Psychometric properties and local normative references of PSC-17, RCADS-25, CATS-2, SNAP-IV, MCHAT-R/F, and CAST: data from a nationwide sample in Greece

Abstract Health professionals in Greece face barriers in assessing child and adolescent mental health conditions due to the lack of instruments with evidence of validity in local samples. This study addresses this gap by evaluating the psychometric properties and establishing common norms for six globally recognized mental health tools in Greece: the Child and Adolescent Trauma Screen-2 (CATS-2), Pediatric Symptoms Checklist-17 (PSC-17), Revised Children’s Anxiety and Depression Scale-25 (RCADS-25), Swanson, Nolan, and Pelham Scale (SNAP-IV), Modified Checklist for Autism in Toddlers-Revised (MCHAT-R/F), and Child Autism Spectrum Test (CAST). We drew on a nationwide Greek survey comprising 1,756 caregivers and 1,201 children and adolescents (age groups: 1 to 18 years). Using Item Response Theory, we assessed internal consistency and factor models according to Consensus-based Standards for the Selection of Health Measurement Instruments (COSMIN) criteria for unidimensionality, local independence, monotonicity, and global model fit. Normative references were calculated using standardized metrics recommended by the Patient-Reported Outcomes Measurement Information System (PROMIS). Final sample sizes ranged from 1,356 (PSC-17, caregiver version) to 198 (CATS-2, caregiver version). Internal consistency was rated as good to excellent across all scales. Factor analyses supported all scales except the MCHAT-R/F (failing monotonicity) and CAST (failing monotonicity and unidimensionality). Local normative references were usually consistent with international samples. This toolkit provides essential evidence-based resources for child and adolescent mental health in Greece, offering a scalable model for other underserved settings. Further research with national probabilistic samples is recommended to enhance risk stratification accuracy.