Given psychiatry's limited understanding of the specific impact of chronic illness, we agree with Canning and Kelleher1 that no first-stage screen is a "good enough" means of identifying psychosocial dysfunction in chronically ill children. However, we would like to clarify some of their results regarding the sensitivity of the Pediatric Symptom Checklist (PSC) and question their conclusions concerning psychosocial screening.
Canning and Kelleher1 tested the performance of the PSC by comparing case classification on the PSC with the presence or absence of a Diagnostic and Statistical Manual of Mental Disorders, Revised Third Edition (DSM-III-R) diagnosis using the Diagnostic Interview Schedule for Children (DISC) version 2.1 as a gold standard. Parent and child reports were gathered by trained lay interviewers. By contrast, the PSC has been validated based on impairment, not diagnosis, using the Children's Global Assessment Scale (CGAS) ratings by clinicians with doctorate degrees.2,3 As a measure