Determining if a child needs a mental health evaluation is not an easy task, neither for the referring physician nor for the family. When complaints from school and behavioral problems at home are numerous, it may be necessary to look further. It is also important to separate normal developmental issues from significant psychological, psychiatric disorders and developmental disabilities.
	There are several questionnaires available to make the decision easier. One of the best screening tools is the Pediatric Symptom Checklist (ref. 1-4) developed by Dr. Michael S. Jellinek from Harvard University School of Medicine. It serves to identify those children who may need a referral for further evaluation.
	Check each item as applicable to the behavior of your child. Then read the explanation below. (This form is not be sent to us, so please print it for your own use and scoring.)
	Child's Name:
Not at all Sometimes Often 1. Complains of aches and pains       2. Spends more time alone       3. Tires easily, little energy       4. Fidgety, unable to sit still       5. Has trouble with teacher       6. Less interested in school       7. Acts as if driven by a motor       8. Daydreams too much       9. Distracted easily       10. Is afraid of new situation       11. Feels sad, unhappy       12. Is irritable, angry       13. Feels hopeless       14. Has trouble concentrating       15. Less interested in friends       16. Fights with other children       17. Absent from school       18. School grades dropping       19. Is down on himself or herself       20. Visits doctor, doctor finds nothing wrong       21. Has trouble sleeping       22. Worries a lot       23. Wants to be with you more than in the past       24. Feels he or she is bad       25. Takes unnecessary risks       26. Gets hurt frequently       27. Seems to be having less fun       28. Acts younger than children of his or her age       29. Does not listen to rules       30. Does not show feelings       31. Does not understand other people's feelings       32. Teases others       33. Blames others for his or her trouble       34. Steals       35. Refuses to share        Total Checked in each column 2    Total Checked in each column 3    Multiply by 2 the total in column 3   Add Scores: Ignore Column 1, Sum (Column 2 ) + 2 * Sum (Column 3)
	After you check out the answers, score the Checklist by assigning 0 points to "Never", 1 point to "Sometimes", and 2 points to "Often". (The form above does not automatically calculate the score, perhaps in the next update) Cumulative score of 28 and above is considered significant and indicates the need for further evaluation and referral. Children with higher scores are at risk for behavioral and learning problems and may benefit from early intervention. Print out this form and discuss it with your child's primary physician.
	1. Jellinek MS, Evens R, Knight R. Screening for psychiatric referrals on a pediatric inpatient service. J Pediatr. 1979; 94 (1): 156-158.   2. Jellinek MS, Murphy JM, Burns B. Brief psychosocial screening in outpatient pediatric practice. J Pediatr. 1986; 109 (2); 371-378.   3. Jellinek MS, Murphy JM, Robinson J, Feins A, Lamb S, Fenton T. The Pediatric Symptom Checklist: screening school age children for psychosocial dysfunction. J Pediatr. 1988; 58 (3):1153-1157.   4. 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 (5): 273-278.