Symptom differentiation of anxiety and depression across youth development and clinic-referred/nonreferred samples: An examination of competing factor structures of the Child Behavior Checklist DSM-oriented scales

Abstract

This study examined the psychometric properties of the DSM-oriented scales of the Child Behavior Checklist (Achenbach, Dumenci, & Rescorla, 2003) using confirmatory factor analysis to compare the six-factor structure of the DSM-oriented scales to competing models consistent with developmental theories of symptom differentiation. We tested these models on both clinic-referred (N = 757) and school-based, nonreferred (N = 713) samples of youths in order to assess the generalizability of the factorial structures. Although previous research has supported the fit of the six-factor DSM-oriented structure in a normative sample of youths ages 7 to 18 (Achenbach & Rescorla, 2001), tripartite model research indicates that anxiety and depressive symptomology are less differentiated among children compared to adolescents (Jacques & Mash, 2004). We thus examined the relative fit of a six- and a five-factor model (collapsing anxiety and depression) with younger (ages 7-10) and older (ages 11-18) youth subsamples. The results revealed that the six-factor model fit the best in all samples except among younger nonclinical children. The results extended the generalizability of the rationally derived six-factor structure of the DSM-oriented scales to clinic-referred youths and provided further support to the notion that younger children in nonclinical samples exhibit less differentiated symptoms of anxiety and depression.

The Revised Child Anxiety and Depression Scale - Parent Version: Extended Applicability and Validity for Use with Younger Youth and Children with Histories of Early-Life Caregiver Neglect

“…Notably, the MDD (depression) subscale had a significantly larger reliability estimate in the older group (α = .82) compared with the younger group (α = .71), p = .009. These results are consistent with the finding that depression undergoes increased symptom differentiation over the course of childhood and adolescent development (Price et al, 2013), and depression symptoms may be less apparent (Kashani, Ray, & Carlson, 1984), although still present (Egger, & Angold, 2006), among younger youth. Nonetheless, the depression subscale scores met the cut off for acceptable reliability in both grade-level groups.…”

“…These results are also consistent with results from McGuire and Richman (1986) who found (internal consistency-based) reliability estimates of the Preschool Behaviour Checklist (completed by caregivers of preschoolers) to be in the .80 range. Although reliability of the RCADS-P Depression scale was significantly higher in the older group sample, this is to be somewhat expected given that symptoms of depression have been found to experience increased symptom differentiation (and thus should be easier to be observed and identified by reporters) as children grow older (Price et al, 2013). The reliability estimate of this younger group subscale nonetheless met benchmark for adequate reliability in the present sample.…”

An examination of the associations between pediatric loss of control eating, anxiety, and body composition in children and adolescents

“…61. The Anxiety Problem scale is also consistent with DSM-IV nosology of anxiety disorders in both clinical and non-clinical samples of youth (Ferdinand, 2008; Price, et al, 2013). …”

Treatment and Prevention of Depression and Anxiety in Youth: Test of Cross-Over Effects

“…For example, targeting negative affectivity has been suggested rather than the discrete disorders of anxiety and depression, especially for children and adolescents, for whom these symptoms are less differentiated than in adults. [69,129] Promising developments for transdiagnostic intervention approaches have been emerging for adults, [70,71] and children. [13,39,72,73] For example, Weersing and colleagues [13] designed a treatment that condensed existing CBT protocols for anxiety and depression to their core components and combined them into a brief, integrated treatment protocol that targeted common underlying processes, such as behavioral avoidance and withdrawal.…”