It is essential that pediatricians and other pediatric health care providers understand the complexities and implications of assessing satisfaction for this group of children because the results of satisfaction surveys will be used in developing policies for service delivery and financing. This article describes the development and evaluation of a satisfaction instrument specifically for children with special needs and their families, and illustrates the major challenges in assuring that satisfaction scales reflect adequately the characteristics of the complex service system for these children. Specifically, this article presents the methods and results of 2 studies. The first study involved the initial development of items and pilot testing of the instrument, and led to a scale that we named the Multidimensional Assessment of Parental Satisfaction