Psychosis risk screening in clinical high-risk adolescents: a longitudinal investigation using the Child Behavior Checklist

Abstract

This is the first study to investigate whether parent-reported social and behavioral problems on the Child Behavior Checklist (CBCL) can be used for psychosis risk screening and the identification of at-risk youth in the general population. This longitudinal investigation assessed 122 adolescent participants from three groups (at-risk, other personality disorders, non-psychiatric controls) at baseline and one year follow-up. The findings indicate that two individual CBCL rating scales, Withdrawn/Depressed and Thought Problems, have clinical and diagnostic utility as an adjunctive risk screening measure to aid in early detection of at-risk youth likely to develop psychosis. Furthermore, the findings shows that a cost-effective, general screening tool with a widespread use in community and pediatric healthcare settings has a promise to serve as a first step in a multi-stage risk screening process. This can potentially facilitate increased screening precision and reduction of high rate of false-positives in clinical high-risk individuals who present with elevated scores on psychosis-risk measures, but ultimately do not go on to develop psychosis. The findings of the present study also have significant clinical and research implications for the development of a broad-based psychosis risk screening strategy, and novel prevention and early intervention approaches in at-risk populations for the emergence of severe mental illness.

Keywords: Adolescents; CBCL; Clinical high-risk; Early intervention; Prevention; Prodrome; Psychosis risk; Screening.

Figure 1. CBCL Total Competence scores by diagnostic group over time

AR=at-risk, OPD=other personality disorders, NC=normal controls

Figure 2. CBCL Internalizing Problems scores by diagnostic group over time

AR=at-risk, OPD=other personality disorders, NC=normal controls

Figure 3. CBCL Externalizing Problems scores by diagnostic group over time

AR=at-risk, OPD=other personality disorders, NC=normal controls