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Longitudinal Stability and Predictive Value of Socio/Emotional/Behavioral Screening in an Outpatient Pediatric

R Christopher Sheldrick1, Justin Birudavol2, Dina R Hirshfeld-Becker3

  • 1Department of Psychiatry (RC Sheldrick), UMass Chan School of Medicine, Worcester, Mass.

Academic Pediatrics
|December 14, 2024
PubMed

Insights

Three common social/emotional/behavioral (SEB) screeners show moderate longitudinal stability in pediatric care. Threshold selection significantly impacts sensitivity and specificity, requiring careful consideration for accurate screening.

Area of Science:

  • Pediatric health
  • Mental health screening
  • Behavioral science

Background:

  • Annual social/emotional/behavioral (SEB) screening is recommended for pediatric visits.
  • Existing SEB screeners have empirical support but limited data on longitudinal use.
  • Few studies evaluate the long-term performance of SEB screeners in clinical practice.

Purpose of the Study:

  • To analyze the longitudinal stability of three SEB screeners.
  • To evaluate the association between SEB screener results and ICD codes.
  • To inform the clinical application of SEB screening tools in pediatrics.

Main Methods:

  • Analysis of electronic health records (EHR) from 9153 children and adolescents across seven pediatric clinics.
  • Longitudinal assessment of three SEB screeners over a 3-year period.
  • Evaluation of screener stability using intraclass correlation coefficients (ICC) and association with ICD codes.

Main Results:

  • Moderate longitudinal stability was found for the Baby Pediatric Symptom Checklist (ICC=.57), Preschool Pediatric Symptom Checklist (ICC=.60), and Pediatric Symptom Checklist-17 (ICC=.69).
  • Positive predictive values ranged from 40-65% across various thresholds.
  • Higher thresholds increased specificity but decreased sensitivity, with a majority of ICD codes not predicted by positive screens.

Conclusions:

  • Common SEB screeners demonstrate longitudinal stability comparable to longer measures.
  • Recommended thresholds vary significantly across screeners, influencing diagnostic accuracy.
  • Careful selection of thresholds is crucial for optimizing SEB screening sensitivity and specificity in pediatric settings.
Abstract

Keywords:
mass screeningpediatricspsychopathology

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