Scoring Instructions

Instructions for Scoring: The standard parent completed 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, 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. The total score is recoded into a dichotomous variable indicating psychosocial impairment or not. For children aged six through eighteen, the cut-off score is 28 or higher (28=impaired; 27=not impaired). For children ages 3-5, the scores on elementary school related items 5, 6, 17 and 18 are ignored and a total score based on the 31 remaining items is completed. The cutoff score for younger children is 24 or greater (Little et al., 1994; Pagano et al., 1996).

All forms of the PSC are scored in the same way although different cutoff scores have been recommended for some of the translations. For the Japanese version of the parent PSC 35, a cutoff score of 17 is recommended (Ishizaki et al., 2000). For the German form, the optimal cutoff has been found to be 24 (Thun-Hohenstein and Herzog, 2007). For the Dutch version, a cutoff of 25 is recommended (Reijneveld et al., 2006). For the Spanish and English versions of the pictorial PSC, the cutoff scores are the same as for the standard parent form. For the PSC-Y in English and Spanish, a cutoff score of 30 is recommended (Pagano et al., 2000). 

For the PSC-17, a total cutoff score of 15 has been recommended (Gardner et al., 2007). Subscale scores for internalizing, conduct, and attention problems can be calculated from specific items and cutoff scores indicating risk on each subscale can be found in (Borowsky et al., 2003). The clustering of these items and the cutoff scores are listed in Appendix 1 after the references below.
 
For the Chilean version of the PSC, subscales for both risk and protective factors are calculated. Detailed instructions for this coding can be obtained by contacting the author Dr. Maria Paz Guzman (mariapazguzman@gmail.com).

Pediatricians whose practices serve a distinct culture should begin by collecting data on a number of cases to ascertain the accuracy of a cutoff score of 28 for their population. If more than 25% or less than 5% of a given population screens positive, it may be especially important to consider using a different cutoff score..

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How to Interpret the PSC: A positive score on the PSC suggests the need for further evaluation by a qualified health (M.D., R.N.) or mental health (Ph.D, LICSW) professional. Both false positives and false negatives occur, and only an experienced clinician should interpret a positive PSC score as anything other than a suggestion that further evaluation may be helpful. Data from past studies using the PSC indicate that 2 out of 3 children who screen positive on the PSC will be correctly identified as having moderate to serious impairment in psychosocial functioning. The one child "incorrectly" identified usually has at least mild impairment, although a small percentage of children turn out to have very little actually wrong with them (e.g., an adequately functioning child of an overly anxious parent). Data on PSC-negative screens indicate 95% accuracy, which, although statistically adequate, still means that 1 out of 20 children rated as functioning adequately may actually be impaired. The inevitability of both false-positive and false-negative screens underscores the importance of experienced clinical judgment in interpreting PSC scores. Therefore, it is especially important for parents or other lay people who administer the form to consult with a licensed professional if their child receives a PSC-positive score.

Validity: Using a Receiver Operating Characteristic Curve, Jellinek and his colleagues ((Jellinek et al., 1988) found that a PSC cutoff score of 28 has a specificity of 0.68 and a sensitivity of 0.95 when compared to clinicians’ ratings of children’s psychosocial dysfunction. In other words, 68% of the children identified as PSC-positive will also be identified as impaired by an experienced clinician, and, conversely, 95% of the children identified as PSC-negative will be identified as unimpaired.  Similarly high rates of validity have been reported for the PSC-Y and for the translations of the PSC. This information can be found in the articles cited in the reference section below.

Reliability: Test-re-test reliability of the PSC ranges from r = .84 - .91. Over time, case/not case classification ranges from 83% - 87%.(Jellinek et al., 1988; Murphy et al., 1992).

Inter-item Analysis: Our studies (Murphy and Jellinek, 1988; Murphy et al., 1996) also indicate strong (Cronbach alpha = .91) internal consistency of the PSC items and highly significant (p < 0.0001) correlations between individual PSC items and positive PSC screening scores.

Qualifications for Use of the PSC: The training required may differ according to the ways in which the data are to be used. Professional school (e.g., medicine or nursing) or graduate training in psychology of at least the Master’s degree level would ordinarily be expected. However, no amount of prior training can substitute for professional maturity, a thorough knowledge of clinical research methodology, and supervised training in working with parents and children. There are no special qualifications for scoring.

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References

Borowsky, I. W., S. Mozayeny and M. Ireland (2003). "Brief psychosocial screening at health supervision and acute care visits." Pediatrics 112(1 Pt 1): 129-33.

Gardner, W., A. Lucas, D. J. Kolko and J. V. Campo (2007). "Comparison of the PSC-17 and alternative mental health screens in an at-risk primary care sample." Journal of the American Academy of Child & Adolescent Psychiatry 46(5): 611-618.

Ishizaki, Y., Y. Fukai, Y. Kobayashi and K. Ozawa (2000). "Validation and cutoff score of the Japanese version of the Pediatric Symptom Checklist: Screening of school-aged children with psychosocial and psychosomatic disorders (in Japanese)." The Journal of the Japan Pediatric Society 104: 831-840.

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

Murphy, J., H. Arnett, M. S. Jellinek, J. Y. Reede and S. J. Bishop (1992). "Routine Psychosocial Screening in Pediatric Practice: A Naturalistic Study with the Pediatric Symptom Checklist." Clinical Pediatrics 31: 660-667.

Murphy, J. M., C. Ichinose, R. C. Hicks, D. Kingdon, J. Crist-Whitzel, P. Jordan, G. Feldman and M. S. Jellinek (1996). "Utility of the Pediatric Symptom Checklist as a psychosocial screen to meet the federal Early and Periodic Screening, Diagnosis, and Treatment (EPSDT) standards: a pilot study." J Pediatr 129(6): 864-9.

Murphy, J. M. and M. Jellinek (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): 450-6.

Pagano, M. E., L. J. Cassidy, M. Little, J. M. Murphy and M. S. Jellinek (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.

Reijneveld, S. A., A. G. Vogels, F. Hoekstra and M. R. Crone (2006). "Use of the Pediatric Symptom Checklist for the detection of psychosocial problems in preventive child healthcare." BMC Public Health 6: 197-204.

Thun-Hohenstein, L. and S. Herzog (2007). "The predictive value of the pediatric symptom checklist in 5-year-old Austrian children." Eur J Pediatr.

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APPENDIX 1: Scoring the PSC 17 subscales

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Pediatric Symptom Checklist - 17

		Never	Sometimes	Often
		(0)	(1)	(2)
Attention problems   => 7
1	Fidgety, unable to sit still	_____	_____	_____
2	Daydreams too much	_____	_____	_____
3	Distracted easily	_____	_____	_____
4	Has trouble concentrating	_____	_____	_____
5	Acts as if driven by a motor	_____	_____	_____
Internalizing problems  => 5		_____	_____	_____
6	Feels sad, unhappy	_____	_____	_____
7	Feels hopeless	_____	_____	_____
8	Is down on him or herself	_____	_____	_____
9	Worries a lot	_____	_____	_____
10	Seems to be having less fun	_____	_____	_____
Externalizing problems  = > 7		_____	_____	_____
11	Fights with others	_____	_____	_____
12	Does not listen to rules	_____	_____	_____
13	Does not understand other people’s feelings	_____	_____	_____
14	Teases others	_____	_____	_____
15	Blames others for his or her troubles	_____	_____	_____
16	Refuses to share	_____	_____	_____
17	Takes things that do not belong to him/her	_____	_____	_____

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