Written questionnaires have been developed to assess children's risks of psychosocial problems based on parents' responses. However, the effectiveness of these questionnaires is limited in populations with low literacy rates, which are also among the most in need of improved mental health screening and care. The present study compared the sensitivity and specificity of a version of the Pediatric Symptom Checklist (PSC)--which contained pictorial descriptions in addition to written text--against the "gold standard" Child Behavior Checklist. We retrospectively analyzed 240 sets of questionnaires completed by the mothers or stepmothers of children who visited clinics in a Community Center in Ciudad Juarez, Mexico, between May and December 2007, under the Seguro Popular insurance program provided to Mexicans with the lowest socioeconomic status. Over 95% of the parental participants had less than a high school level of education. The pictorial PSC was a useful tool for screening for psychosocial impairment, with improved sensitivity and specificity in comparison to previous assessments of the written PSC in similar populations within the U.S. Optimal sensitivity and specificity were achieved when the threshold for clinical follow-up was lowered from 28 to 22 points. Questionnaires that include pictorial descriptions may be valuable for improvements of health screening in communities with low education levels.