BRIEF REPORT Using the Achenbach Child Behaviour Checklist in the differential diagnosis of disruptive behaviour disorders Thomas P Kelly & Paul McArdle IrJ Psych Med 1997; 14(4): 136-138 Abstract Objective: The report considers the utility of the Achenbach Child Behaviour Checklist in the differential diagnosis of the disruptive behaviour disorders. Method: Subscale scores on the parent completed Achenbach Child Behaviour Checklist were compared for three of 15 boys, the first diagnosed with attention deficit hyperactivity disorder, the second diagnosed with oppositional defiant disorder and a third non-clinical control. Result: The attention subscale of the Achenbach Child Behaviour Checklist was found to have a high level of sensitivity to children diagnosed with attention deficit hyperactivity disorder, but relatively poor specificity. The delinquent subscale was found to have limited sensitivity for oppositional defiant/conduct disorder group, but high levels of specificity. The aggressive subscale were found to have relatively high sensitivity for the oppositional defiant/conduct disorder group and relatively high specificity. Conclusion: The Achenbach Child Behaviour Checklist is useful in distinguishing between children with disruptive behaviour disorders and a non-clinical sample. The aggressive subscale appears to have potential clinical utility in the differential diagnosis of the disruptive behaviour disorders. Introduction The differential diagnosis of attention deficit hyperac- tivity disorder 1 from the other disruptive behaviour disorders (conduct disorder and oppositional defiant disor- der) through the use of parent questionnaires has had limited success. 2 However, parent completed question- naires have shown validity in distinguishing children with disruptive behaviour disorders from normal children. 1 The high level of comorbidity is the most likely reason for this limited success. Barkley, DuPaul and Murray 4 indicated that 65% of children with attention deficit hyperactivity disorder also qualifying for a comorbid diagnosis of oppo- sitional defiant disorder and between 40% and 60% showing sufficient anti-social behaviour to meet the crite- ria for conduct disorder in adolescence. One promising tool in the differential diagnosis of these psychiatric disorders is the Achenbach Child Behaviour Checklist.•' The questionnaire is composed of 138 ques- tions, 20 of the questions make up a competence checklist "Thomas P Kelly. Dept of Clinical Psychology, Ridley Building, University of Newcastle-upon-Tyne, NE1 7RU, England. Paul McArdle. Fleming Nuffield Unit, 1 Tankerville Terrace, Jesmond, Newcastle-upon-Tyne, England. * Correspondence SUBMITTED: FEBRUARY 2, 1996. ACCEPTED: OCTOBER 29, 1997. and the remaining 118 make up the behaviour problem scales. Factor analysis of the 1991 profile indicates a different set of factors for males and females and for two separate age groups (4 - 11 yea^s and 11 - 18 years). Normal scores were based on a sample of 2,110 children from a representative sample of socio-economic status and ethnic groups. The questionnaire requires 5th grade read- ing level, roughly the level expected at the end of primary or beginning of secondary school level within the British and Irish education systems. It has been shown to be useful as a screening instrument in paediatric primary care.'' Concurrent validity with other commonly used parent rating forms such as the Connors has been demonstrated. 7 Discriminant validity had been shown in the ability to differentiate between clinic-referred and non-referred chil- dren 5 as well as hyperactive and non-hyperactive children. 4 From study of the questions which load on each factor and DSM-III-R' diagnostic criteria it would be expected that children diagnosed with a conduct disorder or oppo- sitional defiant disorder would score higher than those diagnosed with attention deficit hyperactivity disorder and controls on the delinquent and aggressive behaviour su-bscales. Children with attention deficit hyperactivity disorder should score higher on the attention subscale than children with other disruptive behaviour disorders or controls. In order to assess the diagnostic utility of the questionnaire, the sensitivity and specificity of the ques- tionnaire for the clinical and control groups will be determined using the cut-off points for clinical concern indicated by Achenbach. 5 Method A total of 30 boys between the ages of seven and 14 were diagnosed by a psychiatrist of Senior Registrar or Consul- tant status. Of this 15 boys were diagnosed as having, either a conduct disorder or oppositional defiant disorder, and 15 as having an attention deficit hyperactivity disorder. These control group of 15 were the nearest age siblings of children seen in a head-injury follow-up clinic. The questionnaires were administered as part of routine psychological assessment. Parents usually completed the questionnaire while the child underwent psychometric assessment. Parents with reading difficulties were given the opportunity to take the form home and obtain help in completion. The questionnaire normally took between 20 and 40 minutes to complete. The author has experienced only occasional failure by parents to complete the ques- tionnaire adequately. Scores for each of the eight subscales were calculated as instructed in the manual. 5 These are: three internalising subscales (withdrawn, somatic, and anxious/depressed); two externalising (delinquent and aggressive) and three others (social, thought, and attention). 136