Pediatric Symptom Checklist- 35 (PSC-35)

Assessment Rating:
A
A – Psychometrics Well-Demonstrated
See entire scale
Developer(s):

Michael Jellinek, MD and J. Michael Murphy, EdD

Description / Purpose:

The PSC-35 is used to assess overall psychosocial functioning and to screen for problems overall and in the areas of attention, externalizing, and internalizing problems.

The original Pediatric Symptom Checklist (PSC) is a 35-item parent completed questionnaire that assesses a broad range of emotional and behavioral problems in children.  The PSC is used as a screen for psychosocial problems in pediatric well child visits, school enrollment, and entry into other systems of care for children from 4 to 18 years of age. With repeat administrations it is also used to assess changes in functioning over time. It has been validated for use with a wide range of pediatric and community populations in more than 200 studies over the past 30 years. The PSC is the recommended or required screen in several state Medicaid health insurance programs and in a national school mental health program in Chile.   A briefer version (PSC-17) and a youth self-report version (PSC-Y) have also been validated as have translations into two dozen languages.

Target Population: Children between the ages of 4-18 years

Time to Administer: Approximately 5 minutes

Completed By: Parents, youth

Modalities Available: Computerized, Pen and Paper, Online

Scoring Information: The parent-completed English PSC form consists of 35 items that are rated as: “Never”, “Sometimes”, or “Often” present and scored 0, 1, and 2, respectively. Item scores are summed so that the total score is calculated by adding together the score for each of the 35 items, with a possible range of scores from 0-70. If one to three items are left blank by parents, they are simply ignored (score = 0). If four or more items are left blank, the questionnaire is considered invalid. Total scores are re-coded dichotomously to indicate overall mental health risk based on a cutoff score of 28 or higher on the global scale. The PSC includes subscale scores for internalizing, externalizing and attention problems. The internalizing scale is composed of five questions; a total score >=5 indicates risk. The attention subscale is composed of five questions; a score >=7 indicates risk. The externalizing subscale is composed of seven questions; a total score >=7 indicates risk.

Languages Available: Arabic, Chinese, Dutch, English, French, German, Haitian Creole, Hebrew, Hindi, Italian, Japanese, Khmer, Malayalam (India), Portuguese, Spanish, Tagalog (Philippines)

Training Requirements for Intended Users: None.

Availability: The PSC-35 may be obtained free from Massachusetts General Hospital. Website: http://www.massgeneral.org/psychiatry/services/psc_home.aspx

Contact Information

Company: Massachusetts General Hospital
Website: www.massgeneral.org/psychiatry/services/psc_home.aspx
Name: J. Michael Murphy, EdD
Email:
Phone: (617) 724-3163
Fax: (617) 726-9216
Company: Massachusetts General Hospital
Website: www.massgeneral.org/psychiatry/services/psc_home.aspx
Name: Dr. Michael Jellinek
Email:
Phone: (617) 724-3163
Fax: (617) 726-9216

Summary of Relevant Psychometric Research

This tool has received the Measurement Tools Rating of "A – Psychometrics Well-Demonstrated" based on the published, peer-reviewed research available. The tool must have 2 or more published, peer-reviewed studies that have established the measure’s psychometrics (e.g., reliability and validity, sensitivity and specificity, etc.). Please see the Measurement Tools Rating Scale for more information.

Show relevant research...

Jellinek, M. S., Murphy, J. M, & Burns, B. J. (1986). Brief psychosocial screening in outpatient pediatric practice, Journal of Pediatrics, 109, 371-378.

Sample:

Participants — 206 parents of children ages 6-12 years

Race/Ethnicity — 99% White, 1% Hispanic

Summary:

This paper presents data from the first two studies designed to assess the acceptability, reliability, and validity of the revised PSC as a psychosocial screening questionnaire in outpatient pediatric practice. The validity of the PSC was assessed by ascertaining its rate of agreement with the Child Behavior Checklist (CBCL) in screening cases. Preliminary studies indicate that the PSC correlates well with the CBCL, is reliable, and is an easily administered psychosocial screening instrument for children seen in pediatric settings. Within the outpatient pediatric practices studied, the PSC agreed with the longer CBCL in 89% of the cases in classifying children as well or at risk. When the two instruments disagreed, most of the scores were close to the cutoff.

Jellinek, M. S., Murphy, J. M., Robinson, J., Feins, A., Lamb, S., & Fenton, T. (1988). The Pediatric Symptom Checklist: Screening school-age children for psychosocial dysfunction. Journal of Pediatrics, 112,, 201-209.

Sample:

Participants — Not Specified

Race/Ethnicity — Not Specified

Summary:

The PSC is a 35-item parent-rating scale. The respondent is asked to rate the frequency with which a child exhibits a given behavior. Response format is from 0 ("never") to 2 ("often"). The authors state that the scale is appropriate for use with children 4-16, although the majority of the PSC validation studies have not included children older than 12. It should also be noted that when used with preschoolers, the four PSC items that rate school behavior problems are not included. A total score on the PBS is obtained by summing all items. A cut-off score of 28 is used to identify school-aged children at risk for psychosocial difficulties and a cut-off score of 24 is used for preschoolers. A self-report version of the PSC, the PSC-Y, is also available for adolescents. Use of a cut-off score of 30 on the PSC-Y is recommended to identify adolescents with mental health problems.

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,, 450-456.

Sample:

Participants — 300 pediatric outpatients, aged 6 to 12 years

Race/Ethnicity — Not Specified

Summary:

This study assessed the validity and reliability of the Pediatric Symptom Checklist (PSC) for screening lower-middle-class and minority group children. PSCs were collected from parents of 300 pediatric outpatients aged six to 12 years and 48 of these children and their parents were interviewed in depth. The rate of positive screening was higher for poorer children. Comprehensive interview evaluations and statistical indices suggested that this higher rate was valid. These results indicate that children from minority and lower-middle-class backgrounds were screened as positive on the PSC from 43% to 85% more frequently than nonminority and middle-class children. Although these differences were not statistically significant, the effects were of approximately the same order of magnitude as had been reported for these variables in other studies.

Murphy, J. M., Jellinek, M. J., & Milinsky, S. (1989). The Pediatric Symptom Checklist: Validation in the real world of the junior high school. Journal of Pediatric Psychology, 14, 629-639.

Sample:

Participants — Not specified

Race/Ethnicity — Not Specified

Summary:

This study examined the validity of the Pediatric Symptom Checklist (PSC), a brief parent-completed psychosocial screening questionnaire, in a sample of 166 students from a public middle school. Positive screening on the parent PSC was significantly associated with independent ratings by the students' guidance counselor and teachers of the need for regular counseling; any academic failure during the next 2 years; and PSCs competed by the students about themselves. Most students who screened positive on the parent PSC were found to have significant problems in at least one of the above areas. The PSC also identified a group of students whose difficulties were previously unknown to school personnel.

Walker, W. O., Lagrone, R. G., & Atkinson, A. W. (1989). Psychosocial screening in pediatric practice: identifying high risk children. Journal of Developmental and Behavioral Pediatrics, 10, 134-148.

Sample:

Participants — Not specified

Race/Ethnicity — Not Specified

Summary:

The purpose of this study was to evaluate the effectiveness of the Pediatric Symptom Checklist (PSC) as a psychosocial screening instrument. Using the PSC, the researchers screened 212 patients, ages 6-12 years, at a military outpatient pediatric clinic. Twenty-one children with scores in the "high-risk" range were randomly selected and matched with children scoring in the normal, "not-high-risk" range. Two trained interviewers, blind to individual PSC scores, independently interviewed and rated each subject's level of psychosocial functioning on the Children's Global Assessment Scale (CGAS). The Child Behavior Checklist (CBCL), a standardized psychosocial measure, was also completed by each subject's mother. PSC scores were compared to the CGAS and CBCL scores in terms of sensitivity and specificity. Additional analyses compared data from the study sample with that of previous studies. Results suggest that the PSC is a valid pediatric psychosocial screening instrument for multiethnic patient populations.

Murphy, J. M., Reede, J., Jellinek, M. S., & Bishop, S. J. (1992). Screening for psychosocial dysfunction in inner city children: Further validation of the Pediatric Symptom Checklist. Journal of the American Academy of Child and Adolescent Psychiatry, 31, 221-233.

Sample:

Participants — 123 outpatient, 6-12 years

Race/Ethnicity — Not Specified

Summary:

Children at an inner-city pediatric clinic was screened for psychosocial dysfunction using the Pediatric Symptom Checklist (PSC), a brief parent-completed questionnaire. The prevalence of positive screening scores on the PSC was 22%, significantly higher than the rate found in lower middle to upper middle-class samples. Comparing PSC case classifications with comprehensive assessments made by clinicians, overall agreement was 92% (K = 0.82; sensitivity = 88%; specificity = 100%); a comparison with several other measures provided additional support for the validity of the PSC. The PSC's reliability over time was also acceptable. These findings provide preliminary evidence that the PSC is as valid and reliable for screening children from economically disadvantaged and minority backgrounds as it is for middle and upper middle-class populations.

Murphy, J. M., Arnett, H., Jellinek, M. S., Reede, J. Y., & Bishop, S. J. (1992). Routine psychosocial screening in pediatric practice: a naturalistic study with the Pediatric Symptom Checklist. Clinical Pediatrics, 31, 660-667.

Sample:

Participants — Not specified

Race/Ethnicity — Not Specified

Summary:

This study examined the routine implementation of the Pediatric Symptom Checklist (PSC), a brief questionnaire which screens for psychosocial dysfunction in school-aged children in an outpatient pediatric practice. Results indicated that the PSC was well-accepted by parents and adequately tolerated by busy clinic staff. When the PSC was included as part of the standard procedure for well-child visits, the referral rate for psychosocial problems due to positive PSC scores rose to 12% from the clinic baseline referral rate of 1.5%, a significant increase (P<.01). Half of the children who screened positive on the PSC had not been previously identified by their pediatricians as having psychosocial problems, and more than half had never received any psychological treatment. When implementation of the PSC was discontinued, the referral rate fell to 2%, a rate similar to baseline. The findings suggest that it is possible to incorporate the PSC into routine pediatric practice and that the PSC can help pediatricians identify and better serve children experiencing psychosocial difficulties. The study also suggests that further work is needed to understand the barriers to ongoing implementation.

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), 254-260.

Sample:

Participants — 21,065 children between the ages 4-15 years

Race/Ethnicity — Not Specified

Summary:

The purpose of this study was to assess the feasibly of routine psychosocial screening using the Pediatric Symptom Checklist (PSC) in pediatrics by using a brief version of the checklist in a large sample of representative of the full range of pediatric practice setting in the United States and Canada. Results indicate the overall rate of prevalence of psychosocial dysfunction as measured by the PSC in school-aged and preschool-aged pediatric outpatients (13% and 10%, respectively) were nearly identical to the rates that had been reported in several similar samples (12%-14% among school aged children and 7-14% among preschoolers). Consistent with previous findings children from low-income families were twice as likely to be scored as dysfunctional on the PSC than were children from higher-income families. Similarly, children with a single parent as opposed to those from 2-parent families, and children with a past history of mental health services, showed an elevated risk of psychosocial impairment.

Date Reviewed: October 2017 (Originally reviewed in October 2017)