Pediatric Symptom Checklist (PSC)

Parent/Caregiver Report

Youth Self-Report

Child's Name:

Date:

Child's Age:

Completed By:

Instructions

Emotional and physical health go together in children. Because parents are often the first to notice a problem with their child's behavior, emotions, or learning, you may help your child get the best care possible by answering these questions.

Please indicate which statement best describes your child.

Please mark under the heading that best describes your child:

Never
(0 points)

Sometimes
(1 point)

Often
(2 points)

Additional Questions

Does your child have any emotional or behavioral problems for which she or he needs help?

Yes

Are there any services that you would like your child to receive for these problems?

Yes

PSC Assessment Results

Important Clinical Disclaimer

The Pediatric Symptom Checklist (PSC) is a screening tool and should not be used as the sole basis for clinical diagnosis. Scores ≥28 suggest the need for further evaluation by qualified mental health professionals. This tool is designed to identify children who may benefit from additional assessment and support.