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 i nstruments used to measure emotional and behavioral problems among chi ldren with chronic illness. Method: The Personal Adjustment and Role S kills Scale (PARS III), Child Behavior Checklist (CBCL), and Columbia Impairment Scale (CIS) were compared with each other and with structur ed interview-derived psychiatric diagnoses in 116 chronically ill chil dren, aged 9 to 18 years. Three cutoff scores were used for each measu re. Results: The measures had good concurrent validity despite only mo derate agreement with each other. Their criterion validity was only fa ir. levels of sensitivity were fair at low cutoffs and poor at standar d and high cutoffs; specificity and positive predictive values rose fr om moderate at low cutoffs to high at standard and high cutoffs. The a greement between the scales and a menial disorder diagnosis was only m oderate at any of the cutoff points. Conclusions: Each of these measur es has significant limitations. Both the CBCL and the PARS III appear to measure similar constructs but are likely to underidentify medicall y ill children with comorbid psychiatric problems. Consideration of gl obal 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.