Use of the pediatric symptom checklist in a low-income, Mexican American population

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 <$20000 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.