Studying the "referability" of child clinical problems.

Child clinical problems may differ in their power to evoke clinic referral, and this "referability" of problems may also differ with the gender or culture of the child who manifests them. The authors propose (a) a method for the study of such differences and (b) a new statistic, the referability index (RI). RI reflects the frequency with which a child problem stimulates clinic referral, adjusted for its prevalence in the general population. RI was assessed across 118 child problems as a function of problem type (overcontrolled vs. undercontrolled), child gender, and culture (U.S. vs. Thailand). Problems of both types were more referable in girls than boys: undercontrolled problems were more referable than overcontrolled in the U.S. but, surprisingly, not in Thailand. The findings shed new light on gender and culture differences and illustrate the empirical and heuristic potential of the RI statistic.