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Factor Analysis of the Pediatric Symptom Checklist In a Population of Children with Voiding Dysfunction/Enuresis

Monday, October 22, 2012: 10:06 AM
Grand Ballroom B (Hilton Riverside)
Cortney Wolfe-Christensen, PhD1, David A. Fedele, M.S.2, DeMond Grant, PhD3, Amy L. Veenstra, M.A.4, Larisa Kovacevic, MD, FAAP1, Jack S. Elder, MD, FAAP1 and Yegappan Lakshmanan, MD, FAAP1, (1)Department of Pediatric Urology, Children's Hospital of Michigan, Detroit, MI, (2)Psychology, Bradley/Hasbro Chidren's Research Center, ], (3)Oklahoma State University, (4)Pediatrics, Children's Hospital of Michigan, Detroit, MI


Previous research has indicated that children with urinary and/or fecal incontinence are at increased risk for psychosocial difficulties and therefore should be screened for mental health problems. The Pediatric Symptom Checklist (PSC) is a parent-completed measure of psychosocial difficulties in children. The PSC was originally established for use in primary care settings, but has been validated for use in children with chronic illnesses, such as Sickle Cell Disease, Diabetes, and Gastrointestinal disorders. However, the PSC has not yet been validated for use in a population of children with voiding dysfunction and/or enuresis. The objective of the current study was to determine whether the PSC, holds its previously-established factor structure in the population of children with voiding dysfunction and/or enuresis, or whether scores for these children should be calculated differently to identify those who are at-risk for psychosocial difficulties.


A retrospective chart review was conducted of all children between the ages of 4 and 16 who presented to an outpatient pediatric urology clinic for voiding dysfunction and/or enuresis between January and July 2011. Charts that contained a completed PSC were retained for analyses and demographic information was obtained from the clinical intake form.


Three hundred patients (145 M, 155 F) with the mean age of 9.08 years were included in the study. Two confirmatory factor analyses (CFA) using previously published models in populations of children with medical conditions (e.g., Sickle Cell and Diabetes, and Gastrointestinal disorders) were conducted on the 35 items of the PSC (Table 1). The CFAs did not result in a good fit of the data in our population, so an Exploratory Factor Analysis (EFA) was subsequently conducted. The EFA resulted in a three-factor structure (e.g., Internalizing, Externalizing, and Attention problems), with all but five items evidencing substantial factor loadings (Table 2). Notably, the five items that “fell out” of the analyses were all related to school difficulties.


Findings from the current study indicate that the PSC is a valid measure to screen for psychosocial difficulties in children with voiding dysfunction and/or enuresis. It is suggested that a shortened version of the measure (i.e., 31 items) could be used in this population, although further research is needed to identify a specific cut-off for clinically significant levels of psychosocial problems using the shortened version.  The PSC can be easily incorporated into clinical care, as it is a straightforward measure to administer and score. Children who are at-risk for psychosocial difficulties can be identified and referred for mental health follow-up so that these issues, which could contribute to poor adherence to and compliance to treatment recommendations, can be managed in addition to the child's medical treatment.