Systematic Review

Classification Accuracy of Behavioral Screening Measures for Use in Integrated Primary Care Settings

John V. Lavigne, PHD; Kathryn Mendelsohn Meyers, PHD; Marissa Feldman, PHD


J Pediatr Psychol. 2016;41(10):1091-1109. 

In This Article

Abstract and Introduction


Objective To examine the classification accuracy of measures of overall psychopathology recommended for pediatric primary care screening.

Method A systematic review identified relevant instruments described in the literature. Subsequent systematic reviews identified studies of sensitivity (SE) and specificity (SP) of each measure for various cutoffs and different criteria for disorder (e.g., caseness determined by structured interview, exceeding a cutoff score, referral for psychiatric evaluation).

Results Measures include the Child Behavior Checklist (CBCL), Pediatric Symptom Checklist (PSC), Strengths and Difficulties Questionnaire (SDQ), Brief Infant-Toddler Social Emotional Assessment (BITSEA), and the Ages and Stages Questionnaire: Social-Emotional scale (ASQ:SE). For three measures (CBCL, PSC, and SDQ) studied extensively, achieving relatively high SE and SP values (≥ .70) simultaneously occurred in only 30–55% of the studies reviewed. There are relatively few studies of the ASQ:SE and BITSEA, or of relatively new measures.

Discussion Documented utility of these measures as screening instruments is limited.


The importance of identifying children and adolescents with emotional or behavioral problems in pediatric primary care settings has long been recognized, but the Affordable Care Act (ACA) (U\.S\. Department of Health and Human Services, 2010) has placed increased emphasis on doing so. During health maintenance visits, physicians must address a wide variety of concerns, including matters of health, growth, and development, as well as issues concerning mental health. Therefore, it is not surprising that their ability to identify emotional and behavioral problems of their patients is suboptimal (Costello et al., 1988; Lavigne et al., 1993).

Experts have frequently recommended that screening instruments be used in pediatric primary care to help identify psychiatric problems (Marks & Larosa, 2012; Simonian, 2006; Stancin & Palermo, 1997). For screening to be effective, the screening instrument must be of high quality. This report reviews available studies of the classification accuracy of parent-report measures of children's emotional or behavioral problems. The focus is on measures designed to identify a wide variety of emotional or behavioral problems, i.e., on "general" or "any" disorder or problem area, rather than a specific disorder. This is done for several reasons: (a) the ACA encourages screening for general disorders as well as specific ones; (b) several existing measures have been designed to screen for "any" disorder; and (c) it is not feasible in a single report to address measures for specific disorders as well as general disorders. The purpose of this review is not to make a recommendation about which of these various measures is superior. The measures differ in important ways, including length of the questionnaire and time needed to complete, ease of scoring, age of the target population, and costs. Although all of these factors are important, classification accuracy of the available measures is the focus of this report.