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Preschool Pediatric Symptom Checklist (PPSC)

PPSC + PPSC scoring guide

PPSC validation info

The PPSC is an emotional/behavioral screening instrument for children 18-65 months of age. The PPSC was created as one part of a comprehensive screening instrument designed for pediatric primary care and is modeled after the Pediatric Symptom Checklist. Items for the PPSC were developed by a team of experts who reviewed existing assessment instruments and relevant research literature. Scale construction and initial validation (including factor analysis and tests of construct validity) were conducted with 292 families from pediatric primary care sites and 354 families from referral clinics. 171 additional families were recruited from primary care sites to obtain an independent replication sample.

Exploratory factor analysis revealed 4 dimensions of the PPSC: Externalizing, Internalizing, Attention Problems, and Parenting Challenges. These dimensions were incorporated into a bifactor model that displayed a strong general factor, thus supporting the use of a total score. The PPSC total score shows strong internal and retest reliability, and it identifies children who score in the clinical range of a longer, well-validated and more comprehensive parent-report instrument (the CBCL), as well as children who are reported to have a range of behavioral diagnoses. Moreover, sensitivity and specificity with respect to these criteria were comparable to those of another well-accepted but longer screener, the ASQ:SE. Finally, results for the PPSC's total scale remained consistent when replicated in an independent sample.

PPSC at a glance

PPSC screengrab


  • Behavior

Age range:

  • 18 months, 0 days to 65 months, 31 days
  • The PPSC is on the bottom of the front side of the 24-60 month Age-Specific SWYC Forms


  • Determine the PPSC total score by assigning a "0" for each "Not at All" response, a "1" for each "Somewhat" response, and a "2" for each "Very Much" response, and then sum the results. A PPSC total score of 9 or greater indicates that a child is "at risk" and needs further evaluation.
  • In the event that parents have selected multiple responses for a single question and are unavailable for further questioning, then choose the more concerning answer (i.e. "Somewhat" or "Very Much") farthest to the right.
  • In the event that there is a missing response, that item counts as zero.
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The SWYC and the information on this site are not designed to and do not provide medical advice, professional diagnosis, or treatment. The information and any reference materials posted here by Tufts Medical Center, Inc. are intended solely for the information of the reader. Such information is NOT intended to replace consultation with a qualified medical professional. The SWYC is © Tufts Medical Center.

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