Validating the Child Behavior Checklist 1.5-5 as a screening tool for autism spectrum disorder
Authors: Kitanishi Norton , Bordini Daniela , Ribeiro Marcos V V , Paula Cristiane Silvestre , Brentani Helena , Portelese Joana , Surkan Pamela J , Martins Silvia S , Jesus Mari Jair de , Martins Okuda Paola Matiko , Caetano Sheila C 
Published: October 2024

Early identification of autism spectrum disorder through cost-effective screening is crucial in low- and middle-income countries. The Child Behavior Checklist 1.5-5, using the Autism Spectrum Problems and Withdrawn Syndrome subscales, has potential as a level 1 autism spectrum disorder screening tool, though its construct validity in low- and middle-income countries remains underexplored. We aimed to validate the Child Behavior Checklist 1.5-5 for autism spectrum disorder screening in a representative sample of 1292 Brazilian children aged 3–5 years and 70 autism spectrum disorder children aged 1–5 years. Confirmatory factor analysis evaluated model fit indices and correlation strength between Child Behavior Checklist items and autism spectrum disorder diagnoses. Receiver operating characteristic curves assessed the optimal cutoff score. The Autism Spectrum Problems model demonstrated good fit and reliability (comparative fit index = 0.96, root mean square error of approximation = 0.037, ω = 0.869), as did the Withdrawn Syndrome model (comparative fit index = 0.974, root mean square error of approximation = 0.034, ω = 0.776), with one item per model showing low factor loadings. A cutoff score of 6 on the Autism Spectrum Problems yielded 82.5% sensitivity and 83.4% specificity, while a cutoff of 4 on the Withdrawn scale resulted in 87.9% sensitivity and 82.2% specificity. The Child Behavior Checklist 1.5-5 Autism Spectrum Problems and Withdrawn scales are reliable level 1 autism spectrum disorder screeners for Brazilian children, with good internal consistency and construct validity. Lay abstract Early identification of Autism Spectrum Disorder is very important, especially in low and middle-income countries, where access to resources is often limited. The Child Behavior Checklist 1.5-5 is a tool that has been used to help identify children with autism spectrum disorder through specific behavior patterns. However, its effectiveness in low- and middle-income country settings has not been thoroughly studied. This research focused on evaluating the Child Behavior Checklist 1.5-5 as a screening tool for autism spectrum disorder among Brazilian children. The study involved 1292 children aged 3–5 years from the general population and 70 children with autism spectrum disorder aged 1–5 years. Using advanced statistical methods, the study tested how well the Child Behavior Checklist identified children with autism spectrum disorder and how reliable it was in this context. The findings showed that the Child Behavior Checklist 1.5-5 performed well in identifying autism spectrum disorder, with high reliability and consistency in the results. Although one item in each of the autism spectrum problems and withdrawn syndrome subscales did not perform as strongly, the overall tool was effective. In summary, the Child Behavior Checklist 1.5-5 proves to be a reliable and valid tool for early autism spectrum disorder screening in Brazilian children. This can help ensure that more children in low- and middle-income country settings are identified early and receive the necessary support and interventions to help them thrive. Future research should continue to test this tool in different contexts to confirm its usefulness across various populations.