The low level of literacy and lack of language proficiency possessed by some immigrants from low socioeconomic status backgrounds create communication barriers in the healthcare setting, thus interfering with their ability to access appropriate medical care and their subsequent participation in medical research. Adding pictorial descriptions to questionnaires appears to improve patient response when literacy levels are low. Psychometric results from 4 studies using a pictorial version of the Child Behavior Checklist (Pictorial Child Behavior Checklist, or PCBCL) to assess behavioral and emotional problems in children from low-income Hispanic families attending hospital-based pediatric practices are reported here. The 2 form versions (the original Child Behavior Checklist, or CBCL, vs. the PCBCL), which were randomly assigned, manifested comparable test-retest reliability (Study 1), alternate-form reliability (Study 2), and mean problem scores (Study 3). The PCBCL was also comparable to the CBCL in discriminating between community children attending regular pediatric clinics and children attending an outpatient psychiatric clinic (Study 4). Thus, the PCBCL yielded results that were comparable to those obtained with the CBCL, indicating that it may be a viable alternative for parents confronting communication barriers due to low literacy levels. (Contains 2 figures and 7 tables.)