Diagnostic accuracy of Achenbach scales in detecting youths’ substance use disorders.

Abstract

It is vital to identify substance use disorders (SUDs) in youths and adults early and accurately. Previous studies have investigated the validity and reliability of the Achenbach Child Behavior Checklist (CBCL) and Youth Self Report (YSR) for other related anxiety, mood, and behavior problems. The present study tested if the CBCL and YSR substance use items can discriminate adolescents with versus without a SUD diagnosis accurately enough to justify clinical application within an evidence-based assessment framework. N = 422 outpatient adolescents (age 9-18) and their caregivers completed semistructured diagnostic interviews. Caregivers completed CBCL, and adolescents completed the YSR. K-SADS-PL+ diagnoses indicated that 34 youths met Diagnostic and Statistical Manual (DSM)-IV criteria for SUDs. Receiver Operating Characteristics (ROC) models estimated the likelihood of having Kiddie Schedule for Affective Disorders and Schizophrenia-Present and Lifetime (KSADS-PL) + SUDs based on substance use scores of CBCL or YSR. Scores on all scales significantly identified KSADS-PL-diagnosed SUDs in adolescents: Area under the curve (AUC CBCL = .90, p < .0005; AUC YSR = .84, p < .0005). There was no significant difference in the accuracy comparing each informant used separately; CBCL showed incremental value above the YSR report when both were included in logistic regression models. CBCL and YSR substance items demonstrated diagnostic and clinical utility in identifying SUDs in adolescents. Findings suggest that Achenbach Scales could be a valuable intake instrument in detecting adolescents SUDs. A supplemental clinical vignette illustrates the clinical application of the study findings.

Diagnostic accuracy of the Child and Adolescent Symptom Inventory (CASI-4R) substance use subscale in detecting substance use disorders in youth.

“…With multiple-thresholds DLRs, clinicians can use a more objective predictive system, reducing potential heuristics and sources of bias in clinical judgment (Van Meter, 2020). We provide showing an example of applying the methods to a case both as an appendix and an extended version online (Tsai et al, 2022; https://ericyoungstrom.web.unc.edu/wp-content/uploads/sites/5455/2022/09/80023_Supplemental-Material_ATeay_v1.2.pdf).…”

“…Additional tables related to the diagnostic accuracy of the CASI-4R and this case example are available as supplemental materials (Tsai et al, 2022; https://ericyoungstrom.web.unc.edu/wp-content/uploads/sites/5455/2022/09/80023_Supplemental-Material_ATeay_v1.2.pdf).…”

“…Few have investigated the handful of commonly used intake measures that have embedded SU items to assess common comorbidities. Tsai et al (2022) started to address this gap by evaluating the diagnostic efficiency of SUD items on the Achenbach System of Empirically Based Assessment (ASEBA; Achenbach & Rescorla, 2001) on children and adolescents. The present study extends previous work by investigating the CASI SU subscale, a DSM- referenced screening instrument designed to assess symptoms of a set of common psychiatric disorders, including SU on AYA, in an older age cohort (e.g., late adolescence and early adulthood vs. school-age through high school).…”

Assessing the utility of a novel cortical marker of delay discounting (C-DD) in two independent samples of early adolescents: Links with externalizing pathology

“…An internalizing composite score was composed by summing the 31 items from the anxious/depressed (e.g., “Nervous, high-strung, or tense”), withdrawn/depressed (e.g., “Unhappy, sad, or depressed”), and somatic complaints (e.g., “Has stomach aches without a known medical cause.”) subscales. Although previous research has shown that the CBCL shows strong diagnostic accuracy [ 53 – 55 ], this measure is not a diagnostic tool. In line with this dimensional approach, higher composite scores indicate greater symptom severity.…”