Maternal-reported behavioral and emotional problems in Taiwanese preschool children.
Taiwanese preschoolers score higher than US kids on every CBCL syndrome, so US cut-offs will over-label behavior problems.
01Research in Context
What this study did
Wu et al. (2012) asked 1,074 moms of 2- to young learners across Taiwan to fill out the CBCL/1.5-5.
The team compared the scores to the US norm table that most BCBAs still use today.
What they found
Taiwanese kids scored higher on every CBCL syndrome. 20 % landed in the clinical range versus 10 % in the US sample.
Boys, first-borns and younger preschoolers showed the biggest gap.
How this fits with other research
So et al. (2013) built a 10-item ASD screener from the same CBCL pool. Their cut-points still rest on US norms, so Taiwanese kids could be over-referred.
Leung et al. (2013) validated a cognitive scale in Hong Kong preschoolers and also found age-by-culture effects, backing the idea that Chinese-speaking children score differently.
The ABC-C under-5 study by Prigge et al. (2013) warns that preschool scales can misestimate behavior; Yen-Tzu’s data now show the CBCL is one of those scales.
Freeth et al. (2019) found CBCL under-counts internalizing problems in minimally verbal children with ASD. If you use US cut-offs in Taiwan, you may double the false-positive rate and still miss quiet kids who are anxious.
Why it matters
Stop using US CBCL cut-offs for Taiwanese (or other East-Asian) preschoolers. Local norms shift the clinical line by up to 7 T-score points. That means fewer unnecessary referrals and more accurate early identification. Ask your assessment supplier for region-specific tables or collect your own agency baseline before you write the next report.
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02At a glance
03Original abstract
There has been limited epidemiologic information concerning preschoolers' behavioral and emotional problems in Eastern societies. This study was therefore aimed to investigate behavioral and emotional problems in a large sample of Taiwanese preschoolers using the Child Behavior Checklist for Ages 1.5-5 (CBCL/1.5-5). The CBCL/1.5-5 was scored by mothers of 645 Taiwanese preschoolers aged 24-71 months. Psychometric features of the scale as well as the raw scores and prevalence rates of behavioral problems of Taiwanese preschoolers were compared with those of American counterparts. Several demographic variables with the Total Problems and syndromes scores were also examined. The CBCL/1.5-5 was found to have good to excellent levels of reliability (internal consistency, test-retest reliability and inter-parent agreement) and an acceptable model fit of seven-syndrome factor structure (root mean square error of approximation=0.055) when used with Taiwanese preschoolers. The prevalence rate of Total Problems, Internalizing syndrome and Externalizing syndrome score in the clinical range was 25.1%, 11.2% and 25.4%, respectively. Cross-cultural comparisons showed that Taiwanese preschoolers had higher scores in six narrow-band syndromes (effect size d=0.17-0.43, all p's<0.005) and prevalence rates of four Internalizing-related syndromes and Sleep Problems than American sample (odds ratio=2.4-4.9, all p's<0.005). Analyses of behavioral correlates revealed associations of first birth order with higher Internalizing, Externalizing and Total Problems scores (all p's<0.05). Furthermore, younger ages (24-47 months) and male gender were associated with higher Externalizing and Total Problems scores (all p's<0.05). Our data have provided important epidemiologic information to assist in clinical assessment and management of preschoolers' behavioral and emotional problems in an Eastern society.
Research in developmental disabilities, 2012 · doi:10.1016/j.ridd.2011.11.018