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Journal Article Reviews

Anxiety Disorders Van Meter A, Youngstrom E, Youngstrom J, et al. Clinical decision making about child and adolescent anxiety disorder using the Achenbach System of empirically based assessment. J Clin Child Adolesc Psychol. 2014;43:552–565. With the lifetime prevalence rate of anxiety disorders estimated to be between 9% and 20%, accurate diagnosis and assessment is critical to the treatment of these disorders. However, because some anxiety is normative and can be confounded with developmental stage and other psychopathology, case conceptualization can be challenging. Evidence-based assessment is more consistently accurate than “as usual” clinical decision making. The aim of this study was to examine the discriminative validity of one of the more widely used multiinformant assessment measures, the Achenbach System (e.g., Child Behavioral Checklist [CBCL] and Youth Self-Report [YSR]), within demographically diverse populations across a range of clinical settings. Youth (ages 5–18 yr) from either an outpatient academic clinic (n 5 1084) or urban community mental health clinic (n 5 615) and their parents were administered a structured interview and the above-mentioned self-report questionnaires. Teacher reports were also obtained. Results showed that approximately 13% and 26% of the academic clinical sample and community clinic met diagnostic criteria for any anxiety disorder. The CBCL and YSR “Internalizing” subscale demonstrated good discriminative validity for any anxiety disorder from all other diagnoses within both samples. Comparatively, teacher reports did not perform better than chance for the diagnosis of anxiety. Clinical setting, age, and gender were not found to be moderators for diagnostic efficiency. Negative effect questions were associated with high scores for both depression and anxiety, which precluded identification of thresholds for specific diagnostic categories. The authors concluded that the Achenbach measures do not provide sufficient information to aid in diagnosis of specific anxiety disorders and instead may best be used for “ruling in or out” anxiety as a differential. R.M.