JAACAP open · 2026
Examining the Child Behavior Checklist (CBCL) Utility in a Native American Population.
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Cho Yoon Jae, Leventhal Bennett L, Rennie Brandon J, Geib Ellen F, Krapf Heather D, Nozadi Sara S, Leckie Amber L, Ankenman Katy, Salzman Emma, Ence Whitney, Burnette Courtney, MacKenzie Debra A, Lewis Johnnye, Bishop Somer, Navajo Birth Cohort Study Team, Kim Young Shin
Аннотация
OBJECTIVE: To examine Child Behavior Checklist for Ages 1.5-5 (CBCL) validity for externalizing, internalizing, and total problems T scores when screening for clinically significant behavioral problems in a Navajo (Diné) sample that was not included in CBCL norming.
METHOD: Mothers were recruited during pregnancy through the Navajo Birth Cohort Study/Environmental influences on Child Health Outcomes (NBCS/ECHO). Families completed in-person clinical assessments when children were 42 to 72 months old. Caregivers completed the CBCL and provided histories. Best estimate clinical diagnoses were established by experienced clinician-researchers using records along with comprehensive neuropsychological, psychiatric, and physical examinations.
RESULTS: The CBCL was completed by caregivers for 192 children (98 boys [51.0%]; mean [SD] age 4.0 [0.61] years, range 3-6 years). Of children, 125 (65.1%) received at least 1 diagnosis, with language disorder being the most common followed by speech sound disorder. Every group with a DSM-5 diagnosis had T scores within the normal range when they were derived according to the CBCL manual. T scores obtained by normalization within the study population yielded higher scores for the diagnosed group; however, area under the curve values still ranged from 0.6 to 0.7, displaying poor CBCL discriminative power. Externalizing problems T scores for children with any DSM-5 diagnosis were most discriminative (area under the curve = 0.70).
CONCLUSION: The CBCL was an ineffective single screening tool in the Diné population compared with in-person clinician evaluations, possibly because the Diné were not included in CBCL validation or cross-cultural adaptations. These findings may be relevant to other minority populations not included in CBCL norming.
METHOD: Mothers were recruited during pregnancy through the Navajo Birth Cohort Study/Environmental influences on Child Health Outcomes (NBCS/ECHO). Families completed in-person clinical assessments when children were 42 to 72 months old. Caregivers completed the CBCL and provided histories. Best estimate clinical diagnoses were established by experienced clinician-researchers using records along with comprehensive neuropsychological, psychiatric, and physical examinations.
RESULTS: The CBCL was completed by caregivers for 192 children (98 boys [51.0%]; mean [SD] age 4.0 [0.61] years, range 3-6 years). Of children, 125 (65.1%) received at least 1 diagnosis, with language disorder being the most common followed by speech sound disorder. Every group with a DSM-5 diagnosis had T scores within the normal range when they were derived according to the CBCL manual. T scores obtained by normalization within the study population yielded higher scores for the diagnosed group; however, area under the curve values still ranged from 0.6 to 0.7, displaying poor CBCL discriminative power. Externalizing problems T scores for children with any DSM-5 diagnosis were most discriminative (area under the curve = 0.70).
CONCLUSION: The CBCL was an ineffective single screening tool in the Diné population compared with in-person clinician evaluations, possibly because the Diné were not included in CBCL validation or cross-cultural adaptations. These findings may be relevant to other minority populations not included in CBCL norming.