Brief Assessment Tools for Obsessive-Compulsive Disorders in Children: A Systematic Review

Abstract

OBJECTIVE: The objective of this study was to estimate the comparative performance of brief diagnostic assessment tools. METHODS: Data sources included articles from PubMed, the Cochrane Register of Clinical Trials, the Cochrane Database of Systematic Reviews, Embase, Cumulated Index in Nursing and Allied Health Literature (CINAHL), PsycINFO, and Education Resources Information Center (ERIC), as well as unpublished studies with reported results in ClinicalTrials.gov through May 15, 2024. Studies of children (up to age 21 years) with a clinical suspicion of obsessive-compulsive disorder (OCD) that evaluated the accuracy (predictive validity) of brief assessment tools for OCD, compared with a reference standard, were included. We extracted participant characteristics, scale and reference standard information, results, and risk of bias assessment. We performed random-effects diagnostic meta-analysis where feasible. We assessed strength of evidence for each scale. RESULTS: There is moderate strength of evidence that the 8-question version of the Child Behavior Checklist-Obsessive Compulsive Subscale (CBCL-OCD/OCS) is sufficiently sensitive and specific (summary area under the curve [AUC], 0.84; 95% CI: 0.74-0.91) to prompt specialist referral for additional diagnostic assessment. Other tools may perform as well or better, but the current evidence is insufficient to justify broad conclusions about their performance. Limitations include few studies per scale, most of which were case-control studies, and that the presence of homogenous white populations may preclude generalizability of tool performance. CONCLUSIONS: Based on the current evidence, the CBCL-OCD/OCS probably is sufficiently accurate to indicate which youth should be further evaluated for OCD, but more research is needed to establish whether the 8-question subscale can function as a stand-alone measure. The available evidence is insufficient for other brief assessment tools.