A Study of the Psychometric Properties of the Pediatric Symptom Checklist- 17 Used in Primary Care for Children with Developmental Delays and Disorders
Background: Primary care physicians (PCPs) frequently see pediatric patients with developmental delays and developmental disorders (DD/D) during well child checks. PCPs who operate within organizations that have adopted a collaborative behavioral health model are well-positioned to regularly screen for psychosocial symptomatology among this population because they have regular access both to behavioral health clinicians (e.g., psychologists, social workers) and to patients; are often viewed as authority figures by parents; and generally have longstanding relationships and involvement in children’s care throughout the developmental period. Psychosocial screening is particularly important for youth with DD/D because of the high rate of co-occurring behavioral and emotional difficulties common to this population. While the most widely used primary care psychosocial screener, the Pediatric Symptom Checklist-17 (PSC-17), is validated for use with typically developing children, it has been unclear whether this measure accurately identifies psychosocial comorbidities for pediatric patients with DD/D. Purpose: The present study assessed the accuracy of the PSC-17 for identifying psychosocial impairment in children with DD/D. Evaluating the psychometric properties of this instrument when used with this population was the overarching purpose of this study. Thus, the following research question was addressed: does the PSC-17 accurately identify psychosocial concerns among pediatric patients with DD/D? Methods: Data collected from 3,596 pediatric patients at a primary care clinic affiliated with a large hospital system in metropolitan Texas were analyzed for this study; 174 of these patients had DD/D (e.g., global and specific developmental delays and/or developmental disorders [e.g., autism spectrum disorder [ASD], intellectual disability]) at the time of PSC-17 administration. Descriptive analyses, measurement invariance testing, internal consistency evaluations, sensitivity and specificity calculations, and receiver operating characteristic (ROC) analyses were conducted to assess the psychometric properties of the PSC-17 and address the aforementioned research question. Results: Descriptive statistics showed that sample demographics regarding DD/D and psychosocial diagnosis and impairment aligned with prior studies which used larger, national samples. Hierarchical confirmatory factor analyses (CFAs) supported measurement invariance for children with DD/D compared to children of typical development. Internal consistency of the PSC-17 was adequate-to-strong for children with and without DD/D. However, the sensitivity and specificity results as well as the ROC analyses were inconsistent with prior studies of the PSC-17, likely due to the use of psychosocial diagnoses as true positives. Conclusions: The results of the descriptive, measurement invariance, and descriptive analyses support the use of the PSC-17 for universal primary care screening for all children, including those with DD/D. Replication of the findings related to the descriptive statistics, measurement invariance, and the internal consistency analyses will enhance confidence that the PSC-17 can validly and reliably identify psychosocial impairment in children with DD/D. Future studies should continue to examine PSC-17 psychometric properties for children with DD/D in order to address the limitations of the sensitivity and specificity calculations and ROC analyses. Accurate psychosocial screening in children with DD/D is critical, because the timely and accurate identification of psychosocial comorbidities in those with DD/D can facilitate early and accurate intervention needs and recommendations, which ultimately may enhance long-term functioning of children with DD/D and their families.