Diagnostic efficiency of the CBCL thought problems and DSM-oriented psychotic symptoms scales for pediatric psychotic symptoms

We compared the diagnostic efficiency of the Child Behavior Checklist (CBCL) Thought Problems subscale and the rationally derived DSM-oriented psychotic symptoms scale (DOPSS) to identify clinically concerning psychosis in a multi-site sample of youths seeking outpatient mental health services (N=694). We operationally defined clinically concerning psychosis as the presence of clinically significant hallucinations or delusions, assessed by the Schedule for Affective Disorders and Schizophrenia psychosis items. Both the Thought Problems and DOPSS scores showed significant areas under the curve (AUCs=0.65 and 0.70, respectively), but the briefer DOPSS showed statistically significantly better diagnostic efficiency for any clinically concerning psychosis, but the difference was small enough that it would not be clinically meaningful. The optimal psychosis screening cut-off score (maximizing sensitivity and specificity) was 68.5+ [corresponding diagnostic likelihood ratio (DiLR)=1.59] for the Thought Problems subscale and 1.67+ (DiLR=1.97) for the DOPSS. Both the CBCL Thought Problems and DOPSS are clinically useful for identifying psychotic symptoms in children, and although the DOPSS showed statistically better discriminating power, the difference was small so we would not necessarily recommend the DOPSS over standard scoring.