A study on the applicability of the Strengths and Difficulties Questionnaire among low- and higher-educated adolescents.

Aim: The Strengths and Difficulties Questionnaire self-report (SDQ-SR) is a valid instrument for detection of emotional and behavioral problems. The aim of this study was to compare the psychometric properties of the SDQ-SR for low and higher educated adolescents, and to explore its suitability. Methods: We included 426 adolescents. We compared internal consistency for low-educated, i.e., at maximum pre-vocational secondary education, and higher educated adolescents and assessed whether the five-factor structure of the SDQ holds across educational levels. We also interviewed 24 low-educated adolescents, and 17 professionals. Results: On most SDQ subscales the low-educated adolescents had more problematic mean scores than the higher educated adolescents. Findings on the invariance factor analyses were inconsistent, with some measures showing a bad fit of the five factor model, and this occurring relatively more for the low-educated adolescents. Professionals and adolescents reported that the SDQ included difficult wordings. Discussion: Our findings imply that the scale structure of the SDQ-SR is slightly poorer for low educated adolescents. Given this caveat, psychometric properties of the SDQ-SR are generally sufficient for use, regardless of educational level.

The Strengths and Difficulties Questionnaire Parent Form: Dutch norms and validity.

OBJECTIVE: This study provides Dutch national norms for the parent-reported Strengths and Difficulties Questionnaire (SDQ) for children aged 3-14 years, and assesses the test performance of the SDQ Total Difficulties Scale (TDS) and impairment Scale. We further compared Dutch SDQ norms with those of the United Kingdom (UK), to determine potential variation in country-specific norms. STUDY DESIGN: We analyzed data of 3384 children aged 3 to 14 years. The data were obtained in schools, and in the context of Preventive Child Healthcare. Parents completed the SDQ parent form and the Child Behavior Checklist (CBCL). We determined clinical (10% elevated scores) and borderline (20% elevated scores) SDQ TDS norms. We assessed the test performance (validity) of the SDQ TDS and Impairment Score using the CBCL as criterion. RESULTS: The clinical SDQ TDS norms varied between > 10 and > 14 depending on the age group. The SDQ TDS discriminated between children with and without problems, as measured by the CBCL, for all age groups (AUCs varied from 0.92 to 0.96). The SDQ Impairment Score had added value (beyond the SDQ TDS) only for the age group 12-14 years. For the Netherlands we found lower clinical SDQ TDS norms than those previously reported for the UK (i.e. > 16). CONCLUSION: The clinical SDQ TDS norms varied between > 10 and > 14 depending on the age groups. We found good test performance at these proposed norms. Dutch norms differed somewhat from UK norms. In the Netherlands, the SDQ performed better with Dutch-specific norms than with UK-specific norms.

Computerized adaptive testing to screen children for emotional and behavioral problems by preventive child healthcare.

BACKGROUND: Questionnaires to detect emotional and behavioral problems (EBP) in Preventive Child Healthcare (PCH) should be short which potentially affects validity and reliability. Simulation studies have shown that Computerized Adaptive Testing (CAT) could overcome these weaknesses. We studied the applicability (using the measures participation rate, satisfaction, and efficiency) and the validity of CAT in routine PCH practice. METHODS: We analyzed data on 461 children aged 10-11 years (response 41%), who were assessed during routine well-child examinations by PCH professionals. Before the visit, parents completed the CAT and the Child Behavior Checklist (CBCL). Satisfaction was measured by parent- and PCH professional-report. Efficiency of the CAT procedure was measured as number of items needed to assess whether a child has serious problems or not. Its validity was assessed using the CBCL as the criterion. RESULTS: Parents and PCH professionals rated the CAT on average as good. The procedure required at average 16 items to assess whether a child has serious problems or not. Agreement of scores on the CAT scales with corresponding CBCL scales was high (range of Spearman correlations 0.59-0.72). Area Under Curves (AUC) were high (range: 0.95-0.97) for the Psycat total, externalizing, and hyperactivity scales using corresponding CBCL scale scores as criterion. For the Psycat internalizing scale the AUC was somewhat lower but still high (0.86). CONCLUSIONS: CAT is a valid procedure for the identification of emotional and behavioral problems in children aged 10-11 years. It may support the efficient and accurate identification of children with overall, and potentially also specific, emotional and behavioral problems in routine PCH.

Psychometric Properties of the Dutch Strengths and Difficulties Questionnaire (SDQ) in Adolescent Community and Clinical Populations.

This study assessed the factor structures of the Strengths and Difficulties Questionnaire (SDQ) adolescent and parent versions and their measurement invariance across settings in clinical (n = 4,053) and community (n = 962) samples of Dutch adolescents aged 12 to 17 years. Per SDQ version, confirmatory factor analyses were performed to assess its factor structure in clinical and community settings and to test for measurement invariance across these settings. The results suggest measurement invariance of the presumed five-factor structure for the parent version and a six-factor structure for the adolescent version. Furthermore, evaluation of the SDQ scale sum scores as used in practice, indicated that working with sum scores yields a fairly reasonable approximation of working with the favorable but less easily computed factor scores. These findings suggest that adolescent- and parent-reported SDQ scores can be interpreted using community-based norm scores, regardless of whether the adolescent has been referred for mental health problems.

The Strengths and Difficulties Questionnaire Self-Report: A Valid Instrument for the Identification of Emotional and Behavioral Problems.

OBJECTIVE: Validated questionnaires help community pediatric services to identify emotional and behavioral problems (EBPs). This study assesses the psychometric properties of the self-report version of the Strengths and Difficulties Questionnaire (SDQ) for the identification of EBPs in adolescents (13 to 14years old) and the added value of the SDQ parent-form version. METHODS: We obtained data on 500 adolescents (mean age 13.5 years) from community well-child services and schools. Adolescents completed the SDQ self-report and the Youth Self-Report (YSR). Parents completed the SDQ parent-form and the Child Behavior Checklist (CBCL) for their children. We assessed the internal consistency and validity using the YSR and CBCL as the criteria, and the degree to which the SDQ parent-form provides additional information by comparison with the self-report. RESULTS: The internal consistency of the SDQ total score was good (Cronbach's alpha, 0.75). Sensitivity and specificity using the YSR as the criterion were 0.75 and 0.91, respectively. When the CBCL was adopted as the criterion, these validity indices were lower. The SDQ parent-form does not provide additional information by comparison with self-reporting only when the YSR score is used as the criterion (odds ratio, 0.48; 95% confidence interval, 0.14-1.65); however, it does do so when the CBCL is the criterion (odds ratio, 10.9; 95% confidence interval, 4.23-27.9). CONCLUSIONS: The SDQ self-report is valid for the detection of EBPs in adolescents, and the SDQ parent-form provides additional information by comparison with the self-report. This indicates that it is useful to involve adolescents and their parents as informants for the identification of EBPs in adolescents.

Comparing three short questionnaires to detect psychosocial problems among 3 to 4-year olds.

BACKGROUND: Validated questionnaires help community pediatric services to identify psychosocial problems. Our aim was to assess which of three short questionnaires was most suitable for this identification among pre-school children. METHODS: We included 1,650 children (response 64 %) aged 3-4 years undergoing routine well-child health assessments in 18 services across the Netherlands. Child healthcare professionals (CHPs) interviewed and examined children and parents. Parents were randomized regarding filling out the Strengths and Difficulties Questionnaire (SDQ) or the KIPPPI, a Dutch-origin questionnaire. In addition, all filled out the Ages and Stages Questionnaires: Social-Emotional (ASQ:SE) and the Child Behavior Checklist (CBCL). We assessed the internal consistency and validity of each questionnaire, with CBCL and treatment status as criteria, and the degree to which each questionnaire could improve identification based solely on clinical assessment. RESULTS: The internal consistency of the total problems scale of each questionnaire was satisfactory, Cronbach's alphas varied between 0.75 and 0.98. Only the SDQ discriminated sufficiently between children with and without problems as measured by the CBCL (sensitivity = 0.76 at a cut-off point with specificity = 0.90), in contrast to the other two questionnaires (with sensitivity indices varying between 0.51-0.63). Similar results were found for the treatment status criterion, although sensitivity was lower for all questionnaires. The SDQ seemed to add most to the identification of psychosocial problems by CHPs, but the differences between the SDQ and the ASQ:SE were not statistically significant. CONCLUSIONS: The SDQ is the best tool for the identification of psychosocial problems in pre-school children by community paediatric services.

Three questionnaires to detect psychosocial problems in toddlers: a comparison of the BITSEA, ASQ:SE, and KIPPPI.

OBJECTIVE: Validated questionnaires can improve the identification of psychosocial problems in community pediatric services. Our aim was to assess which of 3 short questionnaires-the Brief Infant-Toddler Social and Emotional Assessment (BITSEA), the Ages and Stages Questionnaires: Social-Emotional (ASQ:SE), and the KIPPPI (Brief Instrument Psychological and Pedagogical Problem Inventory)-was most suitable as a routine screening tool for identification among toddlers. METHODS: We included 2106 parents (response rate 81%) of children aged 6, 14, or 24 months at routine well-child visits in 18 services across the Netherlands. Child health care professionals interviewed and examined children and parents. Parents were randomized to complete either the BITSEA or the KIPPPI; all filled out the ASQ:SE and the Child Behavior Checklist. For each questionnaire, we assessed the internal consistency, validity with Child Behavior Checklist-Total Problems Score (CBCL-TPS) as a criterion, and added value to identification compared to clinical assessment alone. RESULTS: Cronbach's alphas of the total scales varied between 0.46 to 0.91. At the ages of 6 and 14 months, none of the instruments studied had adequate validity. At the age of 24 months, only the BITSEA discriminated sufficiently between children with and without problems (sensitivity = 0.84 at specificity = 0.90), but not the other 2 questionnaires (with sensitivity indices varying between 0.53 and 0.60 at similar specificity). The BITSEA at this age offered slightly higher added value to the identification of psychosocial problems by child health care professionals. CONCLUSIONS: For toddlers aged 6 and 14 months, no questionnaire is sufficiently valid to support the identification of psychosocial problems. The BITSEA is the best short tool for the early detection of psychosocial problems in 2-year-old children.

Characteristics of the strengths and difficulties questionnaire in preschool children.

OBJECTIVES: Validated questionnaires help the preventive child healthcare (PCH) system to identify psychosocial problems. This study assesses the psychometric properties and added value of the Strengths and Difficulties Questionnaire (SDQ) for the identification of psychosocial problems among preschool-aged children by PCH. METHODS: We included 839 children (response 66%) 3 to 4 years of age undergoing routine health assessments in 18 PCH services across the Netherlands. Child healthcare professionals interviewed and examined children and parents. Before the interview, parents completed the SDQ and the Child Behavior Checklist (CBCL). We assessed the internal consistency, the scale structure, and validity (correlation coefficients, sensitivity, and specificity), with CBCL and treatment status as criteria, and the degree to which the SDQ could improve identification solely on the basis of clinical assessment. RESULTS: The internal consistency of the SDQ total difficulties score was good (Cronbach's α, 0.78), but it was worse for some subscales of the SDQ (range, 0.50-0.74). The area under the receiver operating characteristic curve using the CBCL as a criterion was 0.94 (95% confidence interval 0.91-0.97), and sensitivity and specificity were 0.79 and 0.93, respectively. The SDQ added information to the clinical assessment; the odds ratio was 36.48 for added information by using the CBCL as a criterion. CONCLUSIONS: The SDQ is a valid tool for the identification of psychosocial problems in preschool-aged children by PCH. However, the low reliability of some SDQ subscales does not justify use of these subscales for decisions about further treatment.