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The Pediatric Symptom Checklist (PSC) is a 35-item screening questionnaire designed to identify children with difficulties in psychosocial functioning. It primarily measures inner distress and mood, interpersonal relations, and attention. The first checklist was a modification of the Washington Symptom Checklist developed by Weinberger and Gregory in 1968.[1] The PSC is a parent-report assessment designed for use in outpatient pediatric practices. It is not a diagnostic tool — a positive result indicates that the child in question requires further evaluation.[2]
Structure
The PSC was designed because none of the available instruments offered the “optimal combination of efficiency, ease of administration, and screening accuracy” (p.451). [3] The first draft was a shortened and revised form of the Washington Symptom Checklist (WSCL) designed by Weinburger and Gregory. The researchers shortened the WSCL from 67 to 27 questions and removed open-ended questions. They also removed and revised questions to address the five major areas they wanted to review: mood, play, school, friends, and family relations.[1] The PSC was further revised based on “the symptoms of the major diagnoses for children listed in the American Psychiatric Association DSM-III, the clinical impressions of several pediatricians, psychologists, and child psychiatrists, and a review of items from other questionnaires reported to be the most useful in identifying children with emotional problems” (p. 372). [4]
The current PSC contains 35 statements focused on the child’s day-to-day behavior and mood. [2] Parents are asked to indicate how frequently each of the statements, referred to as symptoms, describes the child, with response options of "never", "sometimes", and “often”. Examples of statements include “feels he or she is bad,” “teases others,” and “is distracted easily.” The questionnaire takes 3-5 minutes to complete. [4] The original study of the current PSC focused on children between 6 and 12 years old, but the checklist has been studied and validated in all age groups between 4 and 16 years. [5] [6] [7]
Scoring and interpretation
The PSC is scored by assigning point values to the ratings: 2 = “often”, 1 = “sometimes”, and 0 = “never”. The points are summed for a total score, with possible scores ranging from 0 to 70.[8] An overall score above the cutoff point indicates need for further assessment. The cutoff score for children older than 6 years old is 28.[4] For children younger than 6 years old, four items that pertain to school are excluded. As a result, the range of scores is lower and the cutoff score is lowered to 24. [8]
If a child obtains a score above the cutoff, the pediatrician would review the questionnaire, explore any apparent problem areas, determine the severity of dysfunction, and then decide on what type of follow-up is appropriate: no follow-up needed, treatment already being received, follow-up by pediatrician, or referral to mental health professional.[4]
Versions
There are four versions of the PSC, including a full-length parent-report form (PSC), a full-length youth self-report form (Y-PSC), a shortened parent-report form (PSC-17), and a shortened youth self-report form (Y-PSC-17).
Y-PSC
The Y-PSC was designed to screen adolescents for psychosocial problems in school settings. It was adapted from the PSC by changing relevant pronouns and verbs. For instance, the statement “takes things that do not belong to him or her” was changed to “take things that do not belong to you” and the statement “worries a lot” was changed to “worry a lot”. The recommended cutoff score is 30 and it has the same number of items as the PSC. As a self-report measure, it is useful for identifying symptoms of internalizing disorders, such as anxiety or depression, which are missed by parents (Pagano 2000).
PSC-17
The PSC-17 is a shortened, 17-item version of the PSC. It also includes three sub-scales, internalizing, externalizing, and attention, which were designed to provide physicians with more information about directions for evaluation. Parents respond to statements with ratings on the same scale as the PSC. These ratings are converted to a total score and sub-scale scores. The cut-off for the total score, internalizing problems scale, externalizing problems scale, and attention problems scale are 15, 5, 7, and 7, respectively. As on the PSC, a score above the cutoff is not diagnostic; it indicates only that further evaluation is needed (Gardner 1999).
Y-PSC-17
The Y-PSC-17 was adapted from the PSC-17 for self-report by adolescents. It has not been validated. (Duke 2005).
Psychometrics
Reliability
Validity
Impact
Use in other populations
Limitations
Y-PSC
As a self-report measure for children and adolescents, the Y-PSC is subject to some limitations: respondents may misunderstand questions, especially those with learning or attentional problems, and children may under- or over-report their symptoms (Pagano 2000).
References
- ^ a b Jellinek, M.; Evans, N.; Knight, R. B. (1979). "Use of a behavior checklist on a pediatric inpatient unit". The Journal of Pediatrics. 94 (1): 156–158. doi:10.1016/S0022-3476(79)80386-8.
- ^ a b Jellinek, M. S.; Murphy, J. M.; Robinson, J.; Feins, A.; Lamb, S.; Fenton, T. (1988). "Pediatric symptom checklist: Screening school-age children for psychosocial dysfunction". Journal of Pediatrics. 112 (2): 201–209. doi:10.1016/S0022-3476(88)80056-8.
- ^ Murphy, J. M.; Jellinek, M. S. (1988). "Screening for psychosocial dysfunction in economically disadvantaged and minority-group children: Further validation of the pediatric symptom checklist". American Journal of Orthopsychiatry. 58 (3): 450–456. doi:10.1111/j.1939-0025.1988.tb01605.x.
- ^ a b c d Jellienk, M. S.; Murphy, J. M.; Burn, B. J. (1986). "Brief psychosocial screening in outpatient pediatric practice". The Journal of Pediatrics. 109 (2): 371–378. doi:10.1016/S0022-3476(86)80408-5.
- ^ Jellinek, M. S.; Murphy, J. M.; Little, M.; Pagano, M. E.; Comer, D. M.; Kelleher, K. J. (1999). "Use of the pediatric symptom checklist to screen for psychosocial problems in pediatric primary care: A national feasibility study". Archives of Pediatrics & Adolescent Medicine. 153 (3). doi:10.1001/archpedi.153.3.254.
- ^ Little, M.; Murphy, J. M.; Jellinek, M. S.; Birshop, S. J.; Arnett, H. L. (1994). "Screening 4- and 5-year-old children for psychosocial dysfunction: A preliminary study with the pediatric symptom checklist". Journal of Developmental and Behavioral Pediatrics. 15 (3): 191–197. doi:10.1097/00004703-199406000-00007.
- ^ Murphy, J. M.; Arnett, H. L.; Bishop, S. J.; Jellinek, M. S.; Reede, J. Y. (1992). "Screening for psychosocial dysfunction in pediatric practice: A naturalistic study of the pediatric symptom checklist". Clinical Pediatrics. 31 (11): 660–667. doi:10.1177/000992289203101104.
- ^ a b c Pagano, M.; Murphy, J. M.; Pedersen, M.; Mosbacher, D.; Crist-Whitzel, J.; Jordan, P.; Rodas, C.; Jellinek, M. S. (1996). "Screening for psychosocial problems in 4-5-year-olds during routine EPSDT examinations: Validity and reliability in a Mexican-American sample". Clinical Pediatrics. 35 (3): 139–146. doi:10.1177/000992289603500305. Cite error: The named reference "Pagano 1996" was defined multiple times with different content (see the help page).
- ^ Pagano, M. E.; Cassidy, L. J.; Little, M.; Murphy, J. M.; Jellinek, M. S. (2000). "Identifying psychosocial dysfunction in school-age children: The pediatric symptom checklist as a self-report measure". Psychology in the Schools. 37 (2): 91–106. doi:10.1002/(SICI)1520-6807(200003)37:2<91::AID-PITS1>3.0.CO;2-3.
- ^ Reijneveld, S. A.; Vogels, A. G. C.; Hoekstra, F.; Crone, M. R. (2006). "Use of the pediatric symptom checklist for the detection of psychosocial problems in preventive child healthcare". BMC Public Health. 6. doi:10.1186/1471-2458-6-197.
{{cite journal}}: CS1 maint: unflagged free DOI (link) - ^ Thun-Hohenstein, L.; Herzog, S. (2008). "The predictive value of the pediatric symptom checklist in 5-year-old Austrian children". European Journal of Pediatrics. 167 (3): 323–329. doi:10.1007/s00431-007-0494-z.
- ^ Jutte, D. P.; Burgos, A.; Mendoza, F.; Ford, C. B.; Huffman, L. C. (2003). "Use of the pediatric symptom checklist in a low-income, Mexican American population". Archives of Pediatrics & Adolescent Medicine. 157 (12): 1169–1176. doi:10.1001/archpedi.157.12.1169.