Systematic review: Classification accuracy of behavioral screening measures for use in integrated primary care settings

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.