J Psychopathol Behav Assess (2009) 31:178–189
DOI 10.1007/s10862-008-9119-8
A Psychometric Analysis of the Child Behavior
Checklist DSM-Oriented Scales
Brad J. Nakamura & Chad Ebesutani & Adam Bernstein &
Bruce F. Chorpita
Published online: 9 December 2008
# Springer Science + Business Media, LLC 2008
Abstract The Child Behavior Checklist for Ages 6–18
(CBCL/6-18) possesses newly developed DSM-Oriented
Scales, constructed through expert clinical judgment to
match selected categories for behavioral/emotional prob-
lems as described in the DSM-IV. The present investigation
examined the basic psychometric properties for all six
DSM-Oriented Scales (i.e., Affective, Anxiety, Somatic,
Attention-Deficit/Hyperactivity, Oppositional, and Conduct
Scales) in a large clinical sample of children and adoles-
cents (N=673). Findings from the present study provide
strong evidence for the reliability, as well as convergent and
discriminative validity, of these scales. It appears that the
DSM-Oriented Scales may provide accurate supplementary
information that may be considered when formulating
clinical diagnoses.
Keywords Child behavior checklist . Diagnostic
and statistical manual . Psychometrics . Test validity .
Test reliability
The large research literature on psychological measurement
highlights the value of including multiple informants,
particularly parents, in youth assessment (Barbosa et al.
B. J. Nakamura (*)
Department of Psychology, University of Hawai‘i at Mānoa,
2430 Campus Road,
Honolulu, HI 96822, USA
e-mail: bradn@hawaii.edu
C. Ebesutani : A. Bernstein : B. F. Chorpita
University of California,
Los Angeles, CA, USA
2002; Jensen et al. 1999; Manassis et al. 1997). The Child
Behavior Checklist (CBCL; Achenbach 1991; Achenbach
and Rescorla 2001), the parent version of the Youth Self
Report (YSR; Achenbach 1991; Achenbach and Rescorla
2001), is among the most widely used parent-report
measures of youth symptoms, assessing a wide range of
problems. Beginning with its first edition (Achenbach and
Edelbrock 1983), the CBCL has provided empirically
derived Syndrome and Competence and Adaptive Scales,
as well as Internalizing, Externalizing, and Total Scales.
The extensive data behind the CBCL’s standardized scores
and clinical cutoffs have allowed for its use in a wide
variety of settings and have aided in current understandings
of youth psychopathology (e.g., Goodman and Scott 1999).
Within clinical settings, the CBCL has demonstrated
remarkable utility, particularly with respect to being able to
distinguish between referred and nonreferred populations
(Achenbach 1991; Chen et al. 1994; Drotar et al. 1995). For
example, a recent meta-analytic study found that scores
from the CBCL Internalizing Scale could discriminate
between youths with and without an anxiety disorder, as
well as youths with anxiety disorders and youths with
externalizing disorders (Seligman et al. 2004). Concerning
the more domain-specific CBCL Syndrome Scales, research
suggests significant and often clinically useful associations
with both broad-based (e.g., anxiety and affective disorders
groups) and specific (e.g., Attention Deficit Disorder and
Conduct Disorder) diagnostic groups (Edelbrock and
Costello 1988; Kasius et al. 1997; Kazdin and Heidish
1984; Eiraldi et al. 2000).
Although the CBCL Syndrome Scales have evidenced
several strengths, their empirical derivation via factor
analytic methods has yielded a long-recognized discordance
with nosology from the Diagnostic and Statistical Manual
of Mental Disorders (e.g., American Psychiatric Associa-
J Psychopathol Behav Assess (2009) 31:178–189
tion 2000).1 This discordance has been supported by
several studies that suggest that the CBCL Syndrome
Scales yield only modest associations with DSM-IV
disorders, have limited positive predictive values, and
seemingly do not map well onto specific diagnoses
(Brunshaw and Szatmari 1988; Jensen et al. 1993; Kasius
et al. 1997). This lack of concordance may be of concern
given that the DSM-IV classification system forms the basis
for most psychopathology research and treatment protocols,
and that mental health services reimbursement eligibility in
America is largely tied to DSM-IV diagnoses (Achenbach
and Dumenci 2001; Doucette 2002).
In an effort to provide closer linkage with prevailing
DSM nosology, Achenbach et al. (2003) developed the
CBCL DSM-Oriented Scales to supplement the CBCL
Syndrome Scales. Whereas the Syndrome Scales were
derived empirically via factor analytic methods, DSM-
Oriented Scales were constructed through agreement in
experts’ ratings of the preexisting items’ consistency with
DSM-IV diagnostic criteria. Due to their recent construc-
tion, research on the CBCL DSM-Oriented scales is
limited. Among the investigations conducted to date,
Achenbach et al. (2003) reported that the psychometric
properties of the DSM-Oriented Scales were generally
similar to those of the Syndrome Scales when comparing
among the same large national sample of referred and non-
referred children. For instance, internal consistency and
test-retest reliability for these scales were found to be good,
with Cronbach Alphas ranging from .75 to .84 and test-
retest coefficients ranging from .78 to .88.
Other research, however, has provided mixed results,
warranting further investigations. For instance, van Lang et
al. (2005) examined the CBCL’s child-report counterpart,
the YSR, and found that a measure of Major Depressive
Disorder (MDD) corresponded more closely with the YSR
DSM-Oriented Affective Problems Scale than with either
the YSR Anxious/Depressed or Withdrawn/Depressed
Syndrome Scale. However, these investigators also found
that measures of Generalized Anxiety Disorder (GAD) and
Separation Anxiety Disorder (SAD) corresponded more
closely with the YSR Anxious/Depressed Syndrome Scale
than with the YSR DSM-Oriented Anxiety Problems Scale.
Vreugdenhil et al. (2006) also found low concordance
between the YSR DSM-Oriented scales and DSM-IV
DISC-C diagnoses among incarcerated adolescents. Kendall
et al.( 2007) also argued that the CBCL DSM-Oriented
Anxiety Scale could be improved upon due to some
problematic features (e.g., only six items collectively
1
It is important to note that no “gold standard” exists for determining
diagnoses. Moreover, the question of whether the described disorders
are in fact categorical (as in the DSM) or dimensional (as measured by
CBCL scale scores) is one of active debate (e.g., Haslam, 2003).
179
represent GAD, SAD and Simple Phobia and an absence
of somatic-related items). Accordingly, Kendall et al. (2007)
constructed a modified CBCL-based DSM-Oriented Anxiety
scale with 10 additional items. These authors found that the
modifications led to an increased ability for mothers’ reports
(but not fathers’ reports) to predict anxiety disorder status
among adolescent youths when compared with the CBCL’s
official DSM-Oriented Anxiety Scale, the Internalizing Total
Scale, and the Anxious/Depressed Syndrome Scale.
In summary, although the CBCL DSM-Oriented Scales
have been criticized for not mapping strongly to certain
DSM diagnoses, these scales have nonetheless received
some support in initial investigations (e.g., Achenbach et al.
2003). Additionally, their congruence with DSM nosology
offers the potential for specific categorical applications that
may not be possible with the Syndrome scales. However, the
strengths and weaknesses of their psychometric properties
are not yet well substantiated in large clinical samples. It is
thus useful to further investigate all CBCL DSM-Oriented
Scales for future clinical applications.
The present study evaluated numerous psychometric
properties of all six DSM-Oriented Scales in a large, clinic-
referred sample of youth. Four hypotheses were examined.
First, it was predicted that each DSM-Oriented Scale would
evidence an acceptable level of reliability as demonstrated
through internal consistency analyses. Second, concerning
convergent validity, each DSM-Oriented Scale was
expected to demonstrate convergence (i.e., significant
positive correlations) with all available construct-consistent
instrument scales. Third, with respect to divergent validity,
each DSM-Oriented Scale was expected to demonstrate
divergence (i.e., lack of a significant correlation) with
construct-inconsistent instrument scales. Fourth, concerning
the DSM-Oriented Scales’ discriminative properties, it was
predicted that these scale scores would significantly
discriminate between youths with and without the mental
health diagnosis relevant to each DSM-Oriented Scale.
Method
Participants
The present investigation was conducted across a clinical
sample of youths, whose caregivers completed either the
CBCL/4-18 or CBCL/6-18. Participants were selected on
the basis of the availability of completed CBCL/4-18 (n=
555) and CBCL/6-18 (n=118) data from 813 consecutive
referrals made to the Center for Cognitive Behavioral
Therapy (CCBT), at the University of Hawai‘i at Mānoa,
for a mental health assessment. The CCBT utilized the
CBCL/4-18 for all intake assessments up until approxi-
mately May 2003 and switched to the use of the CBCL/6-
180 J Psychopathol Behav Assess (2009) 31:178–189

18 shortly thereafter. This form changeover occurred after
the authors became aware of the new CBCL/6-18 form.
Participants were excluded from analyses if they were
missing more than (a) eight items on their entire CBCL, (b)
two items from their DSM-Oriented Attention-Deficit/
Hyperactivity Problems Scale (CBCL/4-18 youths would
have at least two of their five items missing due to version
differences explained below) or (c) 20% of their item-
responses necessary for calculating any other DSM-Oriented
scale. These rationally-derived rules for listwise deletion
allowed for maximum use of available data without
excessive reliance on mean-substitution procedures (see
Procedure below) and are more stringent than missing
item-level data rules in previous CBCL studies (cf. Galera
et al. 2005). The mean age of the final combined sample (N=
673) of youths was 12.3 years (SD=3.2; range=4.2 to 19.7),
and the group consisted of 454 boys (67.5%) and 216 girls
(32.1%; gender data were missing for three participants).
A wide range of ethnicities and DSM-IV (1994)
diagnoses were represented in the present sample (see
Table 1). Notably, 120 participants did not receive a
diagnosis. However, the absence of a diagnosis does not
indicate that these youths did not have mental health
concerns or that meaningful recommendations were not
provided following the assessment. Additionally, while the
sample includes more youths with principal diagnoses of an
externalizing (e.g., Disruptive Behavior and Attention/
Hyperactivity) than internalizing (e.g., Anxiety and De-
pression) nature, the proportion of internalizing-type diag-
noses exceeds that typically found in youth disorder
prevalence studies (e.g., Garland et al. 2001). Many of the
assessment instruments utilized in the study (see Measures
below) thus examine internalizing symptoms.
Numerous analytic strategies were applied to investigate
whether there were significant differences between CBCL/
4-18 and CBCL/6-18 youths. One, eight, and seven
separate chi-square tests, respectively, examined the rela-
tionships between CBCL version (CBCL/4-18 and CBCL/
6-18) and (a) gender, (b) principal diagnosis, and (c) parent-
reported child ethnicity (based on major categories in
Table 1). Additionally, a one-way ANOVA was conducted
to determine if there were significant age differences
between CBCL/4-18 and CBCL/6-18 participants. All
analyses were performed using a 99.7% confidence interval
(alpha of .003 after a Bonferroni correction for the 17 tests
above performed using a 95% confidence interval). Only
one of these 17 tests emerged significant. Concerning
principal diagnosis, a one-sample chi-square test for

Table 1 Demographic
information for all study CBCL/4-18 CBCL/6-18 Combined
participants n=555 n=118 N=673

Age:
Minimum 4.2 5.8 4.2
Maximum 19.7 18.0 19.7
Mean (SD) 12.3 (3.1) 12.6 (3.5) 12.3 (3.2)
Gender
Boy 375 79 454
Girl 179 37 216
Missing 1 2 3
Ethnicity
Multiethnic 276 46 322
Asian 85 12 97
White 85 10 95
Pacific Islander 37 7 44
African American 9 2 11
Latino / Hispanic 7 1 8
Native American 0 0 0
Other 45 2 47
Missing 11 38 49
Principal diagnoses
Disruptive behavior 152 50 202
Attention/hyperactivity 124 16 140
Anxiety 112 18 130
Depressive 25 4 29
Adjustment 20 4 24
Youths with co-principal Substance 7 3 10
diagnoses are included in totals Other 56 9 65
for each of their principal None 98 22 120
diagnoses
J Psychopathol Behav Assess (2009) 31:178–189
assessing the relationship between CBCL version (CBCL/
4-18 versus CBCL/6-18) and whether or not a youth had a
“Disruptive Behavior Diagnoses” was found significant, χ2
(1, N=673)=10.4 p=.001, suggesting a greater proportion
of “Disruptive Behavior Diagnoses” associated with the
CBCL/6-18. All other tests were non-significant, suggest-
ing no other systematic differences between the study’s two
sub-samples.
Primary caregivers consisted of 525 biological mothers
(78.0%), 70 biological fathers (10.4%), 24 grandmothers
(3.6%), 17 other caregivers (2.5%), 16 foster mothers
(2.4%), 12 stepfathers (1.8%), 7 grandfathers (1.0%), and
2 stepmothers (0.3%). Marital status among primary care-
givers was 306 married (45.5%), 191 divorced or separated
(28.4%), 104 single (15.5%), and 19 widowed (2.8%)
(marital status data were missing for 53 caregivers).
Measures
Anxiety Disorders Interview Schedule for DSM-IV, Child
and Parent Versions (ADIS-IV-C/P; Silverman and Albano
1996) The ADIS-IV-C/P is a semi-structured clinical
interview for parents and children ages 7 to 17 that is
specifically designed for DSM-IV diagnoses of childhood
anxiety, mood, and behavioral disorders. Assessment
involves two interviews, one with the caregiver(s) and one
with the child. The ADIS-IV-C/P is a revision of the
Anxiety Disorders Interview Schedule for Children (Silverman
1991), which has demonstrated satisfactory reliability across a
range of ages and other parameters (Silverman and Eisen
1992). In the present study, interviews were conducted by Ph.
D.-level clinical child psychologists and senior doctoral
students in clinical psychology who had been trained to
reliability using the ADIS-IV-C/P. Training first involved
observation of three interviews conducted by trained inter-
viewers. The trainee then conducted a series of five inter-
views while being observed by a criterion-trained interviewer.
An interviewer is considered trained after he/she matches the
experienced interviewer on all clinical diagnoses in three of
the five interviews. In a subset of 16 randomly selected
families in this sample, interrater agreement for principal
diagnoses between trainees who administered the ADIS-IV-
C/P and trainers who observed the administration was found
to be excellent (kappa=.77).
Affect and Arousal Scale (AFARS; Chorpita et al. 2000a;
Daleiden et al. 2000) The AFARS is a 27-item self-report
questionnaire designed to measure (Cronbach’s alpha
coefficients for present sample): positive affect (PA; .83),
negative affect (NA; .81), and physiological hyperarousal
(PH; .86) in children and adolescents. The AFARS requires
respondents to rate how true each item is with respect to
their usual feelings. Items are scored on a 4-point scale
181
ranging from 0 (never true) to 3 (always true). Internal
consistency and favorable validity have been demonstrated
for the AFARS’ three scales (Chorpita et al. 2000a;
Daleiden et al. 2000).
Child Behavior Checklist for Ages 6–18 (CBCL/6-18;
Achenbach and Rescorla 2001) The 113 items on this
measure are rated as Not True (0), Somewhat or Sometimes
True (1), or Very True or Often True (2). Validity and
reliability are excellent, and extensive normative data are
available for children ranging from 6 to 18. The CBCL/6-
18 is a slightly modified revision of the Child Behavior
Checklist for Ages 4–18 (CBCL/4-18; Achenbach 1991).
Changes from the CBCL/4-18 to the CBCL/6-18 include
new age norms, the replacement of ineffective items (i.e.,
items 2, 4, 5, 28, 78, 99), and the creation of six DSM-
Oriented Scales. The six DSM-Oriented Scales include: (a)
Affective Problems (Dysthymic and Major Depressive
Disorders), (b) Anxiety Problems [Generalized Anxiety
Disorder (GAD), Separation Anxiety Disorder (SAD), and
Specific Phobia (SPEC)], (c) Attention/Deficit/Hyperactivity
Problems (Hyperactive-Impulsive and Inattentive subtypes),
(d) Conduct Problems [Conduct Disorder (CD)], (e) Oppo-
sitional Defiant Problems [Oppositional Defiant Disorder
(ODD)], and (f) Somatic Problems (Somatization and
Somatoform Disorders).
Children’s Depression Inventory (CDI; Kovacs 1981) The
CDI is a 27-item self-report measure designed to assess
cognitive, behavioral, and affective symptoms of depres-
sion. Each item is scored from 0 to 2, and the sum of all
item scores yields the total CDI score, which ranges from 0
to 54, with higher scores indicating more depressive
symptoms. The CDI has extensive support for its reliability
and validity (e.g., Saylor et al. 1984).
Dimensional Ratings (Chorpita et al. 2000b) Dimensional
Ratings, also known as Clinical Severity Ratings, are
clinician-reported ratings based on the interference rating
scale (i.e., a functional impairment rating scale) developed
previously for the ADIS-C/P (Silverman and Nelles 1988).
Dimensional Ratings range from 0 to 8 and are provided for
each ADIS-IV-C/P diagnostic area on the basis of informa-
tion obtained during each the child and parent interview.
Larger numbers reflect greater stress and impairment, but
not necessarily the presence or absence of a diagnosis (e.g.,
it is possible to get a high Conduct Disorder dimensional
rating without receiving this diagnosis because other
diagnostic symptom criteria were not met). The presence
of a diagnosis, however, meant that the associated Dimen-
sional Rating was at least a “4,” indicating clinically
significant impairment in that area. Each child in the
present investigation was assigned two different ratings
182
for each diagnostic area, one based on the child report
alone, and one based on the parent report alone. Dimen-
sional ratings have been found to demonstrate good to
excellent interrater reliability and convergent validity (Gray
et al. 2001). The dimensional ratings relevant to the current
study included: (a) Child and Parent (Mean) Anxiety,
comprised of constituent Separation Anxiety, Social Anx-
iety, Specific Phobia, Generalized Anxiety, Panic, Agora-
phobia, Obsessions/Compulsions, and Posttraumatic Stress
ratings, (b) Parent Oppositional, and (c) Parent Conduct
dimensional ratings.
Revised Child Anxiety and Depression Scales (RCADS;
Chorpita et al. 2000c) The RCADS is a 47-item revision of
the Spence Children’s Anxiety Scale (SCAS; Spence 1998).
Children rate the extent to which each item is true of them
on a 0 to 3 scale, corresponding to the anchors of “never,”
“sometimes,” “often,” and “always.” Factor analytic inves-
tigations suggest the following six subscales (Cronbach’s
alpha coefficients for present sample): Separation Anxiety
Disorder (SAD; .80), Social Phobia (SOC; .85), General-
ized Anxiety Disorder (GAD; .83), Obsessive-Compulsive
Disorder (OCD; .81), Panic Disorder (PD; .85), and Major
Depressive Disorder (MDD; .84). These subscales have
demonstrated good factorial validity, internal consistency,
one-week test-retest reliability, and convergent and discrim-
inant validity (Chorpita, et al. 2000c).
Revised Children’s Manifest Anxiety Scale (RCMAS; Reynolds
and Richmond 1978) The RCMAS is as 37-item self-report
measure designed to assess the presence of cognitive,
behavioral, or affective symptoms of anxiety and negative
affect. Of the 37 items in total, 28 dichotomous (i.e., yes/
no) items are summed to yield an Anxiety Scale score,
ranging from 0 to 28, with higher scores representing
greater anxiety. The other 9 items are summed to assess
social desirability (i.e., “Lie scale”). Its constituent scales
include (Cronbach’s alpha coefficients for present sample):
Anxiety (.90), Worry/Oversensitivity (.86), Physiological
(.69), Social Concerns/Concentration (.72), and Lie (.75)
components. This instrument has been one of the most
widely used instruments for assessing childhood anxiety,
and has been demonstrated to be reliable across different
gender, racial, and age groups in children from age 7 to 17
(Reynolds and Paget 1983).
Procedure
All participants and their legal guardian(s) underwent
standardized Institutional Review Board-approved notice
of privacy and consent procedures prior to any data
collection. All data were gathered and entered into a central
J Psychopathol Behav Assess (2009) 31:178–189
database through the established operating procedures of
the CCBT clinic, and subsequently extracted electronically
from the system for analyses.
Item-level changes between the CBCL/4-18 and CBCL
6-18 did not affect score-calculations for the DSM-Oriented
Anxiety Problems Scale (items 11, 29, 30, 45, 50, 112),
Somatic Problems Scale (items 56a, 56b, 56c, 56d, 56e,
56f, 56g), or Oppositional Problems Scale (items 3, 22, 23,
86, 95) because the items comprising these scales were
identical across CBCL forms. Item-level changes did,
however, affect (a) one item (item 5) on the DSM-Oriented
Affective Problems Scale (items 5, 14, 18, 24, 35, 52, 54,
76, 77, 91, 100, 102, 103), (b) two items (items 4, 78) on
the DSM-Oriented Attention-Deficit/Hyperactivity Prob-
lems Scale (items 4, 8, 10, 41, 78, 93, 104), and (c) one
item (item 28) on the DSM-Oriented Conduct Problems
Scale (items 15, 16, 21, 26, 28, 37, 39, 43, 57, 67, 72, 81,
82, 90, 97, 101, 106). Achenbach’s ASEBA (2001) manual
recommends using raw scores when conducting analyses on
the narrow-band Syndrome scales in order to account for
the full range of variation in these scales. Consistent with
this recommendation, all analyses in the present investiga-
tion were conducted on DSM-Oriented raw scale scores.
DSM-Oriented Scale scores unaffected by item-level
changes (Anxiety, Somatic, and Oppositional) between the
CBCL/4-18 and CBCL/6-18 versions were calculated by
summing all relevant items within the scale. Consistent
with Achenbach’s (2001) recommendations, DSM-Oriented
Scale scores affected by version differences (Affective,
Attention-Deficit/Hyperactivity, and Conduct) were calcu-
lated by treating changed problem items as missing.
Specifically, these scale scores were calculated by summing
the remaining items and multiplying that score by the total
number of items divided by the total number of items minus
the number of missing items. Following listwise deletion
logic above (see "Participants"), scale scores for other
measures were excluded from analyses in a pairwise
fashion if more than 20% of the item-responses comprising
the scale were missing, with missing items handled with the
same procedure described immediately above.
Analytic Strategy
To test the first hypothesis, Cronbach’s alpha coefficients
were calculated for each DSM-Oriented Scale. Hypothesis
two was evaluated by calculating zero-order bivariate
correlations between each DSM-Oriented Scale and several
construct-consistent instruments scales. See bolded text in
Tables 3 and 4 for all a priori hypothesized DSM-Oriented
Scale by measure convergent (i.e., significant and positive)
correlations. Towards the goal of evaluating divergent
validity, the third hypothesis involved calculating zero-
order bivariate correlations between each scale and several
J Psychopathol Behav Assess (2009) 31:178–189 183

construct-inconsistent instrument scales. See italicized text
in Tables 3 and 4 for all a priori hypothesized DSM-
Oriented Scale by measure divergent (i.e., non-significant)
correlations (cf. Chorpita et al. 2005). Note that Child
Oppositional and Delinquent Dimensional Ratings are not
obtained during ADIS-IV-C/P administration and, there-
fore, were not available for analysis. When a significant and
positive relationship unexpectedly did emerge, Fisher’s z-
tests (Meng et al. 1992) were calculated to determine if the
DSM-Oriented Scale under examination was correlated
significantly more with construct-consistent validity indices
than with the construct-inconsistent scale.
In order to evaluate each scales’ discriminative proper-
ties, the fourth hypothesis involved performing one-way
ANOVAs to evaluate the relationship between the presence
or absence of various DSM-IV (1994) diagnoses (anywhere
in a child’s diagnostic profile; e.g., primary, secondary, or
tertiary, etc.) and relevant DSM-Oriented Scale scores.
Capitalizing on the diagnostic breadth afforded by this
sample, the over-arching strategy within each DSM-
Oriented Scale by diagnosis analysis first involved using
an ANOVA to detect significant differences between three
groups of children: (a) youths with a specific disorder under
examination, (b) youths with a disorder from the same
diagnostic category as the specific disorder under exami-
nation, but without that specific disorder under examina-
tion, and (c) youths that did not have the specific disorder
under examination or any disorder in that same diagnostic
category. For example, concerning the DSM-Oriented
Affective Problems Scale, it was hypothesized that an
ANOVA would detect differences between (a) youths with
Dysthymic Disorder (DD), (b) youths without DD but with
another type depressive disorder [i.e., any type of Major
Depressive Disorder (MDD) or Depressive Disorder Not
Otherwise Specified], and (c) and youths with no depres-
sive disorder. See Table 5 for all a priori hypothesized
DSM-Oriented Scale by disorder analyses.
The strength of the initial ANOVA was assessed by η2,
with .01, .06, and .14 and interpreted as small, medium, and
large effect sizes, respectively (Green and Salkind 2005). In
performing follow-up tests to evaluate pairwise mean
differences among the three types of groups above, Tukey’s
HSD tests were used when Levene’s test of equality of error
variances was found non-significant. If equal variances
could not be assumed, Dunnett’s C test was utilized for post
hoc comparisons. Given the preliminary nature of the
literature on the DSM-Oriented Scales’ diagnostic discrim-
inative properties, youths with the specific disorder under
examination were hypothesized to score higher than youths
with no related diagnosis, but not necessarily higher than
youths with a disorder from the same category. In order to
control the experiment-wise error rate, all analyses were
performed using a moderately conservative 99% confidence
interval (alpha level of .01).
Results
Reliability
Cronbach’s alpha coefficients are presented in Table 2. All
reliability coefficients were favorable, ranging from .71
(Somatic Problems items) to .89 (Conduct Problems items)
in the present sample.
Convergent Validity
As predicted, the DSM-Oriented Affective Problems Scale
correlated significantly and positively with all convergent
validity criterion measures (see Table 3 for these results).
The DSM-Oriented Anxiety Problems Scale also correlated
significantly and positively with all but one (i.e., RCMAS
Total Anxiety Scale) of its convergent validity criterion
measures. The DSM-Oriented Somatic Problems Scale
correlated significantly and positively with the AFARS-
PH Scale, but did not significantly correlate with the
RCMAS Physiological Scale. Correlations of the CBCL
DSM-Oriented Attention-Deficit/Hyperactivity, Opposi-
tional, and Conduct Problems scales with convergent
validity criterion measures are displayed in Table 4. As

Table 2 Alpha coefficients for CBCL/4-18 and CBCL/6-18 DSM-oriented scale scores

CBCL/4-18 sample CBCL 6-18 sample Combined sample

Scale Number of items n Alpha n Alpha n Alpha

Conduct problemsa 17 – – 109 .89 – –

ADHD problemsa 7 – – 116 .85 – –
Oppositional problems 5 542 .79 116 .86 658 .81
Affective problemsa 13 – – 110 .81 – –
Anxiety problems 6 533 .77 116 .79 649 .77
Somatic problems 7 537 .77 115 .71 652 .76
a
As these scales contained new items on the CBCL/6-18, alpha coefficients for these scales could not be computed for those youths with a CBCL/4-18
184 J Psychopathol Behav Assess (2009) 31:178–189

Table 3 Correlation matrix for child behavior checklist DSM-oriented scales and selected internalizing measures

DSM-oriented scales

Affect Anxiety Somatic ADHD ODD CD

Depression measures
Parent depression dimensional rating (n=542) .54** .30** .28** .02 .17** .19**
Child depression dimensional rating (n=525) .41** .17** .20** −.01 .07 .10
RCADS, depression scale (n=619) .33** .16** .25** .07 .09 −.01
Children’s depression inventory, total scale (n=423) .34** .09 .17** .07 .12* .11
Anxiety measures
Parent anxiety (mean) dimensional rating (n=536) .42** .59** .32** .05 .13* .23*
Child anxiety (mean) dimensional rating (n=518) .26** .27** .23** −.01 −.07 −.02
RCADS, total anxiety scale (n = 610) .20** .18** .22** .10 .01 −.05
RCMAS, total Scale (n = 167) .16 .05 .16 −.08 −.08 −.16
Arousal measures
AFARS, physiological hyperarousal scale (n=578) .15** .09 .15** .11* .12* .06
RCMAS, physiological scale (n = 167) .17 .05 .16 .03 .03 −.08

Bold print highlights convergent indices. Italicized print highlights divergent indices
AFARS = Affect and Arousal Scale for Children, RCADS = Revised Children’s Anxiety and Depression Scales, RCMAS = Revised Children’s
Manifest Anxiety Scale
*p<0.01; **p<0.001

predicted, all three of these DSM-Oriented Scales signifi-
cantly and positively correlated with their respective
convergent validity criterion measures.
Divergent Validity
DSM-Oriented Affective, Anxiety, and Somatic Problems
scales Contrary to expectation, the DSM-Oriented Affec-
tive Problems Scale correlated significantly and positively
with Parent Oppositional and Delinquent Dimensional
Ratings (see Table 4). For comparative purposes, two sets
of pairwise follow-up Fisher’s z-tests (Meng et al. 1992)
compared these two unexpected correlations against the
correlations between the DSM-Oriented Affective Problems
Scale and its four convergent validity indices (see bolded
text in Table 3). Concerning the first set of four pairwise
follow-up tests (i.e., the correlation between the DSM-
Oriented Affective Problems Scale and the Parent Opposi-
tional Dimensional Rating versus the correlation between
the DSM-Oriented Affective Problems Scale and (a) the
Parent Depression Dimensional Rating, (b) Child Depres-
sion Dimensional Rating, (c) RCADS MDD Scale, and (d)
CDI Total Scale), the DSM-Oriented Affective Problems
Scale was found to be significantly more correlated with the
Parent Depression Dimensional Rating than with the Parent
Oppositional Dimensional Rating, z(579)=4.88, p<.001.
No other correlations, however, were significantly different.
Regarding the second set of four pairwise follow-up tests
(i.e., the correlation between the DSM-Oriented Affective
Problems Scale and the Parent Delinquent Dimensional
Rating versus the correlation between the DSM-Oriented
Affective Problems Scale and the same four convergent
indices above), the DSM-Oriented Affective Problems Scale
was found to be significantly more correlated with (a) the
Parent Depression Dimensional Rating, z(540) = 7.49,
p<.001, (b) the Child Depression Dimensional Rating, z
(518)=4.64, p<.001, (c) the RCADS MDD Scale, z(508)=
3.11, p=.002, and (d) the CDI Total Scale, z(326)=3.19,
p=.001, than with the Parent Delinquent Dimensional
Rating. Both ANOVA analyses for DD, F(2, 670)=37.9,
p<.001, η2 =.10, and MDD, F(2, 670)=42.1, p<.001,
η2 =.11, were significant. Follow-up tests evaluating pairwise
differences supported the fourth hypothesis and pointed to
higher scores for youths with DD and MDD over youths
with no depressive disorders (see Table 5 for means, standard
deviations, and all pairwise comparison results).
Results concerning the DSM-Oriented Anxiety Problems
Scale were mostly supported (see Table 4). There were no
significant relationships between this scale and one of two
divergent validity criteria. Unexpectedly, this scale signif-
icantly and positively related to the Parent Oppositional
Dimensional Rating (see Table 4). Follow-up Fisher’s z-
tests (Meng et al. 1992) revealed that the DSM-Oriented
Anxiety Problems Scale was significantly more correlated
with only one of its four convergent indices (see bolded text
in Table 3). Specifically, the DSM-Oriented Anxiety
Problems Scale was significantly more correlated with the
Parent Anxiety (Mean) Dimensional Rating, z(536)=8.92,
p<.001, than with the Parent Oppositional Dimensional
Rating. Concerning the fourth hypothesis, all overall DSM-
Oriented Anxiety Scale ANOVAs were found significant:
(a) SAD, F(2, 670)=59.0, p<.001, η2 =.15, (b) Panic
Disorder (any type) or Agoraphobia without a History of
Panic (PDA), F(2, 670)=59.7, p<.001, η2 =.15, (c) SOC,
J Psychopathol Behav Assess (2009) 31:178–189
Table 4 Correlation matrix for child behavior checklist DSM-oriented scales and selected externalizing measures
DSM-oriented scales
Affect
Inattention/hyperactivity measures
Parent inattention dimensional rating (n=545) .12*
Child inattention dimensional rating (n=528) .09
Parent hyperactivity dimensional rating (n=545) .08
Child hyperactivity dimensional rating (n=529) .05
Disruptive behavior measures
Parent oppositional dimensional rating (n=547) .31**
Parent delinquent dimensional rating (n=544) .16**
Bold print highlights convergent indices. Italicized print highlights divergent indices
*p<0.01; **p<0.001
F(2, 670)=57.7, p<.001, η2 =.15, (d) SPEC, F(2, 670)=
59.3, p<.001, η2 =.15, (e) OCD, F(2, 670)=62.8, p<.001,
η2 =.16, (f) GAD, F(2, 670)=58.8, p<.001, η2 =.15, and (g)
Posttraumatic Stress Disorder (PTSD), F(2, 670=57.7,
p<.001, η2 =.15. As seen in Table 5, all subsequent
pairwise test results supported the fourth hypothesis and
indicated that youths with the specific disorder under
examination had significantly higher scores than youths
with no anxiety disorder.
Predictions on the divergent validity relationships be-
tween the DSM-Oriented Somatic Problems Scale were
uniformly supported (see Table 4). Regarding the fourth
hypothesis, all overall ANOVAs were significant: (a) MDD,
F(2, 670)=28.8 p<.001, η2 =.08, (b) PDA, F(2, 670)=28.1,
p<.001, η2 =.08, and (c) SAD, F(2, 670)=30.8, p<.001,
η2 =.08. Follow-up pairwise results partially supported
predictions (see Table 5) in that youths with MDD and
PDA scored higher than youths without other somatically
associated diagnoses. However, youths with SAD did not
score higher than youths without other somatically associ-
ated diagnoses.
DSM-Oriented Attention-Deficit/Hyperactivity, Oppositional,
and Conduct Problems scales As displayed in Table 3,
predictions for the DSM-Oriented Attention-Deficit/
Hyperactivity Problems Scale were supported, and this scale
did not correlate significantly with any anxiety or depression
scale scores. The overall ANOVA examining mean differ-
ences between youths with Attention-Deficit/Hyperactivity
Disorder, Combined Type (ADHD-C), Attention-Deficit/
Hyperactivity Disorder, Primarily Hyperactive/Impulsive
Type (ADHD-PH), Attention-Deficit/Hyperactivity Disorder,
Primarily Inattentive Type (ADHD-PI), and youths without
ADHD was found significant, F(3, 669)=35.5, p<.001,
η2 =.14. The fourth hypothesis was supported and youths
with any type of ADHD scored significantly higher on this
scale than youths without this disorder.
185
Anxiety Somatic ADHD ODD CD
.05 .04 .56** .34** .27**
.05 .02 .23** .13* .14**
.09 .03 .62** .38** .34**
.05 .00 .31** .20** .20**
.16** .08 .43** .67** .64**
−.03 −.09 .21** .37** .65**
Divergent validity correlation results for the DSM-
Oriented Oppositional Problems Scale are displayed in
Table 3. Predictions were somewhat supported and no
significant relationship emerged for five of eight examined
relationships. For the three unexpected findings, three sets
of follow-up Fisher’s z-tests (Meng et al. 1992) compared
the three unexpected correlations against the correlation
between the DSM-Oriented Oppositional Problems Scale
and its convergent validity index (i.e., the Parent Opposi-
tional Dimensional Rating). These follow-up analyses
revealed that the DSM-Oriented Oppositional Problems
Scale was significantly more correlated with the Parent
Oppositional Dimensional rating than with the (a) Parent
Depression Dimensional Rating, z(541)=10.7, p<.001, (b)
Parent Anxiety (Mean) Dimensional Rating, z(536)=11.6,
p<.001, and (c) CDI Total Scale score z(327)=9.11,
p<.001. One-way ANOVA results, F(2, 670)=87.2, p<
.001, η2 =.21, were consistent with the fourth hypothesis
and children with ODD also evidenced higher DSM-
Oriented Oppositional Problems Scale scores than youths
without a disruptive behavior disorder.
Divergent validity results for the DSM-Oriented Conduct
Problems scale almost mirrored those demonstrated by the
DSM-Oriented Oppositional Problems scale (see Table 3).
Specifically, the DSM-Oriented Conduct Problems scale
demonstrated no significant correlations for six of eight
examined pairwise relationships. However, follow-up hy-
potheses were again supported and Fisher’s z-tests (Meng et
al. 1992) revealed that this DSM-Oriented Scale was
significantly more correlated with the Parent Delinquent
Dimensional rating than with the (a) Parent Depression
Dimensional Rating, z(540)=9.74, p<.001 and (b) Parent
Anxiety (Mean) Dimensional Rating, z(535)=10.3, p<.001.
One-way ANOVA results were hypothesis-consistent,
F(2, 670)=172.7, p<.001, η2 =.34, and children with CD
evidenced higher DSM-Oriented Conduct Problems scale
scores than youths without a disruptive behavior disorder.
186 J Psychopathol Behav Assess (2009) 31:178–189

Table 5 DSM-oriented means DSM-oriented scale by disorder analyses n Mean (SD)

and (standard deviations) for
children with and without se- Affective problems
lected diagnoses anywhere in a
Dysthymic disorder 10 9.1 (5.9)
their diagnostic profile1 a
Major depressive or DEP NOS disorder without dysthymic disorder 37 10.5 (5.2)
b
No dysthymic, major depressive, or DEP NOS disorder 626 4.8 (4.1)
a
Major depressive disorder 34 11.3 (5.4)
b
Dysthymic or DEP NOS disorder without major depressive disorder 13 7.4 (3.8)
b
No dysthymic, major depressive, or DEP NOS disorder 626 4.8 (4.1)
Anxiety problems
a
Separation anxiety disorder 34 5.6 (3.3)
a
Anxiety disorder without separation anxiety disorder 169 4.8 (3.1)
b
No anxiety disorder 470 2.6 (2.5)
a
Panic disorder 9 6.7 (2.5)
a
Anxiety disorder without panic disorder 190 4.9 (3.2)
b
No anxiety disorder 470 2.6 (2.5)
a
Social phobia 96 5.1 (3.1)
a
Anxiety disorder without social phobia 107 4.9 (3.2)
b
No anxiety disorder 470 2.6 (2.5)
a
Specific phobia 40 5.7 (3.3)
a
Anxiety disorder without specific phobia 163 4.8 (3.1)
b
No anxiety disorder 470 2.6 (2.5)
a
Obsessive compulsive disorder 27 6.4 (2.9)
a
Anxiety disorder without obsessive compulsive disorder 176 4.8 (3.1)
b
No anxiety disorder 470 2.6 (2.5)
a
Generalized anxiety disorder 39 5.6 (3.0)
a
Anxiety disorder without generalized anxiety disorder 164 4.8 (3.2)
b
No anxiety disorder 470 2.6 (2.5)
a
Posttraumatic stress disorder 27 4.7 (3.1)
a
Anxiety disorder without posttraumatic stress disorder 176 5.0 (3.2)
DBD NOS = Disruptive b
Behavior Disorder Not Other- No anxiety disorder 470 2.6 (2.5)
wise Specified, DEP NOS = Somatic problems
a
Depressive Disorder Not Major depressive disorder 34 4.8 (3.6)
ab
Otherwise Specified, Panic Panic or separation anxiety disorder without major depressive disorder 36 3.5 (3.2)
b
Disorder = Panic Disorder with No major depressive, panic, or separation anxiety disorder 603 1.9 (2.3)
or without Agoraphobia. Given ab
Separation anxiety disorder 34 3.5 (3.7)
the absence of youths with Panic or major depressive disorder without separation anxiety disorder 36 4.7 (3.2) a

Somatization and Somatoform No major depressive, panic, or separation anxiety disorder 603 1.9 (2.3) b
Disorders in the current clinical a
Panic disorder 9 6.3 (2.5)
sample and Chorpita et al.,’s a
Major depressive or separation anxiety disorder without panic disorder 61 3.8 (3.5)
(2000c) findings on somatic b
arousal in selected internalizing No major depressive, panic, or separation anxiety disorder 603 1.9 (2.3)
disorders, analyses for the Attention-deficit/hyperactivity problems
a
Somatic Problems scale above Attention-deficit/hyperactivity disorder, combined type 84 9.1 (3.3)
ab
examined youths with Major Attention-deficit/hyperactivity disorder, hyperactive type 10 8.7 (2.2)
b
Depressive Disorder, Panic Attention-deficit/hyperactivity disorder, inattentive type 97 6.4 (3.2)
Disorder and/or Separation c
No attention-deficit/hyperactivity disorder 482 5.1 (3.6)
Anxiety Disorder Oppositional problems
1
All diagnoses, whether princi- Oppositional defiant disorder 158 6.3 (2.3) a
pal or non-principal, for which a
Conduct disorder or DBD NOS without oppositional defiant disorder 112 5.7 (2.8)
children met full DSM-criteria b
were included in their diagnostic No oppositional defiant, conduct or DBD NOS disorder 403 3.5 (2.4)
profiles Conduct problems
a
abc
Differing letter superscripts Conduct disorder 77 12.8 (6.7)
b
indicate a significant pairwise Oppositional defiant disorder or DBD NOS without conduct disorder 193 7.0 (4.9)
c
mean differences at 99% No oppositional defiant, conduct or DBD NOS disorder 403 3.4 (3.4)
confidence interval
J Psychopathol Behav Assess (2009) 31:178–189
Discussion
Findings from this study provide support for the reliability
and validity of the expert judgment-derived DSM-Oriented
Scales in a large clinical sample of youth. Internal
consistency was favorable and convergent validity hypotheses
were almost uniformly supported across all scales. Divergent
validity results were also very favorable, though slightly more
mixed than the convergent validity findings.
Several points warrant discussion. First, contrary to
prediction, significant relationships were found between the
DSM-Oriented Affective Problems scale and oppositional
and conduct indices. Although potentially surprising, these
findings are somewhat consistent with the literature. Namely,
depressive feelings in children can present as irritability
(American Psychiatric Association 2000) and previous
research has highlighted a moderate, but significant, rela-
tionship between oppositional/rule-breaking behavior and
feelings of depression (Goodman and Scott 1999; Loeber et
al. 2004). In some ways, this relationship can be seen as
corroborated within this investigation in that significant and
positive relationships were also found between DSM-
Oriented Oppositional and Conduct Problems Scales and
depressive indices.
Second, concerns have previously been raised regarding
the ability of the DSM-Oriented Scales to adequately measure
various DSM-Oriented constructs, particularly given that the
CBCL DSM-Oriented Scales contain relatively few items and
do not contain items comprising all DSM symptom criteria
(e.g., Kendall et al. 2007). Despite these concerns, findings of
the present study indicated that all CBCL DSM-Oriented
Scales were able to discriminate youths with and without
relevant DSM diagnoses. This finding runs counter to prior
research that suggested poor discriminative properties for the
DSM-Oriented Anxiety Problems Scale (Kendall et al. 2007;
van Lang et al. 2005). Specifically concerning this scale’s
performance in this study, it is also worth noting that this
scale could discriminate in predicted directions between
children with and without all major types of anxiety
disorders, despite being constructed only around conceptions
of GAD, SAD, and SPEC. With constituent items such as,
“Too fearful or anxious” and “Worries”, it seems that this
scale may not reflect specific diagnoses but rather anxiety
disorders in general.
Third, these overall findings are somewhat surprising
given that Vreugdenhil et al. (2006) found low concordance
between the YSR DSM-Oriented Scales and DSM DISC-C
diagnoses. However, it should be noted that Vreugdenhil et
al. examined YSR DSM-Oriented Scales (child report) with
incarcerated youths, whereas the present study examined
CBCL DSM-Oriented Scales (parent report) with an
outpatient sample. In addition, diagnoses in Vreugdenhil
et al.’s investigation were based on the DISC-C (child
187
report) while diagnoses in the present study were based on
the ADIS-IV-C/P as well as overall clinician impressions.
Accordingly, the differences between samples and mea-
surement approaches may account in part for these
seemingly competing findings.
Although the results of the present study are promising
with respect to the psychometric properties of the CBCL
DSM Oriented Scales, a few caveats are in order. First, in
order to maximize the size of the present sample, analyses
were performed across a pooled sample of participants
completing either the CBCL/4-18 or CBCL/6-18. Instru-
ment variance may have been decreased had all youths
filled out the CBCL/6-18. This was not possible, however,
given the timing with which the research clinic adopted the
CBCL/6-18 over the CBCL/4-18. However, it should again
be underscored that DSM-Oriented Anxiety, Somatic, or
Oppositional Problems Scale items and calculations were
identical across CBCL versions. Issues with missing items,
therefore, only applied to the DSM-Oriented Affective,
Oppositional, and Conduct scales, with the authors closely
adhering to CBCL/6-18 manual directions (Achenbach,
2001) for calculating DSM-Oriented Scales scores for
CBCL/4-18 instruments. Concerning potential differences
in the current study between CBCL/4-18 and CBCL/6-18
youth on demographic data, only one of seventeen
comparisons pointed to statistically significant differences
between these groups. Given the substantial size of
the CBCL/4-18 sample, noteworthy of mention is that the
authors also performed all study analyses with only the
CBCL/4-18 sample for comparative purposes against those
of the combined sample. Presenting these comparative
analyses is outside of the scope of this investigation.
However, it should be mentioned that all but two of the
results presented above were either replicated or in some
instances found stronger (i.e., in terms of direction and
statistical significance) for all analyses performed with the
CBCL/4-18 sample. Using only CBCL/4-18 youths, youths
with PTSD did not score higher than youths without PTSD
on the DSM-Oriented Anxiety Problems Scale and youths
with ADHD-PI did not score higher than youths without
ADHD-PI on the DSM-Oriented Oriented Attention-Deficit/
Hyperactivity Problems Scale. Given this study’s mixed
sample, it will be important for future studies examining
psychometric properties of the DSM-Oriented Scales to
collect data from large clinical samples with only the CBCL/
6-18 version.
Another limitation is that only the CBCL, and not the
Teacher Report Form (TRF) or Youth Self-Report (YSR),
was examined in this study. Consequently, the reliability
and validity findings for the DSM-Oriented Scales in the
present study generalize only to the CBCL. Psychometric
properties of the TRF and YSR DSM-Oriented scales in
large clinical samples thus remain open to future inquiry.
188
Research following this study could build upon this
investigation’s limitations for furthering empirical scrutiny
of the psychometric properties of the CBCL’s DSM-
Oriented Scales. With this first validation study providing
the necessary foundation for subsequent psychometric
research, forthcoming investigations could perform com-
parative analyses between DSM-Oriented and Syndrome
Scales. For example, receiver operating characteristics
curve methodology could be used for comparing these
scales’ discriminative diagnostic abilities and choosing
optimal cut-points for making diagnostic decisions. In the
meantime, the strong performance of the DSM scales
suggests warranted supplemental usage with clinical pop-
ulations of youth.
Despite these limitations and indications for future
research, the present study is the first systematic investiga-
tion of the CBCL DSM-Oriented Scales’ psychometric
properties in a large clinical sample of youth. Findings lend
empirical support to the basic psychometric properties of
the clinical judgment-derived DSM-Oriented Scales.
Results from the present investigation indicate acceptable
internal consistency for these scales as well as excellent
convergent and divergent validity. In conclusion, it appears
that the CBCL DSM-Oriented Scales may provide accurate
supplementary information that may be considered when
formulating clinical diagnoses.
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