title: Persistence and change in pediatric symptom checklist scores over 10 to 18 months.
abstract: OBJECTIVE
  There are many studies of the Pediatric Symptom Checklist (PSC), but none has followed a naturalistic sample longitudinally. We aimed to examine persistence and change in PSC scores over time in children seen in an ambulatory pediatric setting.
  
  
  METHODS
  The sample of 1033 patients was PSC screened at 2 consecutive preventive care visits (10 to 18 months apart) in 2 pediatric clinics. Longitudinal analyses were conducted to assess predictors of change in PSC category and score.
  
  
  RESULTS
  Approximately 30% of the initially screened population did not return for preventive pediatric care. Those who did not return were significantly more likely to have positive PSC scores than those who returned (8% compared with 4.3%, P < .01). PSC scores were highly stable at visit 2 for those who initially scored negative, but they fluctuated more for those who initially scored positive. After controlling for sociodemographic variables and counseling at either visit, referral at visit 1 (P < .0001) predicted changes in mean PSC scores at visit 2. On average, PSC score decreased 3.2 points among those referred at visit 1 but increased 1.6 points in nonreferred children.
  
  
  CONCLUSIONS
  This is the first study to document the stability and change in PSC scores in a sample of ambulatory pediatric patients. The statistically significant association between pediatrician referral and improved PSC scores provides evidence for the value of referral in primary care, although the study did not examine the relationship between PSC screening and referral. The high rate of positive scores in children who did not return for follow-up suggests the need for alternative strategies for this population.
authors.affiliation: Institute for Community Health, Cambridge Health Alliance, 163 Gore Street, Cambridge, Massachusetts 02141, USA. khacker@challiance.org
authors.forename: Karen A
authors.initials: KA
authors.lastname: Hacker
authors.forename: Sandra
authors.initials: S
authors.lastname: Williams
authors.forename: Enkhbolor
authors.initials: E
authors.lastname: Myagmarjav
authors.forename: Howard
authors.initials: H
authors.lastname: Cabral
authors.forename: Michael
authors.initials: M
authors.lastname: Murphy
mesh_terms: D000293:Adolescent; D000553:Ambulatory Care / Q000706:statistics & numerical data*; D002648:Child; D002653:Child Behavior Disorders / Q000175:diagnosis* / Q000453:epidemiology; D002662:Child Health Services / Q000706:statistics & numerical data*; D002675:Child, Preschool; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D015994:Incidence; D016014:Linear Models; D008297:Male; D008403:Mass Screening / Q000379:methods; D015999:Multivariate Analysis; D010372:Pediatrics / Q000379:methods / Q000592:standards*; D011336:Probability; D011581:Psychological Tests; D012017:Referral and Consultation / Q000706:statistics & numerical data; D018570:Risk Assessment; D012920:Social Behavior Disorders / Q000175:diagnosis / Q000453:epidemiology; D012959:Socioeconomic Factors; D013997:Time Factors