The assessment of paranoia in young people: Item and test properties of the Bird Checklist of Adolescent Paranoia

Background: Precise assessment tools for psychotic experiences in young people may help identify symptoms early and facilitate advances in treatment. In this study we provide an exemplar - with a paranoia scale for youth – for improving measurement precision for psychotic experiences using item response theory (IRT). We evaluate the psychometric properties of the new measure, test for measurement invariance, and assess its potential for computerised adaptive testing (CAT). Method: The 18-item Bird Checklist of Adolescent Paranoia (B-CAP) was completed by 1103 adolescents including patients with mental health problems (n=302) and those from the general population (n=801). IRT was used to examine the item properties, test reliability, and measurement invariance. The efficiency of an adaptive B-CAP was assessed in a simulation of 10,000 responses.Results: All B-CAP items were highly discriminative (a=1.15-2.76), whereby small shifts in paranoia led to a higher probability of item endorsement. Test reliability was high (a>0.90) across a wide range of paranoia severity (θ= -0.46-3.36). All items were invariant for gender, age, and population groups. Test-retest reliability was good (r=0.95). The simulated adaptive B-CAP performed with high reliability with an average of 10.9 items and only 5-6 items at higher levels of paranoia severity. Conclusions: The B-CAP is a reliable assessment tool with excellent psychometric properties to assess both non-clinical and clinical levels of paranoia in young people, with potential as an efficient adaptive test. In future, these approaches could be used to develop a multidimensional CAT to assess the full range of psychotic experiences in youth