The PSC-17: A brief pediatric symptom checklist with psychosocial problem subscales. A report from PROS and ASPN

Objective. Primary care practitioners often fail to recognize psychosocial problems in children. The Pediatric Symptom Checklist (PSC) is a validated parental-report screen for these problems, with more than a decade of use in a wide range of studies and practices. We used factor analysis to create a briefer version of the PSC, to find subscales for specific psychosocial problems, and to determine if the shorter instrument met criteria for validity. Settings and sample. The data were: (a) parental reports on 18,045 children seen in a national sample of primary care offices and (b) parental and child reports of 406 children seen in a hospital-based, mental health clinic. Design and methods. Primary care data: each participating clinician enrolled a consecutive sample of approximately 65 children aged 4-15 years presenting for non-emergency care in the presence of a parent or primary caretaker. Parents completed the PSC during the office visit. Mental health clinic data: children were recruited from outpatient and inpatient programs, school-based clinics, and community physicians. Results. We performed a cross-validated factor analysis on the PSC to determine whether we could shorten it and create subscales to screen for multiple dimensions of psychopathology. Results confirmed the existence of subscales for internalizing, attention, and externalizing problems. These subscales had strong face validity and high internal consistency. We then used the mental health clinic data to validate the subscales by computing receiver operating characteristic (ROC) curves against previously validated screening instruments. The ROC curves had good area under the curve statistics (range 0.83-0.89), with good sensitivities (0.77-0.87) and specificities (0.68-0.80) at the optimal cut-off points. Implications for practice. Clinicians looking for a brief parent screening tool may wish to use the PSC-17. A child's profile on the internalizing, externalizing, and attention subscales can provide clinicians with directions to pursue in further assessment of the children.