• Eric A Youngstrom.
• PhD, Department of Psychology, University of North Carolina at Chapel Hill, Davie Hall CB 3270, Chapel Hill, NC 27599-3270, USA. eay@unc.edu.
• J Pediatr Psychol. 2014 Mar 1;39(2):204-21.

ObjectiveTo 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.MethodSecondary analyses of data from 589 families seeking outpatient mental health services, completing the Child Behavior Checklist and semi-structured diagnostic interviews.ResultsInternalizing 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.ConclusionsThis 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.

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