Identification of emotional and behavior problems in obese children using Child Behavior Checklist (CBCL) and 17-items Pediatric Symptom Checklist (PSC-17)

Abstract

Background Obesity can result in emotional and behavior problems in school-age children. Child Behavior Checklist (CBCL) is a standard instrument for evaluating behavior problems, however it is considered not practical. The 17-item Pediatric Symptom Checklist (PSC-17) is a more simple instrument but its diagnostic value has never been evaluated in obese children.Objectives To evaluate the diagnostic value of PSC-17 compared to CBCL as the gold standard.Methods This cross-sectional study was done in May - June 2009. Children aged 6-12 years with obesity were included. Parents filled the CBCL and PSC-17 questionnaires. Sensitivity, specificity, predictive values, and likelihood ratios were calculated for PSC-17.Results Most subjects aged 6-9 years (83%). Boys out numbered girls. Emotional and behavior problems detected by CBCL and PSC-17 were identified in 28% and 22% subjects, respectively. The most common problem was internalization (withdrawal, somatic complaints, anxiety/depression). The PSC-17 had sensitivity and specificity of 69.2% and 95.6% respectively. Positive and negative predictive values were 85.7% and 89%, whereas positive and negative likelihood ratios were 15.7 and 0.32.Conclusions The prevalence of emotional and behavior problems detected using CBCL and PSC-17 in obese children was 28% and 22%, respectively. The PSC-17 has moderate sensitivity to screen emotional and behavior problem in obese children.[Paediatr Indones. 2010;50:42-8].

Association between obesity and behavioral/emotional disorders in primary school-aged children: a cross-sectional study

“…This was lower compared to other studies in Indonesia, which showed positive prevalence of 22-29%. 5,8 This difference was predicted to be caused by different sample sizes and data retrieval method. The PSC-17 data collection in one study was done using verbal interviews to parents instead of self-filled.…”

“…Furthermore, attention sub-scale covers attention deficit-hyperactivity disorder, which is screened by following symptoms: "fidgety, unable to sit still", "daydreams too much", "has trouble concentrating", "acts as if driven by a motor", and "distracted easily". 5 Parents rated each item based on the frequency of "never", "sometimes", or "often". Their responses were then scored as 0, 1, or 2, respectively.…”

“…We used the cut off score ≥5 for internalization sub-scale, ≥7 for externalization sub-scale, ≥7 for attention sub-scale, and ≥15 for total score. 5 Gardner et al 7 instructed to give the number 0 on items that were not answered, and the questionnaire was still considered valid if there was maximal one unanswered item for each subscale. This policy was applied in this study.…”

“…Obesity in children is associated with mental illnesses such as: depression, anxiety, low selfesteem, eating disorders (bulimia), hyperkinetic disorders, and increased aggressiveness. 3,4 In Jakarta, Harahap et al 5 found that there were 22% obese children with emotional and behavioral problems. This study was conducted using the 17-item Pediatric Symptom Checklist (PSC-17), which was as good as the gold standard method to screen emotional and behavioral problems in children.…”

“…This was the first study to evaluate emotional and behavioral problems in Indonesian children, in which the association between obesity and emotional/behavioral problems was still not well acknowledged. 5 Therefore, the purpose of this study is to further find the association between obesity and behavioral/emotional disorders in Indonesian children.…”