A Primer on Receiver Operating Characteristic Analysis and Diagnostic Efficiency Statistics for Pediatric Psychology: We Are Ready to ROC

• DOI: 10.1093/jpepsy/jst062
• Publication Date: 2013-08-22T01:40:40Z
• Authors: Eric A. Youngstrom
• Keywords: Parents; Psychiatric Status Rating Scales; Mood Disorders; 05 social sciences; Psychology, Child; Checklist; 3. Good health; 03 medical and health sciences; 0302 clinical medicine; ROC Curve; Data Interpretation, Statistical; Humans; 0501 psychology and cognitive sciences; Child

Objective To offer a practical demonstration of receiver operating characteristic (ROC) analyses, diagnostic efficiency statistics, and their application to clinical decision making using a popular parent checklist to assess for potential mood disorder. Method Secondary analyses of data from 589 families seeking outpatient mental health services, completing the Child Behavior Checklist and semi-structured diagnostic interviews. Results Internalizing Problems raw scores discriminated mood disorders significantly better than did age- and gender-normed T scores, or an Affective Problems score. Internalizing scores <8 had a diagnostic likelihood ratio <0.3, and scores >30 had a diagnostic likelihood ratio of 7.4. Conclusions This study illustrates a series of steps in defining a clinical problem, operationalizing it, selecting a valid study design, and using ROC analyses to generate statistics that support clinical decisions. The ROC framework offers important advantages for clinical interpretation. Appendices include sample scripts using SPSS and R to check assumptions and conduct ROC analyses.