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Use of the Pediatric Symptom Checklist in a Low-Income, Mexican American Population
Douglas P. Jutte, MD, MPH;
Anthony Burgos, MD, MPH;
Fernando Mendoza, MD, MPH;
Christine Blasey Ford, PhD;
Lynne C. Huffman, MD
Arch Pediatr Adolesc Med. 2003;157:1169-1176.
Objective To evaluate the usefulness of the Pediatric Symptom Checklist (PSC) in identifying behavioral problems in low-income, Mexican American children.
Design A cross-sectional study design was used to examine the PSC as a screening test, with the Child Behavior Checklist (CBCL) as the criterion standard.
Setting The study was conducted at a health center in a diverse low-income community.
Patients Eligible patients were children and adolescents, 4 to 16 years of age, who were seen for nonemergent, well-child care. Of 253 eligible children during a 9-month study period, 210 agreed to participate in the study. There was a 100% completion rate of the questionnaires. The average age of the children was 7.5 years, and 45% were female. Ninety-five percent of patients were of Hispanic descent (Mexican American); 86% of families spoke only Spanish. Socioeconomic status was low (more than three fourths of families earned <$20 000 annually).
Results The CBCL Total scale determined that 27 (13%) of the children had clinical levels of behavioral problems. With a cutoff score of 24, the PSC screened 2 (1%) of the 210 children as positive for behavioral problems. Using the CBCL as the criterion standard, the PSC sensitivity was 7.4%, and the specificity was 100%. Receiver operator characteristic analysis determined that a PSC cutoff score of 12 most correctly classified children with and without behavioral problems (sensitivity, 0.74; specificity, 0.94).
Conclusions When using the PSC, a new cutoff score of 12 for clinical significance should be considered if screening low-income, Mexican American children for behavioral problems. Additional study is indicated to determine the causes of the PSC's apparently lower sensitivity in Mexican American populations.
From the Departments of Pediatrics (Drs Jutte, Burgos, Mendoza, and Huffman) and Psychiatry and Behavioral Sciences (Dr Ford), Stanford University School of Medicine, and Outcomes Measurement and Research Department, The Children's Health Council (Dr Huffman), Palo Alto, Calif.
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