Performance of screening tools for mental health problems in chronically ill children

We examined the sensitivity, specificity, positive predictive value, and negative predictive value of three different screens for child and adolescent emotional and behavioral disorders among a large group of chronically medically ill children and adolescents. The performance of the Child Depression Inventory (CDI), Pediatric Symptom Checklist (PSC), and Child Behavior Checklist (CBCL) in detecting emotional or behavioral disorders was compared with the diagnoses obtained by an intensive structured psychiatric interview (Diagnostic Interview Schedule for Children, Version 2.1) of 112 children and adolescents with chronic medical conditions, and their parents, recruited from a tertiary-care medical center. The CDI, PSC, and CBCL all demonstrated low sensitivity, positive predictive value, and negative predictive value, but high specificity. We conclude that these three commonly used screening tests performed poorly as screens because of their low sensitivity among children and adolescents with chronic medical conditions. The CDI, PSC, and CBCL should not be relied on as screening instruments for psychopathologic conditions in children and adolescents with chronic medical conditions. Although the screening measures studied may confirm a clinician's concern, the negative findings of this study suggest their use may be misleading and undermine the pediatrician's clinical judgment.