SYSTEMS: School-Years Screening Test for the Evaluation of Mental Status

This paper introduces the School-Years Screening Test for Evaluation of Mental Status (SYSTEMS). It was designed to be used by neurologists, pediatricians, and other health professionals assessing children with suspected cognitive problems or changes. SYSTEMS was initially based on the adult Mini-Mental State Examination developed by Folstein, Folstein, and McHugh in 1975. SYSTEMS is a 7- to 12-minute, one-on-one interview test containing 46 items for use in children between 5 and 12 years of age. Although a full diagnosis cannot be made, the results do provide an indication of whether to send a child for further detailed cognitive assessment. The development of SYSTEMS comprised seven studies with a total of 1207 children involved from Sydney primary schools and neurology clinics of the New Children's Hospital, Westmead, New South Wales, Australia. All children were administered the SYSTEMS. Some of the children also were administered the Stanford-Binet Intelligence Test, 4th edition, or the Differential Ability Scales. Results showed that the SYSTEMS was internally consistent, unbiased by sex, socioeconomic indicators, or language groups; discriminated well by age; and strongly correlated (r = 0.88) with mental age. No significant differences in results obtained by two trained administrators were evident and no indication of apparent practice effect was found. The SYSTEMS was found to have desirable levels of sensitivity (83% and 92%), specificity (76% and 95%), and likelihood ratio for cognitive impairment (3.63 and 17.5) when compared with neurologic judgments and the Differential Ability Scales, respectively.