03062nas a2200325   4500008004100000020004100041245008100082210006900163250001500232260000800247300001100255490000700266520201300273653001502286653001002301653004002311653005702351653003302408653001102441653001102452653001802463653000902481653002802490653001202518653005502530100001502585700001802600700001502618856010302633       2002                        eng d  a0025-7079 (Print)0025-7079 (Linking)00aMultidimensional adaptive testing for mental health problems in primary care0 aMultidimensional adaptive testing for mental health problems in   a2002/09/10  cSep  a812-230 v403 aOBJECTIVES: Efficient and accurate instruments for assessing child psychopathology are increasingly important in clinical practice and research. For example, screening in primary care settings can identify children and adolescents with disorders that may otherwise go undetected. However, primary care offices are notorious for the brevity of visits and screening must not burden patients or staff with long questionnaires. One solution is to shorten assessment instruments, but dropping questions typically makes an instrument less accurate. An alternative is adaptive testing, in which a computer selects the items to be asked of a patient based on the patient's previous responses. This research used a simulation to test a child mental health screen based on this technology. RESEARCH DESIGN: Using half of a large sample of data, a computerized version was developed of the Pediatric Symptom Checklist (PSC), a parental-report psychosocial problem screen. With the unused data, a simulation was conducted to determine whether the Adaptive PSC can reproduce the results of the full PSC with greater efficiency. SUBJECTS: PSCs were completed by parents on 21,150 children seen in a national sample of primary care practices. RESULTS: Four latent psychosocial problem dimensions were identified through factor analysis: internalizing problems, externalizing problems, attention problems, and school problems. A simulated adaptive test measuring these traits asked an average of 11.6 questions per patient, and asked five or fewer questions for 49% of the sample. There was high agreement between the adaptive test and the full (35-item) PSC: only 1.3% of screening decisions were discordant (kappa = 0.93). This agreement was higher than that obtained using a comparable length (12-item) short-form PSC (3.2% of decisions discordant; kappa = 0.84). CONCLUSIONS: Multidimensional adaptive testing may be an accurate and efficient technology for screening for mental health problems in primary care settings.10aAdolescent10aChild10aChild Behavior Disorders/*diagnosis10aChild Health Services/*organization & administration10aFactor Analysis, Statistical10aFemale10aHumans10aLinear Models10aMale10aMass Screening/*methods10aParents10aPrimary Health Care/*organization & administration1 aGardner, W1 aKelleher, K J1 aPajer, K A  uhttp://www.iacat.org/content/multidimensional-adaptive-testing-mental-health-problems-primary-care