale of the YSR and CBCL and DISC/DSM-III diagnoses of Conduct Disorder in a community sample of children aged 6–16 years.

Associations that were found between the internalising narrow-band scales and corresponding DSM diagnoses were weaker and less specific. For instance, Kasius et al.(1997) examined the association between CBCL scale scores in the clinical range and DSM-III-R (American Psychiatric Association, 1987) diagnoses, assessed with the DISC 2.3 (NIHM, 1992), in an outpatient sample of 231 Dutch children and adolescents aged 6–16 years. Odds ratios reflecting associations between scores on the CBCL scales Anxious/Depressed and Withdrawn, and their DSM-III-R counterparts (anxiety and affective disorders) were much lower than the odds ratios found for CBCL externalising scales and DSM disruptive disorders. In addition, the associations found between the CBCL scales Anxious/Depressed and Withdrawn, and DSM disorders were less specific than between CBCL externalising scales and DSM disruptive disorders. For instance, scores on the CBCL scale Anxious/Depressed were associated with the majority of anxiety and mood disorders, and scores on the CBCL scale Withdrawn predicted diagnoses of Generalised Anxiety Disorder (GAD), Major Depressive Disorder (MDD), and Dysthymia.

This relative lack of specific correspondence between the internalising narrow-band scales and DSM diagnostic categories may result from the fact that the scale Anxious/Depressed contains items regarding anxiety and depression. Therefore, to enhance comparison of the empirical-quantitative approach and the clinical-diagnostic approach, several studies have tried to generate YSR/CBCL constructs that reflect DSM disorders (e.g., Achenbach, Dumenci, & Rescorla (2001), Achenbach, Dumenci, & Rescorla (2003); Connor-Smith & Compas, 2003; Lengua et al., 2001). For instance, Achenbach, Dumenci, & Rescorla (2001), Achenbach, Dumenci, & Rescorla (2003) constructed DSM-IV scales for YSR/CBCL problem behaviours. For each YSR/CBCL item, international experts were asked to indicate to which extent it could be regarded as consistent with a number of predefined DSM-IV disorders. In case of high correspondence between the experts’ ratings, an item was assigned to a YSR/CBCL DSM-IV scale. Among other DSM-IV scales, the DSM-IV scale Anxiety Problems was constructed, reflecting symptoms of DSM-IV GAD, Separation Anxiety Disorder (SAD), and Specific Phobia. In addition, the DSM-IV scale Affective Problems was constructed, which reflects symptoms of DSM-IV Dysthymia and MDD.

However, although the psychometric qualities of all DSM-IV scales need further examination, the validity of the DSM-IV scale Anxiety Problems might require special attention. This DSM-IV scale consists of six items, and is supposed to represent symptoms of three DSM-IV anxiety disorders: three items representing GAD, two items SAD, and one item Simple Phobia. However, given the low number of items comprised by the Anxiety Problems scale, it can be questioned whether this scale reflects the DSM-IV dimensions of anxiety disorders sufficiently. Contrarily, the DSM-IV scale Affective Problems contains almost all criteria of DSM-IV MDD, and might be strongly associated with its DSM-IV counterpart.

The purpose of the present study was to investigate the concurrent validity of the DSM-IV scales Anxiety Problems and Affective Problems. First, it was investigated to which extent the DSM-IV scales Anxiety Problems and Affective Problems reflect symptoms of DSM-IV anxiety disorders and MDD in a community sample of Dutch young adolescents aged 10–12 years. Second, it was examined whether the DSM-IV scales Anxiety Problems and Affective Problems show a stronger correspondence with DSM-IV dimensions of anxiety disorders and MDD than the empirically derived narrow-band scales Anxious/Depressed and Withdrawn. Information obtained with the YSR was compared with data from the Revised Child Anxiety and Depression Scale (RCADS; Chorpita, Yim, Moffitt, Umemoto, & Francis, 2000), a self-report questionnaire designed to assess DSM-IV dimensions of anxiety disorders and depressive disorders. These two self-report questionnaires were used because both include scales for anxiety and depression, and (previous) Dutch versions of both questionnaires showed to have good psychometric properties (e.g., Verhulst, van der Ende, & Koot, 1997; Nauta et al., 2004). In addition, self-reports were used because it has been shown that parents tend to under-report their children's anxiety and depression (Garber, Keiley, & Martin, 2002; Stanger & Lewis, 1993), and children probably provide a more valid description of their emotional states than parent reports (e.g., Gould et al., 1993).

Section snippets

Sample and procedure

The TRacking Adolescents’ Individual Lives Survey (TRAILS) is a prospective cohort study of Dutch young adolescents aged 10–12 years, who are followed biennially until the age 24. The main objective of TRAILS is to chart and explain the development of mental health from young adolescence into adulthood, both at the level of psychopathology and at the level of underlying vulnerability and environmental risk factors. The present study used data from the first assessment wave of TRAILS, which ran

Results

Correlations between scores on the YSR/DSM-IV scales Anxiety Problems and Affective Problems, scores on the YSR narrow-band scales Anxious/Depressed and Withdrawn, and scores on the RCADS scales SAD, GAD, SoPh and MDD, are presented in Table 1.

Discussion

This study investigated the concurrent validity of the YSR/DSM-IV scales Anxiety Problems and Affective Problems in a community sample of Dutch young adolescents aged 10–12 years. It was examined to which extent the DSM-IV scales reflect symptoms of DSM-IV anxiety disorders and MDD, as assessed with the RCADS. In addition, it was examined whether the DSM-IV scales showed a stronger correspondence with symptoms of DSM-IV anxiety disorders and MDD than the empirically derived YSR narrow-band

Acknowledgements

This research is part of the TRacking Adolescents’ Individual Lives Survey (TRAILS). We gratefully acknowledge the invaluable contribution of the staff members and fieldworkers during the preparation and execution of the data collection of TRAILS. Participating centres of TRAILS include various Departments of the University of Groningen, the Erasmus Medical Center of Rotterdam, the University of Nijmegen, University of Leiden, and the Trimbos Institute, The Netherlands. TRAILS is financially

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