SDQ in the Hands of Fathers and Preschool Teachers-Psychometric Properties in a Non-clinical Sample of 3-5-Year-Olds

Early emotional and behavioural problems predict use of habilitation services among children: Findings from a longitudinal follow-up study

PURPOSE

To explore the association between early emotional and behavioural problems and use of habilitation services among children in Sweden.

METHODS

In this longitudinal cohort study, we used data on children, 3-5 years of age, whose mothers (n = 7343) and fathers (n = 6322) had responded to the Strengths and Difficulties Questionnaire (SDQ) for assessment of emotional and behavioural problems, and who were followed for approximately 6.5 years with regard to use of habilitation services. The relations between emotional and behavioural problems and use of habilitation services were explored through cox regression models.

RESULTS

In unadjusted models, children with identified emotional and behavioural problems were more likely to utilise habilitation services compared to those with no identified problems. These associations were shown for both mothers' (HR: 5.02) and fathers' (HR: 4.25) SDQ ratings. In adjusted cox-regression models, the associations remained significant for both mothers' (AHR: 4.24) and fathers' (AHR: 4.03) ratings.

CONCLUSIONS

Early emotional and behavioural problems predict later habilitation service use among children in Sweden. Assessment of these problems in all children at child health services could facilitate early identification and timely interventions. Habilitation centres in Sweden could integrate mental health care into the standard treatment for children using these services.

Psychometric properties of the Norwegian version of the Strength and Difficulties Questionnaire in a preschool sample

PURPOSE

The Strength and Difficulties Questionnaire (SDQ) is widely used internationally, however less so in preschool populations and validations studies are thus needed. This study examined the psychometric properties of the Norwegian version parent report of the SDQ - preschool version (SDQ 2-4).

MATERIALS AND METHODS

Parents of 289 Norwegian children in the age span 1-6 years old filled out the SDQ 2-4, the Child Behavior Checklist (CBCL), and background information. Internal consistency, factor structure, and convergent validity were assessed.

RESULTS

The results showed satisfying internal consistency for the total difficulties score, but worse for some of the subscales. The five-factor structure showed a good fit. Good convergent and divergent validity was found in terms of correlations with CBCL. Sex differences were found on all scales, boys scoring higher on all problem scales.

CONCLUSIONS

The SDQ 2-4 can be a promising instrument to screen for emotional and behavioral difficulties among Norwegian preschoolers, particularly in high-risk populations.

Preschool-level socio-economic deprivation in relation to emotional and behavioural problems among preschool children in Sweden

AIMS

The aim of this study was to explore the association between preschool-level socio-economic deprivation and emotional and behavioural problems among preschool children in Sweden using a multilevel approach.

METHODS

In this cross-sectional study, we used data on 2267 children whose parents and preschool teachers had responded to items measuring individual-level socio-economic deprivation and the Strengths and Difficulties Questionnaire (SDQ) for assessment of emotional and behavioural problems. Further, the Socioeconomic Structure Compensation Index (SSCI), collected from Uppsala municipality, was used to assess preschool-level socio-economic deprivation. Unadjusted and adjusted multilevel logistic regression models were used to explore the relations between preschool-level socio-economic deprivation and emotional and behavioural problems.

RESULTS

In unadjusted models, children who attended preschools classified as highly deprived had elevated odds for emotional symptoms (odds ratio (OR) 1.71) as rated by parents. However, this association did not remain significant after adjusting for individual-level socio-economic deprivation factors. In both unadjusted and adjusted models, children who attended preschools classified as moderately deprived had elevated odds for peer-relationship problems as rated by parents (OR 1.63; adjusted OR 1.48). There were no significant associations between preschool deprivation and emotional and behavioural problems as rated by preschool teachers.

CONCLUSIONS

Swedish preschools may have a compensatory capacity in addressing children's emotional and behavioural problems, whereas preschool-level deprivation remained significantly associated with peer-relationship problems after controlling for individual-level socio-economic deprivation factors. This implies that peer-relationship problems in deprived preschools need to be addressed in a broader community context.

Screening accuracy of the parent-report preschool Strengths and Difficulties Questionnaire in primary care

OBJECTIVE

To evaluate the screening test accuracy and reliability of the parent-report preschool Strengths and Difficulties Questionnaire (P-SDQ) in primary care settings.

METHODS

Children 24-48 months were recruited at scheduled primary care visits in Toronto, Canada. Parents completed the P-SDQ at baseline, 2 and 12 weeks. At 12 weeks, parents were invited to a semi-structured diagnostic phone interview, the Preschool Age Psychiatric Assessment (PAPA). Criterion validity between baseline P-SDQ scores (Total Difficulties Score [TDS], internalizing and externalizing subscale) and DSM-5 diagnoses on PAPA was evaluated using area under the curve (AUC) and calculating screening test properties (sensitivity and specificity). Test-retest reliability at baseline and 2 weeks was evaluated using intraclass correlation coefficient (ICC).

RESULTS

183 children were enrolled, mean age 39.3 (SD 7.4) months, 46.4% male, 120 (66%) completed P-SDQ at 2 weeks, 107 (58%) completed PAPA at 12 weeks. Of those with a PAPA, 26 (24%) had any psychiatric diagnosis, 22 (21%) had internalizing disorders, and 9 (8%) had externalizing disorders. TDS identified any diagnosis with AUC = 0.67 (95% CI: 0.55, 0.79); internalizing subscale identified internalizing disorders with AUC = 0.61 (95% CI: 0.47, 0.74); externalizing subscale identified externalizing disorders with AUC = 0.77 (95% CI: 0.60, 0.94). Sensitivity and specificity, and test-retest reliability, were satisfactory for TDS and externalizing subscale, and less satisfactory for the internalizing subscale.

CONCLUSION

The externalizing subscale has sufficient accuracy and reliability to identify children aged two to four years at risk for attention deficit/hyperactivity disorder and disruptive behavior disorders in primary care.

Validation of the Arabic Version of Strengths and Difficulties Questionnaire in Early Childhood Education in Qatar

This study examined the validity of the Arabic version of the Strengths and Difficulties Questionnaire (SQD, teacher version) among a sample of young children in Qatar. Teachers rated 502 children aged four to five years from public preschools using the SDQ teacher version. The factor structure of the SDQ was analyzed using exploratory and confirmatory factor analyses. I calculated Cronbach's alpha coefficient and item-total correlations to determine the reliability of the five subscales and overall SDQ. The findings showed acceptable reliability, with the exception of the Peer Problems Scale. Common fit statistics-including the comparative fit index, non-normed fit index, and goodness-of-fit index-were used for the confirmatory factor analysis. In general, satisfactory psychometric characteristics were observed for the preschool SDQ, suggesting that the questionnaire could be administered to preschool-age children in Qatar.

Structural validity of the Norwegian version of the Strengths and Difficulties Questionnaire in children aged 3-6 years

Introduction

This study examined the structural validity of the teacher-report Strength and Difficulties Questionnaire (SDQ) in Norwegian preschoolers aged 3-6 years. We tested the original five-factor structure, the five-factor structure with two broader second-order factors, and a three-factor structure, all suggested in the literature. Since the positively worded items in SDQ have been shown to introduce noise, we also examined all three structures with a positive construal method factor for these items.

Methods

Preschool teachers from 43 preschools completed the SDQ questionnaire for 1,142 children [48% girls, mean age 4.3 (SD 0.9) years]. Confirmatory factor analyses were used to estimate and compare the six models. Measurement invariance was tested across sex (multi-group approach) and age (multiple-indicator multiple-cause approach).

Results

The original five-factor structure of SDQ was supported, where the model fit improved when including a method factor for positively worded items. Both models showed scalar invariance across sex and age. The second-order and the three-factor structures were not supported.

Conclusion

We recommend using the original five-factor structure when using SDQ for both clinical and research purposes in young children and adding a method factor when using structural equation modeling.

Assessment of child psychological attributes using strength and difficulties questionnaire for prediction of child behavior at first dental visit: a cross-sectional study

INTRODUCTION

Predicting child behavior before the first dental visit is considered an effective approach that enables the dentist to guide child behavior during the dental treatment.

AIM

The present study aimed to detect psychological attributes of children seeking dental treatment for the first time using the strength and difficulties questionnaire (SDQ), evaluate actual child behavior during the dental treatment using Frankl Behavior Rating Scale, and test the association between these attributes and child behavior.

MATERIAL AND METHOD

The study was conducted on 128 children aged between 4 and 7 years attending the outpatient Pediatric Dentistry clinic for the first time. Parents were asked to answer the SDQ, then a simple restorative treatment under local anesthesia was performed for children to evaluate their behavior using Frankl Behavior Rating Scale.

RESULTS

About 19.5% of the study sample were categorized as psychologically abnormal, where emotional and conduct problems were the most prevalent psychological attributes by a percentage of 22.7% and 20% respectively. A strong correlation was detected between the total difficulty score and child behavior.

CONCLUSIONS

Psychological problems are common among children aged from 4 to 7 years and they also affect their dental behavior.

The Ages and Stages Questionnaire: Social-Emotional-What Is the Optimal Cut-Off for 3-Year-Olds in the Swedish Setting?

OBJECTIVE

Expressions of emotional and behavioral symptoms in preschool age can predict mental health problems in adolescence and adulthood. The Ages and Stages Questionnaires: Social-Emotional (ASQ:SE) has been successful in detecting social and emotional problems in young children in some countries but had not been tested in Sweden. The objective of this study was to determine the optimal cut-off for the ASQ:SE instrument when administered to 3-year-old children in a northern Swedish setting, using the Strengths and Difficulties Questionnaire (SDQ) as the reference.

METHODS

The ASQ:SE (36-month interval, first edition) was administered at routine 3-year-olds' visits to Child Health Care centers in Region Västerbotten, Sweden. During the study period (September 2017 to March 2018) parents were invited to also fill out the SDQ (2-4 year version). In the final analyses 191 children fulfilled the criteria for inclusion in the study sample. Non-parametric Receiver Operating Characteristic analysis was performed to quantify the discriminatory accuracy of ASQ:SE based on SDQ.

RESULTS

The Pearson correlation between ASQ:SE and SDQ indicated strong correlation between the two instruments. The Receiver Operating Characteristic curve showed good accuracy of ASQ:SE in relation to SDQ. However, our results suggest that the existing ASQ:SE cut-off score of 59 was not optimal in the Swedish context. Changing the cut-off from 59 to 50 would allow us to detect 100% (n = 14) of children with problems according to SDQ, compared to 64% (n = 9) when the cut-off was 59. However, the proportion of false positives would be higher (9% compared to 3%).

CONCLUSION

The main finding was that for 3-year-olds in Sweden a decreased ASQ:SE cut-off score of 50 would be optimal. This would increase the detection rate of at-risk children according to SDQ (true positive), thus prioritizing sensitivity. Our conclusion is that, although this change would result in more false positives, this would be justifiable.

Asthma and allergies correlate with mental health problems in preschool children

AIM

To explore the relations between asthma, allergies and mental health problems in preschool children, aged 3-5 years.

METHODS

In this cross-sectional Swedish study, we used data on 4649 children in Uppsala municipality whose parents and preschool teachers had responded to questions measuring asthma and allergies, and the Strengths and Difficulties Questionnaire (SDQ) for assessment of mental health problems. Logistic regression models were used to explore the relations between asthma and allergies and mental health problems.

RESULTS

Children with asthma (8.5%) had elevated odds of having emotional symptoms as rated by parents (OR: 1.34; 1.02-1.76) and teachers (OR: 1.44; 1.09-1.91). According to parents' ratings, these children also had elevated odds of showing mental health problems in general according to the SDQ total score (OR: 1.42; 1.05-1.94). Children with food allergies or intolerance (4.4%) only had elevated odds of having emotional symptoms (OR: 1.64; 1.16-2.33), as reported by parents. These results remained significant after adjustment for parental background factors.

CONCLUSION

Preschool children with asthma and food allergies or intolerance are at risk of having concurrent mental health problems. Mental health problems should be assessed in children with these disorders. Adequate support and/or referral to specialised services should be offered when needed.

Importance of living arrangements and coparenting quality for young children's mental health after parental divorce: a cross-sectional parental survey

BACKGROUND

Parental separation has been associated with adverse child mental health outcomes in the literature. For school-aged children, joint physical custody (JPC), that is, spending equal time in both parents' homes after a divorce, has been associated with better health and well-being than single care arrangements. Preschool children's well-being in JPC is less studied. The aim of this study was to investigate the association of living arrangements and coparenting quality with mental health in preschool children after parental separation.

METHODS

This cross-sectional population-based study includes 12 845 three-year-old children in Sweden. Mental health was measured by parental reports of the Strength and Difficulties Questionnaire and coparenting quality with a four-item scale. The living arrangements of the 642 children in non-intact families were categorised into JPC, living mostly with one parent and living only with one parent.

RESULTS

Linear regression models, adjusted for sociodemographic confounders, showed an association between increased mental health problems and living mostly and only with one parent (B=1.18; 95% CI 0.37 to 2.00, and B=1.20; 95% CI 0.40 to 2.00, respectively), while children in intact families vs JPC did not differ significantly (B=-0.11; 95% CI -0.58 to 0.36). After adjusting the analyses for coparenting quality, differences in child mental health between the post divorce living arrangements were, however, minimal while children in intact families had more mental health problems compared with JPC (B=0.70; 95% CI 0.24 to 1.15). Factorial analysis of covariance revealed that low coparenting quality was more strongly related to mental health problems for children in intact families and JPC compared with children living mostly or only with one parent.

CONCLUSIONS

This study suggests that coparenting quality is a key determinant of mental health in preschool children and thus should be targeted in preventive interventions.

Social interaction and gender as factors affecting the trajectories of children's engagement and hyperactive behaviour in preschool

Background and aims

Social interactions in preschool and a child's gender are, in cross‐sectional studies, related to the child's overall levels of hyperactive behaviour and engagement in preschool activities. However, whether social interaction and gender can predict children's engagement and hyperactivity is not thoroughly investigated. This study aims to investigate the longitudinal influence of gender, child‐to‐child interaction, and teacher responsiveness on the association between trajectories of children's levels of core engagement and hyperactive behaviour. It was hypothesized that peer‐to‐child interaction and teacher responsiveness in preschool settings are related to positive change in engagement among children with hyperactive behaviour, especially for boys.

Sample and methods

Swedish preschool staff completed questionnaires assessing the variables of interest for children aged 1–5 (N = 203). Data were collected on three occasions over a two‐year period. Latent growth curve (LGC) models were used to explore whether teacher responsiveness, peer‐to‐child interaction, and gender predict trajectories of engagement and hyperactivity.

Results

The results revealed that high levels of hyperactivity were associated with lower levels of engagement on the first occasion. Positive peer‐to‐child interactions and responsive teachers were significant predictors of an increased level of engagement and decreased level of hyperactive behaviour, especially for boys.

Conclusions

The findings underscore the need to improve social interactions, especially peer‐to‐child interactions, to improve engagement in children with hyperactive behaviour, especially boys. Implications for practices and research are discussed.

Facilitating implementation of an evidence-based method to assess the mental health of 3-5-year-old children at Child Health Clinics: A mixed-methods process evaluation

BACKGROUND

A number of instruments for identifying mental health problems in children are available, but there is limited knowledge about how to successfully implement their use in routine practice. The Strengths and Difficulties Questionnaire (SDQ) is an instrument with sound psychometric properties. Because using multi-informant SDQs when assessing young children has been emphasized, parent- and preschool teacher reports on the SDQ were introduced at Child Health Clinics in a Swedish municipality. This paper aimed to describe a facilitation programme developed to support the introduction of SDQ in clinical practice and evaluate how nurses perceived the facilitation strategies used. Moreover, the dose (delivery) and reach (response rate and population coverage) of the questionnaires were assessed.

METHODS

The mixed-methods process evaluation was guided by Moore et al.'s framework. Process data were excerpted from monitoring data, the trial database, research group documents, study materials, group interviews with nurses, and a survey on nurses' opinions and experiences of the screening method and the implementation process. Data were analysed using descriptive statistics and qualitative content analysis.

RESULTS

Facilitation strategies used included: educational meetings, educational outreach visits, newsletters, facilitative administrative support, and adaptations made in procedures and materials when required. Although nurses described a variety of barriers at the organisational and individual level, they were in favour of using the SDQ in clinical practice and emphasised the importance of the facilitation strategies used for its implementation. While dose levels (77-91%) indicated that nurses essentially delivered the intervention as intended, parental response rates remained between 54 and 63% and population coverage at around 50%, throughout the intervention period.

CONCLUSION

The facilitation program was perceived to support the implementation of the SDQ at the yearly check-ups in the child healthcare setting, but further efforts are required to reach all families.

Swedish norms for the Strengths and Difficulties Questionnaire for children 3-5 years rated by parents and preschool teachers

The Strengths and Difficulties Questionnaire (SDQ) is a widespread tool for assessing behavior problems in children and adolescents. Despite being investigated thoroughly concerning both validity and reliability, peer reviewed studies that provide norms, especially for preschool children, are lacking. This paper provides Swedish norms using data from a large community sample of children aged 3–5, based on mothers’, fathers’, and preschool teacher’s ratings. Preschool teachers’ ratings were generally lower than parents’ ratings, which contradicts some previous studies. Differences between girls and boys were found, suggesting that boys display higher levels of behavior problems. Lower parental education and country of origin outside of Sweden were also associated with more difficulties. Cut‐offs are presented for each age group, gender and rater category. Population‐specific norms and percentile cut‐offs provided in this study facilitate identifying children in need of interventions in paediatric care and enable cross‐country comparisons of children’s mental health problems.

Warning signs of preschool victimization using the strengths and difficulties questionnaire: Prevalence and individual and family risk factors

Introduction

School victimization by peers is an important social problem with serious short- and long-term consequences poorly studied at preschool ages, which can lead to school bullying without timely intervention. Longitudinal data was used to determine the prevalence of warning signs of preschool peer victimization and its individual and family risk factors.

Methods

Data was obtained from 577 community preschoolers. School victimization was measured using the Strengths and Difficulties Questionnaire (SDQ) administered to parents and teachers of children at ages 4 and 5. Risk factors for the child (demographics, conduct and emotional problems, aggressiveness) and the family (maternal problems during pregnancy and early development, parenting styles, adaptive functioning and parents’ problems) were previously recorded at 3 years old.

Results

Combined information from parents and teachers showed that 4.2% of preschoolers presented warning signs of victimization at ages 4 and 5. Low socioeconomic status, poor emotional control, early problems making friends and low level of parenting education in social norms at age 3 predicted later victimization at ages 4 and 5 (AUC = .78).

Conclusion

Peer victimization affects a considerable percentage of preschoolers. Early detection may help to reduce the risk of escalation.

Assessing the factor structure of the Spanish language parent Strengths and Difficulties Questionnaire (SDQ) in Honduras

With worldwide prevalence rates between 10% and 20%, mental illness in children and adolescents is an issue for which culturally sensitive screening tools are needed. The Strengths & Difficulties Questionnaire (SDQ) is a commonly used measure that has been translated into numerous languages, although some research suggests issues with cross-cultural validity. Only four other studies have tested the Spanish-language SDQ in Latin America. In this study, we aimed to help fill this gap by assessing the factor structure of the parent or teacher version of the Spanish-language SDQ (for children ages 4–17) with 967 parent or other caregiver respondents of primary school-aged children (ages 4 to 17) in the Department of Intibucá, Honduras. When unable to find a good fitting factor model previously identified in the literature, we conducted split sample exploratory factor analysis (EFA) and confirmatory factor analysis (CFA), along with measurement invariance testing with the best fitting EFA-extracted model based on gender for caregiver respondent and child gender. Results showed that while many EFA models had a good fit, CFI and TLI was < .90 for all extracted models when confirmed in the second sample with CFA. We then modified the best fitting extracted three-factor, 24-item model, which dropped item 15, by allowing select item residuals to correlate, increasing CFI and TLI to > .90 for female child gender. This modified three-factor model was partially invariant for configural and scalar models between child genders. Configural and scalar models would not converge for adult genders. Of note, metric models were not produced in Mplus related to items’ cross-loading on more than one factor. These findings suggest that the SDQ Spanish language parent or teacher version may not perform optimally cross-culturally in this area of Honduras. Future research should confirm these findings with other Honduran populations.

Agreement between mothers', fathers', and teachers' ratings of behavioural and emotional problems in 3-5-year-old children

BACKGROUND

The Strengths and Difficulties Questionnaire (SDQ), a valid and reliable instrument for measuring children's mental health, is available in parent- and teacher versions, making it an ideal tool for assessing behavioural and emotional problems in young children. However, few studies have evaluated inter-parent agreement on the SDQ, and in most studies on SDQ agreement, parent scores are either provided by only one parent or have been combined into one parent score. Furthermore, studies on SDQ inter-rater agreement usually only reflect degree of correlation, leaving the agreement between measurements unknown. The aim of the present study was therefore to examine both degree of correlation and agreement between parent and teacher SDQ reports, in a community sample of preschool-aged children in Sweden.

METHODS

Data were obtained from the Children and Parents in Focus trial. The sample comprised 4,469 children 3-5-years-old. Mothers, fathers and preschool teachers completed the SDQ as part of the routine health check-ups at Child Health Centres. Inter-rater agreement was measured using Pearson correlation coefficient and intraclass correlation (ICC).

RESULTS

Results revealed poor/fair agreement between parent and teacher ratings (ICC 0.25-0.54) and good/excellent agreement between mother and father ratings (ICC 0.66-0.76). The highest level of agreement between parents and teachers was found for the hyperactivity and peer problem subscales, whereas the strongest agreement between parents was found for the hyperactivity and conduct subscales.

CONCLUSIONS

Low inter-rater agreement between parent and teacher ratings suggests that information from both teachers and parents is important when using the SDQ as a method to identify mental health problems in preschool children. Although mothers and fathers each provide unique information about their child's behaviour, good inter-parent agreement indicates that a single parent informant may be sufficient and simplify data collection.