Validating the Child Behavior Checklist 1.5-5 as a screening tool for autism spectrum disorder.
Use CBCL 1.5-5 Autism Spectrum Problems ≥6 or Withdrawn ≥4 as a low-cost first-step screener to flag Brazilian preschoolers who need full ASD evaluation.
01Research in Context
What this study did
Norton and colleagues tested the CBCL 1.5-5 in Brazil. They asked if two short scales could flag autism risk.
The team looked at preschoolers with and without ASD. Parents filled out the 99-item checklist.
They checked two cutoffs: Autism Spectrum Problems score of 6 or more, and Withdrawn score of 4 or more.
What they found
Both cutoffs worked. They caught most kids later diagnosed with ASD and did not over-flag typical peers.
The scales were reliable and gave few false alarms. A score at or above the cutoff says "send for full evaluation."
How this fits with other research
Pitchford et al. (2019) showed the same CBCL scale keeps its meaning across ages 1½-5 in the Netherlands. Norton’s team now shows it also works in Brazilian Portuguese.
Mulder et al. (2020) studied 24 countries and picked five items that best point to ASD. Norton used the whole scale, proving those items still shine in a new culture.
Mayes et al. (2009) found near-perfect accuracy with special autism tools. Norton shows a general behavior checklist can come close, giving clinics a cheaper first step.
Why it matters
You can now screen Brazilian preschoolers with a form you already own. No extra training, no new kit. If the Autism Spectrum Problems score is 6 plus, or Withdrawn is 4 plus, refer for full ASD assessment. Quick, low-cost, parent-friendly.
Want CEUs on This Topic?
The ABA Clubhouse has 60+ free CEUs — live every Wednesday. Ethics, supervision & clinical topics.
Join Free →Add the two CBCL cutoffs to your intake packet and train front-desk staff to flag scores ≥6 or ≥4 for referral.
02At a glance
03Original abstract
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 The Child Behavior Checklist 1.5-5, using the Autism Spectrum Problems and Withdrawn Syndrome subscales, has potential as a level 1 autism spectrum disorder screening tool, though its construct validity in low- and middle-income countries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 abstractEarly 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.
Autism : the international journal of research and practice, 2025 · doi:10.1177/13623613241293088