PROS Pearls:

* As part of the Child Behavior Study, investigators examined primary care clinicians' recognition of parent reported psychosocial problems. Neither insurance status of the individual patient nor overall prevalence of managed care insurance in the practice was related to recognition of problems by primary care clinicians.

* After controlling for the severity of the psychosocial problem, clinicians were more likely to recognize problems among older and male patients. Proportionately lower levels of recognition among girls and younger patients underscores previously expressed concerns about lack of attention to psychosocial problems in females and younger children.

* Patients whose clinicians were pediatricians (versus family physicians, physician assistants and nurse practitioners) and patients who were seen by their own primary care clinician were much more likely to be recognized as having a psychosocial problem than those who were not. Familiarity with the patient was the most significant factor in predicting clinician recognition.

* Before the visit, parents completed the Pediatric Symptom Checklist (PSC), a brief questionnaire of child psychosocial symptoms. Of children with PSC scores suggestive of marked psychosocial dysfunction, only 54% were noted by clinicians as having psychosocial problems (a figure consistent with other literature on primary care recognition of psychosocial problems).

* Practitioners should consider scheduling changes and other mechanisms for increasing contact between individual families and specific clinicians. Also, clinicians should focus particular attention on younger children and girls whose parents have concerns about behavior or feelings.