A continuing dilemma: whether and how to screen for concerns about children's behavior.

Abstract

1. Ellen Perrin, MD, MA* 2. Terry Stancin, PhD† 1. *Professor of Pediatrics, The Floating Hospital for Children, Tufts-New England Medical Center, Boston, MA 2. †Associate Professor of Pediatrics, MetroHealth Medical Center and Case Western Reserve University School of Medicine, Cleveland, OH After completing this article, readers should be able to: 1. Describe the prevalence of child behavior problems in primary care settings. 2. List possible reasons that child behavior problems are underidentified by pediatricians. 3. Describe formal and informal procedures for identifying behavioral problems in children. 4. Delineate the advantages of and concerns about formal and informal methods for screening and assessing behavioral problems in children. 5. Decide whether and how to incorporate screening methods into practice. 6. Describe options for improving mental health services for children, including development of collaborative care practices. Pediatricians are accustomed to the use of screening in the course of primary care for children and adolescents. Screening for some problems, such as lead poisoning or anemia, involves relatively simple procedures compared with the more daunting task of screening for possible behavioral or developmental concerns. To merit population screening, a condition must be important, reasonably common, identifiable by screening before becoming evident clinically, have an effective treatment that is enhanced if provided early, and have an acceptable screening test available. Screening tests must be inexpensive to administer and score, be acceptable to patients, produce reliable results, and have adequate validity. It has been established that substantial variations and delays in children’s motor and cognitive development meet these criteria. (1) However, behavioral variations and problems are harder to define and to classify, and the boundaries of pediatricians’ responsibility are less clearly delineated. Clearly, behavioral and emotional difficulties are important in terms of both personal suffering and social consequences. High rates of depression, school failure, and violence are some indicators of late consequences. These problems are common, with up to 50% of parents expressing concern about their child’s behavior and many surveys documenting an identifiable emotional difficulty in 25% of school-age children. Limited but improving evidence documents the effectiveness of treatment for various mental health …