Concurrent validity of the DSM-IV scales Affective Problems and Anxiety Problems of the Youth Self-Report
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Behaviour and Aggressive Behaviour), and three internalising narrow-band syndrome scales (Anxious/Depressed, Withdrawn, and Somatic Complaints).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
References (29)
- et al.
Assessment of symptoms of DSM-IV anxiety and depression in childrena revised child anxiety and depression scale
Behaviour Research and Therapy
(2000) - et al.
Reliability and validity of the spence children's anxiety scale and the screen for child anxiety related emotional disorders in German children
Journal of Behavior Therapy and Experimental Psychiatry
(2002) - et al.
Lifetime comorbidity among anxiety disorders and between anxiety disorders and other mental disorders in adolescents
Journal of Anxiety Disorders
(1997) - et al.
Three traditional and three new childhood anxiety questionnairestheir reliability and validity in a normal adolescent sample
Behaviour Research and Therapy
(2002) - et al.
A parent-report measure of children's anxietypsychometric properties and comparison with child-report in a clinic and normal sample
Behaviour Research and Therapy
(2004) Integrative guide for the 1991 CBCL/4-18, YSR and TRF Profiles
(1991)- Achenbach, T. M., Dumenci, L., & Rescorla, L. A. (2001). Ratings of relations between DSM-IV diagnostic categories and...
- et al.
DSM-oriented and empirically based approaches to constructing scales from the same item pools
Journal of Clinical Child and Adolescent Psychology
(2003) Diagnostic and statistical manual of mental disorders
(1980)Diagnostic and statistical manual of mental disorders
(1987)
Diagnostic and statistical manual of mental disorders
Comorbidity
Journal of Child Psychology and Psychiatry
Statistical power analysis for the behavioral sciences
Analogue measures of DSM-IV mood and anxiety disorders based on behavior checklists
Journal of Psychopathology and Behavioral Assessment
Cited by (52)
The bidirectional association between sleep problems and anxiety symptoms in adolescents: a TRAILS report
2020, Sleep MedicineCitation Excerpt :However, low internal consistencies may have obscured association patterns [48]. Moreover, the validity of the YSR/anxiety scales used in this study is questionable; Van Lang and colleagues [30], found that the YSR anxiety scale was less strongly associated with DSM-IV anxiety symptoms than anxiety scales of the Revised Child Anxiety and Depression Scale (RCADS). This suggests that our anxiety scale may not be fully comparable to anxiety measures used in other studies.
Theory of mind and suicide ideation and attempt in adolescent inpatients
2019, Journal of Affective DisordersCitation Excerpt :Given the high rates of psychiatric disorder and comorbidity in the current sample, we utilized standardized t-scores for DSM-oriented clinical scales in our analyses, and multiple scales [affective problems, anxiety problems, ADHD problems] were included as clinical covariates in primary analyses (for further information, see below). The YSR is a widely-used self-report based measure, whose psychometric properties and concurrent validity with other diagnostic/symptom-based measures have been well-established (e.g., Ferdinand, 2008; van Lang et al., 2005). Suicide ideation and attempt were captured via the Computerized Diagnostic Interview Schedule for Children (CDISC; Shaffer et al., 2000)—a structured diagnostic interview for DSM-IV psychiatric disorder diagnoses, which is intended for use in youth aged 9–17 years of age (Shaffer et al., 2000).
The Revised Child Anxiety and Depression Scale: A systematic review and reliability generalization meta-analysis
2017, Journal of Affective DisordersCriterion validity of the Strengths and Difficulties Questionnaire (SDQ) with inpatient adolescents
2014, Psychiatry ResearchCitation Excerpt :The DSM-oriented scales were used for the present study to compare their performance against the SDQ, which was also designed to reflect DSM-IV criteria. Several studies have reported positive psychometric properties of the DSM-oriented scales (Achenbach et al., 2003; Nakamura et al., 2009), while other research has found mixed results (van Lang et al., 2005; Vreugdenhil et al., 2006; Kendall et al., 2007). Convergent and divergent validity have been supported with several anxiety and depression scales (see Nakamura et al. (2009) for a summary of this validity research).
Chronicity of depressive problems and the cortisol response to psychosocial stress in adolescents: The TRAILS study
2013, Psychoneuroendocrinology