This study investigated the utility of several scales of the Child Behavior Checklist (CBCL) when diagnosing anxiety disorders in youth. Participants were the mothers and fathers of 130 children (ages 7 to 14; M = 9.61 years, SD = 1.74; 69 boys, 61 girls) who were evaluated at a specialty mental health clinic (100 were referred for treatment; 30 were nonanxious volunteers). For both mothers' and fathers' reports, the highest correlations were found between the Anxious/Depressed subscale and the severity of generalized anxiety disorder (GAD); the second highest relations were between the Withdrawn subscale and the severity of social phobia (SP). Using either mothers' reports or fathers' reports, receiver operating characteristics (ROC) analyses identified cutoff scores that were useful in ruling in the presence of an anxiety disorder in general but did not identify cutoff scores to rule in the presence of principal GAD or principal SP. For mothers' reports only, receiver operating characteristics analyses identified a useful cutoff score to rule out the presence of an anxiety disorder, as well as a cutoff score to rule out the presence of principal GAD. Finally, discriminant function analyses determined the most useful subscales for ruling in and ruling out an anxiety disorder in general, as well as principal GAD and principal SP. Findings are discussed with regard to diagnosis of child anxiety and the clinical utility of the CBCL with anxious youth.

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Objective: In light of the current controversy about whether severe temper outbursts are diagnostic of mania in young children, we conducted a study to characterize such children, focusing on mania and other mood disorders, emotion regulation, and parental psychiatric history. Methods: Study participants included 51 5-9-year-old children with frequent, impairing outbursts (probands) and 24 nonreferred controls without outbursts. Parents completed a lifetime clinical interview about their child, and rated their child's current mood and behavior. Teachers completed a behavior rating scale. To assess emotion regulation, children were administered the Balloons Game, which assesses emotion expressivity in response to frustration, under demands of high and low regulation. Parental lifetime diagnoses were ascertained in blind clinical interviews. Results: No child had bipolar disorder, bipolar disorder not otherwise specified (NOS), or major depression (MDD). The most prevalent disorder was oppositional defiant disorder (88.2%), followed by attention-deficit/hyperactivity disorder (74.5%), anxiety disorders (49.0%), and non-MDD depressive disorders (33.3%). Eleven probands (21.6%) met criteria for severe mood dysregulation. During the Balloons Game, when there were no demands for self-regulation, children with severe outbursts showed reduced positive expressivity, and also showed significant deficits in controlling negative facial expressions when asked to do so. Anxiety disorders were the only diagnoses significantly elevated in probands' mothers. Conclusions: Overall, young children with severe temper outbursts do not present with bipolar disorder. Rather, disruptive behavior disorders with anxiety and depressive mood are common. In children with severe outbursts, deficits in regulating emotional facial expressions may reflect deficits controlling negative affect. This work represents a first step towards elucidating mechanisms underlying severe outbursts in young children.

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