A comparison of measures of adjustment, symptoms, and impairment among children with chronic medical conditions

Objective: To examine the concurrent and criterion validity of three instruments used to measure emotional and behavioral problems among children with chronic illness. Method: The Personal Adjustment and Role Skills Scale (PARS III), Child Behavior Checklist (CBCL), and Columbia Impairment Scale (CIS) were compared with each other and with structured interview-derived psychiatric diagnoses in 116 chronically ill children, aged 9 to 18 years. Three cutoff scores were used for each measure. Results: The measures had good concurrent validity despite only moderate agreement with each other. Their criterion validity was only fair: levels of sensitivity were fair at low cutoffs and poor at standard and high cutoffs; specificity and positive predictive values rose from moderate at low cutoffs to high at standard and high cutoffs. The agreement between the scales and a menial disorder diagnosis was only moderate at any of the cutoff points. Conclusions: Each of these measures has significant limitations. Both the CBCL and the PARS III appear to measure similar constructs but are likely to underidentify medically ill children with comorbid psychiatric problems. Consideration of global functioning across domains, with a measure such as the CIS, might provide an alternative approach to behavioral and symptom checklists in the assessment and management of children with chronic conditions.