Recent Revisions to the Children's Yale-Brown Obsessive-Compulsive Scale
The Children's Yale-Brown Obsessive-Compulsive Scale Second Edition (CY-BOCS-II) was developed in 2019 as a comprehensive revision of the original CY-BOCS, introducing structural and content modifications to improve psychometric properties and clinical utility in youth with OCD. 1
Key Structural Changes in CY-BOCS-II
Modified Item Structure
- The CY-BOCS-II eliminated one item from the original scale, allowing clinicians to obtain both original CY-BOCS and CY-BOCS-II scores in a single administration by adding item 4 to the CY-BOCS-II and then "back-coding" the ratings to generate corresponding original CY-BOCS scores. 2
- This design preserves comparability with the extensive existing literature while incorporating improvements from the revision. 2
Factor Structure Differences
- Exploratory factor analysis of the CY-BOCS-II revealed a 2-factor structure that differs from its adult counterpart (the Y-BOCS-II), reflecting developmental differences in how obsessive-compulsive symptoms manifest in youth versus adults. 1
- This finding contrasts with the original CY-BOCS validation studies and suggests the revision better captures the unique presentation of pediatric OCD. 1
Psychometric Performance of CY-BOCS-II
Reliability Metrics
- The CY-BOCS-II demonstrates moderate-to-strong internal consistency (Cronbach's α = 0.75-0.88) across all scales, which is comparable to the original CY-BOCS (α = 0.87). 1, 3
- Inter-rater reliability is excellent (intraclass correlation coefficient = 0.86-0.92), representing an improvement over the original CY-BOCS compulsions subscale (ICC = 0.68). 1, 3
- Test-retest reliability is outstanding (intraclass correlation coefficient = 0.95-0.98), indicating superior temporal stability compared to earlier versions. 1
Validity Evidence
- Construct validity is supported by strong correlations with clinician-rated OCD severity measures and moderate correlations with anxiety symptom measures, demonstrating appropriate convergent and divergent validity patterns. 1
- The validation sample included 102 youth aged 7-17 years from specialty OCD treatment centers, providing robust evidence for clinical populations. 1
Clinical Application Considerations
Assessment Requirements
- Clinicians must apply clinical expertise when using the content-independent CY-BOCS-II to correctly categorize obsessive-compulsive symptoms and differentiate them from other intrusive-thought disorders. 2
- The scale quantifies severity based on time spent on obsessions/compulsions, perceived distress levels, and degree of functional interference in daily activities. 4
Critical Pitfalls to Avoid
- Failure to assess family accommodation—such as reassurance or participation in rituals—can compromise the accuracy of interference ratings on the CY-BOCS-II, leading to potential underestimation of symptom severity. 2
- Avoidance behaviors can lead to underestimation of true symptom severity, as patients who extensively avoid triggering situations may spend less time on active obsessions/compulsions, artificially lowering scores despite severe functional impairment. 4
Severity Classification Framework
Score Interpretation
- The CY-BOCS-II maintains the same severity classification system as the original scale: 0-7 (subclinical), 8-15 (mild), 16-23 (moderate), 24-31 (severe), with scores ranging from 0-40. 4
- A total score of ≥28 indicates severe, treatment-refractory OCD in youth aged 8-18 years, serving as a threshold for considering intensified or alternative therapeutic strategies. 4
Treatment Monitoring
- A clinically meaningful treatment response is defined as a ≥35% reduction from baseline scores, applicable to both the original CY-BOCS and CY-BOCS-II. 2
- The scale has demonstrated sensitivity to change in telepsychiatry treatment studies, where youth with OCD showed significant improvement on CY-BOCS measures following internet-based therapy. 5