Clinical Practice Guidelines About Screening for Disruptive Behavior Problems at Well-Child Visits: A Rapid Review of the Literature on the Accuracy of Parents’ Behavioral Concerns

Abstract

The current recommendations of the Canadian Paediatric Society about monitoring children’s disruptive behaviors at well-child visits call for screening if behavioral concerns are being raised by parents. But do parents’ concerns about their child’s behavior constitute a reliable means for primary care providers (PCPs) to decide either in favor or against screening? We conducted a rapid systematic review of the literature by identifying documents that cited the landmark study by Glascoe and her colleagues (1991) on the accuracy of behavioral concerns at identifying children with a disruptive behavior problem. Citation tracking was done using Web of Science (Core Collection; 17 October 2018) and SCOPUS (19 October 2018). Only one recent published study was identified. The calibration of concerns’ specificity (and other indices alike) yielded, at best, a fair value of the weighted kappa coefficient κ(0,0) (i.e., 0.255 and 0.094). Also, the calibration of concerns’ sensitivity (and other indices alike) yielded, at best, a moderate value of the weighted kappa coefficient κ(1,0) (i.e., 0.533 and 0.392). Overall, the results do not support the current recommendations. In fact, behavioral concerns do not provide PCPs with enough information to reach a decision about screening. We discuss different ways of gathering the necessary information.