Pediatric Symptom Checklist (PSC) LF-35

Subject Reference/ID: Cognitive Screening Age: 21 Total Test Time: 1:10 (min:secs) Test Date: April 1, 2014 17:27:52 Administrator: PSC Screening Language: English (United States) Administered using CNS Vital Signs Online Version 1.0 Completed by: good Fidgety, unable to sit still Acts as if driven by a motor Daydreams too much Distracted easily Has trouble concentrating Attention Problem Subscale Feels sad, unhappy Feels hopeless Down on him or herself Worries a lot Seems to be having less fun Anxiety/Depression Subscale Fights with other children Does not listen to rules Does not understand other people's feelings Teases others Blames others for his or her troubles Takes things that do not belong to him or her Refuses to share Conduct Problem Subscale Complains of aches or pains Spends more time alone Tires easily, little energy Has trouble with teacher Less interested in school Is afraid of new situations Is irritable, angry Less interested in friends Absent from school School grades dropping Visits doctor with doctor finding nothing wrong Has trouble sleeping Wants to be with you more than before Feels he or she is bad Takes unnecessary risks Gets hurt frequently Acts younger than children his or her age Does not show feelings PSC 35 Total Score
36. Does your child have any emotional or behavioral problems for which she/he needs help? Yes 37. Are there any services that you would like your child to receive for these problems? Yes 38. If yes, what type of services? no one Instructions for Scoring: The number that precedes each item only represents the sequence in which the item was asked. The standard parent completed PSC form consists of 35-items that are rated as "never", "sometimes", or "often" present and scored 0, 1, and 2, respectively. Item scores are summed, with a possible range of scores from 0-70. This computerized version does not allow the participant to skip questions. How to Interpret the PSC: A positive score on the PSC suggests the need for further evaluation by a qualified health (M.D., PsyD., R.N.) or mental health (Ph.D, LICSW) professional. The total score is recoded into a dichotomous variable indicating a possibility of AT RISK* or NOT at RISK of psychosocial impairment. PSC 35 Total Score: AT RISK* - Children with scores of 28 or higher usually have significant impairments in overall psychosocial functioning. NOT at RISK - Children with scores of 27 or below usually do not have significant impairments in overall psychosocial functioning. Attention Problem Subscale: AT RISK* - Children with scores of 7 or higher on this subscale usually have significant impairments in attention. NOT at RISK - Children with scores of 6 or below on this subscale usually do not have significant impairments in attention. Anxiety/Depression Subscale: AT RISK* - Children with scores of 5 or higher on this subscale usually have significant impairments with anxiety and/or depression. NOT at RISK - Children with scores 4 or below on this subscale usually do not have significant problems with anxiety and/or depression. Conduct Problem Subscale: AT RISK* - Children with scores of 7 or higher on this subscale usually have significant problems with conduct. NOT at RISK - Children with scores 6 or below on this subscale usually do not have significant problems with conduct. *Note: Scores in the AT RISK range usually warrant further evaluation but are not in themselves specific diagnoses. Used with permission copyright 1999 M.S. Jellinek and J. M. Murphy, Massachusetts General Hospital (http://psc.partners.org)

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2 - Often 1 - Sometimes 2 - Often 2 - Often 1 - Sometimes 8 1 - Sometimes 1 - Sometimes 2 - Often 2 - Often 2 - Often 8 1 - Sometimes 2 - Often 2 - Often 2 - Often 2 - Often 2 - Often 2 - Often 13 2 - Often 2 - Often 1 - Sometimes 2 - Often 2 - Often 2 - Often 2 - Often 1 - Sometimes 2 - Often 2 - Often 2 - Often 2 - Often 2 - Often 2 - Often 2 - Often 2 - Often 2 - Often 2 - Often 63