Individuals with autism spectrum disorders (ASD) present with relatively high rates of co-occurring emotional (internalizing) and behavioral (externalizing) disorders (EBDs; e.g., see Brereton, Tonge, & Einfeld, 2006
; Gadow, DeVincent, Pomeroy, & Azizian, 2004
; Klinger, Dawson, & Renner, 2003
; Lainhart, 1999
). It is often difficult to distinguish co-occurring EBDs requiring specific treatment from behaviors reflecting the core diagnostic and associated features of ASD. Failure to accurately identify EBDs forestalls intervention, which may result in greater functional impairment and personal distress for the affected child and family, and may moderate response to interventions that target ASD symptoms (e.g., social communication). No EBD measures have been developed specifically for preschoolers with ASD to assist in diagnostic decision making. In addition, the psychometric properties of existing measures designed for use with the general population have not been studied in ASD samples (Leyfer, Folstein, Bacalman, et al., 2006
; Ozonoff, Goodlin-Jones, and Solomon, 2005
The Child Behavior Checklist 1.5-5 (CBCL; Achenbach & Rescorla, 2000
) is a widely used norm-referenced measure that assesses for a wide range of EBDs in children aged 1.5 to 5 years. The CBCL’s empirically-derived scales were developed through factor analysis of data from the general pediatric population. However, it is not clear if the CBCL factor model, which represents its scoring structure, is valid for the ASD population. This study evaluated the CBCL factor model using archival data
from a well characterized sample of preschool children with ASD. Results inform practitioners about the validity of the instrument’s scoring structure when assessing for EBDs in this population.
Despite its widespread use, we identified only one study that investigated the CBCL in a sample of children with developmental disabilities. Sikora, Hall, Hartley, Gerrard-Morris, and Cagle (2008)
found that the sensitivity of the CBCL’s Withdrawn
and Pervasive Developmental Problems
scales was superior to that of the Gilliam Autism Rating Scale (Gilliam, 1995
) when attempting to identify children with autism. Overall sensitivities were 64.6% for the Withdrawn
scale, 79.8% for the Pervasive Developmental Problems
scale, and 53.2% for the GARS Autism Quotient
. The CBCL scales demonstrated higher sensitivity across gender and levels of cognitive functioning; however, all scales evidenced low specificity. The study represents an initial assessment of the CBCL’s effectiveness in screening for the presence of ASD.
The developmental characteristics of children with ASD justify the need to investigate the validity of the CBCL factor model for this group. Their core impairments in social interaction, communication, and behavior, as well as (for most) cognitive delays affect both the qualitative and quantitative dimensions of their emotional and behavioral presentation. For example, many demonstrate inappropriate and/or restricted range of affect, atypical expression of emotions, and difficulty communicating needs or reporting subjective states. Thus, many children with ASD may evidence different phenotypic expressions of disorders identified in the general pediatric population (Matson & Nebel-Schwalm, 2007
). When these children are assessed with the CBCL, patterns of covariation among the items may differ from the patterns observed in the test development sample. It is therefore possible that the CBCL factor model might not adequately account for the patterns of covariation evidenced by children with ASD.
In this study, confirmatory factor analysis tested the adequacy of the CBCL factor model in a sample of preschool children with ASD. The CBCL factor model represents the instrument’s scoring structure which is widely used in clinical practice. A confirmatory procedure, as opposed to an exploratory factor analysis, was used to directly evaluate whether the empirically-derived factor model is valid for this group of children. Results have direct implications for the relevance of the CBCL in diagnostic decision-making.