Measuring behaviour in children with high cholesterol levels
CMAJ 1997;157:372
Re: "Cholesterol screening of children at high risk: behavioural and psychological effects" (CMAJ 1997;156:489-96 [abstract / résumé]) by Dr. Ellen Rosenberg and associates
In response to: D.P. Joyce & M.M. Limbos
We acknowledge that the lack of a baseline score limits our ability to attribute the behaviour problems reported by the mothers of children with newly diagnosed hyperlipidemia to the diagnosis. Dr. Joyce and Ms. Limbos are also concerned that the 6-month period during which the parent is asked to report on the child's behaviour includes many months before diagnosis. Although parents may attempt to review the entire 6 months, they are likely to recall recent events more clearly and to give more weight to them in their replies. Second, data were collected 1 month after the definitive diagnosis, but this diagnosis was the culmination of an extended evaluation process which, in one of the hospitals, involved 4 visits to the clinic. Therefore, the diagnosis was at least a strong possibility for much of the 6 months before the first CBCL was completed. Finally, these concerns do not apply to the cases of long-term hyperlipidemia.
The second issue concerns the omission of the social competence section. We decided to omit this section because our primary interest was in psychological and behavioural problems. The social competence section was also omitted in the interests of time; as it was, each mother spent more than an hour completing questionnaires. The social competence of these children is certainly of interest and concern.
Finally, we feel that a division of CBCL scores into high ("clinical range") and normal is the most meaningful way of examining data on a group of children in a research study. We agree that a score near the cut-off point needs to be interpreted within the whole clinical context when treating an individual child. Yet we know that children with scores in the clinical range are much more likely than those with normal scores to have behavioural problems that cause important difficulties in their lives. It is true that the clinical significance of a mean score of 62 in one group versus 64 in another group is not at all clear.
A larger-than-normal proportion of our subjects had behavioural problems. This is a cause for concern and needs to be assessed in other populations before widespread lipid screening can be recommended.
Ellen Rosenberg, MD
Associate Professor
Department of Family Medicine
McGill University
Montreal, Que.
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