Comparison of behavioral screening tests commonly used in primary care

	Ages & Stages - Social and Emotional, Second Edition^[1]	Conners - 3^[2]	Moods and Feelings Questionnaire^[3,4]	Pediatric Symptom Checklist - 17^[5,6]	Pediatric Symptom Checklist - 35^[6-8]	Pediatric Symptom Checklist - Youth Report^[6,9]	Strengths and Difficulties Questionnaire^[10]
Considerations related to patient population
Ages	1 to 72 months	Caregiver and teacher questionnaires – 6 to 18 years Self-report – 8 to 18 years	8 to 18 years	6 to 18 years	3 to 5 years (with some questions removed) 6 to 18 years	11 to 18 years	3 to 16 years
Domains	Self-regulation Compliance Communication Adaptive functioning Autonomy Affect Interactions with people	Inattention Hyperactivity/impulsivity Learning problems Executive functioning Defiance/aggression Peer/family relations DSM-5 symptoms scales: ADHD inattentive ADHD hyperactive-impulsive Conduct disorder Oppositional defiant disorder	Depression	Emotional and behavioral problems	Emotional and behavioral problems	Emotional and behavioral problems	Emotional symptoms Conduct problems Hyperactivity/inattention Peer relationship problems Prosocial behavior
Time to complete	10 to 15 minutes	20 minutes	5 to 10 minutes	2 minutes	Under 5 minutes	2 minutes	10 minutes
Reading level	Fourth to sixth grade	Caregiver and teacher – Fourth to fifth grade Self-report – Third grade	–	Fifth to sixth	–	–	–
Available languages	English Spanish French Arabic	English Spanish French	Arabic (Modern Standard) Arabic (Iraq) Filipino Finnish German Norwegian Portuguese Spanish	Chinese English Spanish Vietnamese Norwegian	English and multiple other languages	English Spanish Haitian-Creole Setswana French Portuguese (Brazilian American)	English and multiple other languages
Additional information	Can be used with ASQ3 for comprehensive developmental-behavioral screening	–	Also available as adult self-report	–	Pictorial version with subtitles available in English, Spanish, and Filipino	17 question youth self-report in English and Spanish available, but has not been validated	–
Considerations related to practice characteristics
Description	Approximately 30 questions (varies with age)	Full length – 99 to 115 items Short form – 41 to 45 items ADHD index – 10 items	Descriptive phrases with 3-point Likert scale Long form – 33 to 34 phrases Short form – 13 phrases Includes child self-report (long and short form) and caregiver report (long and short form)	17 items	35 items	35 items (self-report)	25 questions completed by parent, teacher, or self-report in 11- to 16-year olds
Determination of positive/negative result	3 results: No or low risk – Development appears appropriate "Monitor" zone – Review concerns and monitor "Cutoff" – Above the cutoff means referral recommended	Provides T-scores*	Suggested long form cutoffs: Child – ≥29 Caregiver – ≥27 Suggested short form cutoffs: Child – ≥12 Caregiver – ≥11	Total score of 15 or higher – Significant behavioral or emotional problems Internalizing subscale – Cutoff 5 or more items Attention subscale – Cutoff 7 or more items Externalizing subscale – Cutoff 7 or more items	For children ages 6 to 18 years, cutoff score is 28. For children ages 3 to 5 years, the scores on elementary school related items 5, 6, 17, and 18 are ignored and a total score based on the 31 remaining items is computed. The cutoff score for younger children is 24.	Cutoff score of 30 recommended	Classification system: Close to average Slightly raised High Very high
Validity and test performance	Concurrent validity – 84% Test-retest reliability – 89% Sensitivity – 81% overall Specificity – 83% overall	Sensitivity and specificity vary based on predictor scale and target group (ADHD inattentive, combined, hyperactive-impulsive, learning disorder, disruptive behavior disorder)^[2] Sensitivity range – 55 to 96% Specificity range – 22 to 91%	Child self-report: Sensitivity – 68% Specificity – 88% Caregiver report: Sensitivity – 75 to 86% Specificity – 73 to 87%	Total PSC-17 scale: Sensitivity – 82% Specificity – 81%	Cutoff score of 28: Sensitivity – 95% Specificity – 68%	Cutoff score of 30: Sensitivity – 94% Specificity – 88%	Sensitivity – 63 to 94% Specificity – 88 to 98%
Who can deliver	Professionals Paraprofessionals Clerical staff	Anyone can deliver Health care provider interprets results	No training requirement	Anyone can deliver Health care provider interprets results	Anyone can deliver Health care provider interprets results	Self-administered Health care provider interprets results	Self-administered
Time to score and interpret	1 to 3 minutes	20 minutes (administration and scoring time)	3 to 5 minutes (short) 5 to 10 minutes (long)	2 minutes	3 to 5 minutes	2 minutes	10 minutes (total administration and scoring)
Cost to purchase^¶	Starter kit in one language – $295	Online Software Kits with DSM-5 Update start at $899 Manual Scoring Kits with DSM-5 Update start at $599	Free from Duke University	Free from: Massachusetts General Hospital Brightfutures.org	Free from: Massachusetts General Hospital Brightfutures.org	Free from: Massachusetts General Hospital Brightfutures.org	Free (with permission) at www.sdqinfo.org
Ease of integration into EMR	Online management and questionnaire completion options	Online software available	Can be digitized	Online software available	Online software available	Online software available	Online scoring and report generation available

DSM-5: Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition; ADHD: attention deficit hyperactivity disorder; ASQ3: Ages & Stages Questionnaire - Third Edition; EMR: electronic medical record.

* T-scores indicate how the patient's scores compare to the scores of others. Fifty represents the mean and one standard deviation is equal to 10 (a T-score of 40 is one standard deviation below the mean; a T-score of 60 is one standard deviation above the mean).

¶ Prices verified on March 10, 2022.

Data from:

Ages & Stages Questionnaires: Social-Emotional, Second Edition (ASQ:SE-2). Paul H Brookes Publishing Co, Inc 2017. Available at: agesandstages.com/products-services/asqse-2 (Accessed on January 13, 2020).
Conners CK. Conners 3^rd edition: The leading assessment of ADHD & comorbid disorders in children and youth ages 6 to 18. MHS Assessments. Available at: https://www.mhs.com/MHS-Assessment?prodname=conners3 (Accessed on November 18, 2017).
Daviss WB, Birmaher B, Melhem NA, et al. Criterion validity of the Mood and Feelings Questionnaire for depressive episodes in clinic and non-clinic subjects. J Child Psychol Psychiatry 2006; 47:927.
Weitzman C, Wegner L, the Section on Developmental and Behavioral Pediatrics, et al. Promoting optimal development: Screening for behavioral and emotional problems. Pediatrics 2015; 135:384.
Wasserman RC, Kelleher KJ, Bocian A, et al. Identification of attentional and hyperactivity problems in primary care: A report from pediatric research in office settings and the ambulatory sentinel practice network. Pediatrics 1999; 103:e38.
Jellinek MS, Murphy JM. Pediatric Symptoms Checklist. The General Hospital Corporation 2017. Available at: https://www.massgeneral.org/psychiatry/treatments-and-services/pediatric-symptom-checklist (Accessed on January 13, 2020).
Jellinek MS, Murphy JM, Robinson J, et al. Pediatric Symptom Checklist: Screening school-age children for psychosocial dysfunction. J Pediatr 1988; 112:201.
Jellinek MS, Murphy JM. The recognition of psychosocial disorders in pediatric office practice: The current status of the Pediatric Symptom Checklist. J Dev Behav Pediatr 1990; 11:273.
Pagano ME, Cassidy LJ, Little M, et al. Identifying psychosocial dysfunction in school-age children: The Pediatric Symptom Checklist as a self-report measure. Psychol Sch 2000; 37:91.
Strengths & Difficulties Questionnaires: Information for researchers and professionals about the Strengths & Difficulties Questionnaires. Youthinmind Ltd. Available at www.sdqinfo.org (Accessed on January 29, 2020).

Adapted from: American Academy of Pediatrics. Addressing mental health concerns in primary care: A clinician's toolkit (https://www.aap.org/en-us/advocacy-and-policy/aap-health-initiatives/Mental-Health/Documents/MH_ScreeningChart.pdf) (Accessed on November 27, 2017).

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Comparison of behavioral screening tests commonly used in primary care