Screening, management, and appropriate referral for pediatric behavior problems.

Pediatric behavior problems are common but often go undiagnosed. This article addresses assessment of these problems in the primary care setting, including interview of parent and child, history, physical assessment, direct observation of parent-child interaction, and the use of behavior rating scales (the Preschool Children's Behavior Checklist, the Pediatric Symptom Checklist, and the Eyberg Child Behavior Inventory). Comorbidity of behavior problems with psychological disorders is discussed and a distinction is made between mild and severe behavioral difficulties. Positive parenting and healthy discipline skills are expounded, including catching children being good, active listening, conveying positive regard, ignoring minor transgressions, giving good directions, use of praise, and time-out. Criteria for consultation and referral are provided and the role of the health care provider is emphasized.