Important: This post is for informational and educational purposes only and should not be taken as medical advice. You should always consult your physician before making any medical decisions for your child.
If you’ve ever wondered whether your child’s behavior is “normal,” you’re certainly not alone.
It’s natural to observe how your child navigates the world and wonder if their behaviors are typical for their developmental stage. To get more clarity, you might look for tools that can provide helpful insights.
Pediatricians often start with a simple tool like the Pediatric Symptom Checklist (PSC-17, or for adolescents and teens, the PSC-17Y) as an initial screening of your child’s behavior.
There are also more comprehensive assessments like the Child Behavior Checklist (CBCL) from the Achenbach System. This one is more commonly used by psychologists, psychiatrists, and other mental health professionals than in primary care settings.
In this blog post, you’ll find out what’s considered “normal” behavior and how the CBCL and PSC-17 assessments can support your understanding of your child. Plus, we’ll share a few ways to address concerning behavior when it comes up.
Understanding your child’s behavior: when should you be concerned?
As a parent, you likely notice behavioral patterns in your kid, even if you aren’t always sure whether they’re “normal” or not. Maybe they struggle to regulate emotions in certain situations, or can’t always focus on tasks at school.
But how do you know if what you’re seeing is a normal, healthy part of their development, or something else? The reality is that all children struggle to concentrate at times or have an occasional meltdown in public.
However, if you notice the following behaviors on a regular basis or to an extreme degree, it may suggest that there’s something deeper to explore with your pediatrician:
- Frequent meltdowns and tantrums that seem disproportionate to the situation
- Excessive difficulty concentrating on tasks or following basic directions
- Social anxiety or struggles that seem disproportionate to the situation
- Regular aggressive behaviors, like hitting, biting, yelling at others, etc.
It’s normal for children to go through phases of challenging behavior. But if you feel certain behaviors are impacting your child’s well-being, bringing it up with your pediatrician is a great first step. They can help you understand what’s typical and, if needed, provide a screening or helpful resources.
How to professionally evaluate your child’s behavior
If you’re concerned about your child’s behavior and want to have them professionally screened, the next step is to consult your pediatrician.
In many cases, your primary care doctor or pediatrician will complete the Pediatric Symptom Checklist (PSC-17) screening with your child. This quick and simple screening tool helps identify children who may show signs or be at risk of developing emotional or behavioral issues.
If the results aren’t conclusive or you’re referred to a mental health specialist, you might also encounter the Child Behavior Checklist (CBCL). This comprehensive assessment can offer a more thorough overview of your child’s behavioral patterns if deemed necessary.
What is the Pediatric Symptom Checklist (PSC-17)?
Many pediatricians screen children using the PSC-17 survey, which can identify potential behavioral and emotional problems so you can be proactive about next steps.
The PSC-17 is used to screen child behavior, while the PSC-17Y is used for adolescents. As an initial screening test, the PSC-17 allows primary care providers to assess behavioral patterns and identify any potential causes for concern in a matter of minutes.
How does the PSC-17 work?
The caregiver completing the form will answer 17 questions, indicating the frequency of each behavior according to 3 categories:
- Never
- Sometimes
- Often
Once you have a score from the checklist, your primary care provider can evaluate the probability that your child might benefit from further support for their mental health and well-being.
What is the Child Behavior Checklist (CBCL)?
The CBCL assessment or Achenbach behavior checklist is an assessment used by psychologists and other mental health specialists.
These professionals can use it to draw more definitive conclusions regarding behavioral and emotional problems in children and adolescents from 6 to 18 years old.
The Child Behavior Checklist gives your child a score for both internalizing and externalizing behaviors.
Internalizing behaviors: This refers to how your child manages their emotions internally. Internalizing behaviors can include:
- Lack of energy
- Low self-esteem
- Social withdrawal
- Persistent sadness
- Stress-induced headaches
- Excessive worry or nervousness
Externalizing behaviors: These behaviors are directed outward, impacting others your child interacts with. Externalizing behaviors can include:
- Difficulty sitting still
- Refusing to follow rules
- Challenging authority figures
- Acting without considering consequences
- Physical or verbal aggression toward others
Once you have your child’s scores, you can use them to categorize behaviors as either typical, borderline, or clinical.
How does the CBCL work?
The Child Behavior Checklist makes up one-third of a more complete assessment, known as the Achenbach System of Empirically Based Assessment (ASEBA).
The three parts of the assessment are:
- Child Behavior Checklist – You as the parent complete this checklist first.
- Teacher’s Report Form (TRF) – Your child’s teachers complete this report form.
- Youth Self-Report (YSR) – Your child provides answers for this report.
To fill out the CBCL, you need to answer 113 questions using a pencil and paper or a computer. You’ll answer questions with a 0, 1, or 2 to indicate the frequency of various behaviors in your child over the past six months.
- 0 = The behavior is absent.
- 1 = The behavior occurs sometimes.
- 2 = The behavior occurs often.
The checklist should take you around 20 minutes to complete, and you can use it to help identify areas where your child may need support, like:
- ADHD
- Social challenges
- Aggressive behavior
- Anxiety or depression
- Rule-breaking behavior
- Physical (somatic) complaints
- Trouble with emotional regulation
- Concerns with thinking and attention
- Other issues with conduct or oppositional defiance
The assessment isn’t used to detect Autism Spectrum Disorders (ASD).
There have been various studies on the CBCL assessment that confirm a positive relationship between its behavioral conclusions and professional psychological diagnoses.
When should you use the PSC-17 vs the CBCL?
If you’re concerned about your child’s behavior, you can ask your pediatrician if it’s a good idea to complete the PSC-17.
Due to the short length of this screening, it’s an easier option for clinicians to screen for a broad range of concerns quickly and effectively. Plus, some reports suggest that the PSC-17 holds up to the more robust Child Behavior Checklist (CBCL), in its ability to screen for possible mental health concerns. That’s why we typically recommend this step first.
The CBCL assessment is a more advanced screening test performed by specialists. It can be a useful follow-up for a more comprehensive view of your child’s behavior.
How to handle big emotions in your child
Whether or not you’ve gone through the PSC-17 or Achenbach behavior checklist, handling big emotions in your child can feel stressful or even overwhelming. Know that it’s normal if their big emotions lead to big feelings for you, too. This happens for a lot of parents, and it’s possible to find coping strategies that support you and your little one.
In particular, “temper tantrums” can be frustrating to handle, especially while out in public. However uncomfortable this can be, it’s a normal part of early development for many children.
Outbursts can occur because children are still learning to manage their emotions, and sometimes the easiest thing for them to do is let it all out. Here are a few recommendations to navigate big emotions when they happen.
Stay calm
It’s easy to get flustered when your child has a meltdown, especially if you also experience anxiety. However, if you can see yourself as the calm in the storm, you can help your child feel more secure.
This can be easier said than done in some cases. But over time, try to practice pausing before you react. This allows you to regulate your own emotions and respond in a way that’s more supportive and aligned with your values as a pare
Set a healthy example for expression
Children are impressionable, which means they’re likely to mimic the behavior they see around them. You and their other caregivers are the most important influences in their lives.
Focus on becoming an example of how your child can deal with uncomfortable emotions. For example, if you take some time alone, verbalize what’s wrong, or label the emotions you feel, you help your child see how they can do these things when they feel upset too.
Use breathing exercises
When the moment is right, teach your child some deep breathing exercises. It’s best to practice things like this when you’re both calm, for example during playtime or before bed. That way, when a stressful moment happens, they can recall a technique they already know to get some relief.
Here’s an easy breathing activity to try. Tell your child to “smell the flower,” taking a deep breath in, and “blow out the birthday candles,” taking a long and slow exhale. This lets them practice deep breaths in a way that’s fun and easy to remember later on.
Do kids raised in cities like Manhattan experience more anxiety?
As an NYC-based pediatric clinic, this is a question we get from parents a lot. While there’s some evidence to suggest that urban environments may be tougher on your child’s mental health, it’s far from conclusive.
Generally speaking, your child will be exposed to more stimuli in Manhattan than they would in a rural area. However, this isn’t necessarily cause for concern. In some ways, exposure to the sensory input of living in the city can be beneficial for your child.
Experiences like navigating busy streets, adapting to noise, and interacting with people from various backgrounds can help build mental resilience, adaptability, and social awareness. City living offers unique growth opportunities that can serve your child well as they get older.
It’s worth noting that NYC families are often very driven, and may have faster-paced lifestyles than families in other areas. Taking time to practice stress relief activities together can be a great way to set your child up to balance their ambitions with their well-being.
Child Behavior Checklist or PSC-17, what’s your next step?
The Child Behavior Checklist is a useful tool to help you categorize and understand your child’s behavioral patterns. While it’s not a substitute for a professional medical diagnosis, it can offer insights that help you better understand your child’s behavior.
The best first step is to consult your pediatrician and ask if it’d be beneficial to go through the PSC-17 assessment, as this will give you clarity on what your next move should be.
If you’re looking for more support for your child, consider joining our concierge pediatric membership to access your child’s pediatrician around the clock. We’re here to answer questions and provide resources that support your child and you as a parent.
