Identification of emotional and behavior problems in obese children using Child Behavior Checklist (CBCL) and 17-items Pediatric Symptom Checklist (PSC-17)

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Dwi Fachri Harahap
Damayanti Rusli Sjarif
Soedjatmiko Soedjatmiko
Dwi Putro Widodo
Mayke Sugianto Tedjasaputra


Background Obesity can result in emotional and behavior problems in school-age children. Child Behavior Checklist (CBCL) is a standard instrument for evaluating behavior problems, however it is considered not practical. The 17-item Pediatric Symptom Checklist (PSC-17) is a more simple instrument but its diagnostic value has never been evaluated in obese children.
Objectives To evaluate the diagnostic value of PSC-17 compared to CBCL as the gold standard.
Methods This cross-sectional study was done in May - June 2009. Children aged 6-12 years with obesity were included. Parents filled the CBCL and PSC-17 questionnaires. Sensitivity, specificity, predictive values, and likelihood ratios were calculated for PSC-17.
Results Most subjects aged 6-9 years (83%). Boys out numbered girls. Emotional and behavior problems detected by CBCL and PSC-17 were identified in 28% and 22% subjects, respectively. The most common problem was internalization (withdrawal, somatic complaints, anxiety/depression). The PSC-17 had sensitivity and specificity of 69.2% and 95.6% respectively. Positive and negative predictive values were 85.7% and 89%, whereas positive and negative likelihood ratios were 15.7 and 0.32.
Conclusions The prevalence of emotional and behavior problems detected using CBCL and PSC-17 in obese children was 28% and 22%, respectively. The PSC-17 has moderate sensitivity to screen emotional and behavior problem in obese children.[Paediatr Indones. 2010;50:42-8].

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Harahap D, Sjarif D, Soedjatmiko S, Widodo D, Tedjasaputra M. Identification of emotional and behavior problems in obese children using Child Behavior Checklist (CBCL) and 17-items Pediatric Symptom Checklist (PSC-17). PI [Internet]. 3Mar.2010 [cited 15Aug.2020];50(1):42-. Available from:
Developmental Behavioral & Community Pediatrics
Received 2016-08-15
Accepted 2016-08-15
Published 2010-03-03


Kimm SYS, Obarzanek E. Childhood obesity: a new pandemic of the new millenium. Pediatrics. 2002;110:1003-7.
2. Thibault H, Rolland-Cachera MF. Prevention strategies of childhood obesity. Arch Pediatr. 2003;10:1100-8.
3. Sjarif DR. Obesitas pada anak dan permasalahannya. Hot topics in pediatrics II. Prosiding Pendidikan Kelanjutan Berkala Ilmu Kesehatan Anak XV; 2002 Feb 18-19; Jakarta, Indonesia. Jakarta: Balai Penerbit Universitas Indonesia, 2002; p. 219-34.
4. Susanti TE. Prevalensi dan faktor risiko obesitas pada anak sekolah dasar usia 10-12 tahun di lima wilayah DKI Jakarta [tesis]. Jakarta: Universitas Indonesia; 2007.
5. Janssen I, Craig WM, Boyce WF, Pickett W. Association between overweight and obesity with bullying behaviors in school-age children. Pediatrics. 2004;113:1187-94.
6. Puhl RMRM, Brownell KD. Psychosocial origins of obesity stigma: toward changing a powerful and pervasive bias. Obes Rev. 2003;4:213-27.
7. Schwimmer JB, Burwinkle T.M, Varni, JW. Health-related quality of life of severely obese children and adolescents. JAMA. 2003;289:1813-9.
8. Mellin AE, Neumark-Sztainer D, Story M, Ireland M, Resnick MD. Unhealthy behaviors and psychosocial difficulties among overweight adolescents: The potential Impact of familial factors. J Adolesc Health. 2002;31:145-53.
9. Achenbach TM. Manual for child behavior checklist/ 4-18 and 1991 profile. Burlington: University of Vermont, Department of Psychiatry; 1991.
10. Jellinek MS, Murphy JM, Robinson J, Feins A, Lamb S, Fenton T. Pediatric Symptom Checklist: screening school-age children for psychosocial dysfunction. J Pediatr. 1988;112:201-9.
11. M Muhammad R, Endang DL, Suci M, Dwi H, Sri M. Prevalensi dan beberapa faktor yang memengaruhi gangguan psikososial pada anak obes usia sekolah dasar di Kotamadya Surakarta. Cermin Dunia Kedokteran. 2007;34:304-6.
12. Myers MD, Raynor HA, Epstein LH. Predictors of child psychological changes during family-based treatment for obesity. Arch Pediatr Adolesc Med. 1998;152:855-61.
13. R Reck UK, Korsten K, Haeberle K, Hauschild KK, Dickhuth HH, Schulz E. The psychosocial situation of obese children: psychological factors and quality of life. Psych Res Behav Manage. 2009:2;23-9.
14. Vila G, Zipper E, Dabbas M, Bertrand C, Robert JJ, Ricour C, Mouren-Simeoni MC. Mental disorders in obese children and adolescents. Psychosom Med. 2004;66:387-94.
15. Psychosocial development in middle childhood. In: Papalia DE, Olds SW, Feldman RD, editors. Human development. 10th ed. New york: Mc-Graw-Hill, 2007; p. 354-90.
16. B Bradley RH, Hours R, Nader PR, O’Brien M, Belsky J, Crosnoe R. The relationship between body mass index and behavior in children. J Pediatr. 2008;153;629-34.
17. Flodmark CE. The happy obese child. Int J Obes. 2005;29:531-3.
18. Epstein LH , Klein KR, Wisniewski L. Child and parent factors that influence psychologycal problems in obese children. Int J Eat Disord. 1994;15:151-8.
19. Hastings PD, Zahn-Waxler C, Robinson J, Usher B, Bridges D. The development of concern for others in children with behavior problems. Dev Psychol. 2000;36: 531-46.
20. Wardle J, Cooke L. The impact of obesity on psychological well-being. Best Pract Res Clin Endocrinol Metab. 2005;19:421-40.
21. Stunkard AJ, Sorensen TIA. Obesity and socioeconomic status—a complex relation. N Engl J Med. 1993;329: 1036–7.
22. Costello EJ, Keeler GP, Angold A. Poverty, race/ethnicity and psychiatric disorder: a study of rural children. Am J Public Health. 2001;91:1494–8.
23. Seifer R, Sameroff AJ, Baldwin CP, Baldwin A. Child and family factors that ameliorate risk between 4 and 13 years of age. J Am Acad Child Adolesc Psychiatry. 1990;31:893-903.
24. Rae-Grant N, Thomas H, Offord RD, Boyle MH. Risk, protective factors, and prevalence of behavioral and emotional disorders in children and adolescens. J Am Acad Child Adolesc Psychiatry. 1989;28:262-8.
25. Jensen PS, Bloedau L, Degroot J, Ussery T, Davis H. Children at risk: I. Risk factors and child symptomatology. J Am Acad Child Adolesc Psychiatry. 1990;29:51-9.
26. Stradmeijer M, Bosch J, Koops W, Seidell J. Family functioning and psychosocial adjustment in overweight youngsters. Int J Eat Disord. 2000;27:110–4.
27. Reijneveld SA, Vogels AG, Hoekstra F, Crone MR. Use of the Pediatric Symptom Checklist for the detection of psychosocial problems in preventive child healthcare. BMBMC Public Health. 2006;6:197.
28. Jutte DP, Burgos A, Mendoza F, Ford CB, Huffman LC. Use of the Pediatric Symptom Checklist in a low-income, mexican american population. Arch Pediatr Adolesc Med. 2003;157:1169-76.
29. Madiyono B, Moeslichan S, Sastroasmoro S, Budiman I, Purwanto H. Perkiraan besar sample. In: Sastroasmoro S, Ismael S, editors. Dasar-dasar metode penelitian klinis. 2nd ed. Jakarta: CV Sagung Seto, 2002; p. 259-87.