Early detection of psychological problems in a population of children with enuresis: construction and validation of the Short Screening Instrument for Psychological Problems in Enuresis.

ABSTRACT

PURPOSE: The current study focuses on the construction and validation of the Short Screening Instrument for Psychological Problems in Enuresis, for emotional problems and symptoms of attention deficit hyperactivity disorder, in a population of children with enuresis. MATERIALS AND METHODS: In phase I factor analyses were performed on 31 items of the Internalizing scale of the Child Behavior Checklist and on 18 items of the Attention Deficit Disorder scale of the Disruptive Behavior Disorders Rating Scale to select the most discriminating items. The question format and cutoff score for referral were determined by maximization of correctly classified patients, with the full Child Behavior Checklist and Disruptive Behavior Disorders Rating Scale as standards. In phase II 109 children with enuresis (76 males and 33 females, mean age 8.5 years, SD 2.4) admitted to a tertiary care university hospital entered the validation study. The parents completed the Short Screening Instrument for Psychological Problems in Enuresis and the original questionnaires, ie Child Behavior Checklist and Disruptive Behavior Disorders Rating Scale. RESULTS: Seven items (factor loading greater than 0.65) were selected for "emotional problems," 3 (greater than 0.80) for "attention problems" and 3 (greater than 0.75) for "hyperactivity/impulsivity problems." Full screening was indicated when at least 2 problem behaviors occurred at least "sometimes" for Child Behavior Checklist items or "frequently" for Disruptive Behavior Disorders Rating Scale items. Validation of the Short Screening Instrument for Psychological Problems in Enuresis revealed good accuracy for all subscales (approximately 88%), excellent specificity (0.91 to 0.99) and low to fair sensitivity (0.29 to 0.75). CONCLUSIONS: The Short Screening Instrument for Psychological Problems in Enuresis meets its goal because it leads to time efficient and early detection of problems of emotion, attention and hyperactivity/impulsivity. The implementation of this short questionnaire can contribute to better followup of medical treatment.