Gender associated developmental trajectories of SDQ-dysregulation profile and its predictors in children

BACKGROUND

Severe mood dysregulation is common in childhood and can be highly impairing. The Dysregulation Profile (DP) can be considered as a broader phenotype of emotional dysregulation, including affect, cognition and behaviour. Since mood dysregulation may persist, but differently in boys and girls, the gender associated course needs to be considered longitudinally to gain a better insight in order to support the children more adequately. This study is focusing on gender associated subgroup trajectories of the Strengths and Difficulties Questionnaire-Dysregulation Profile (SDQ-DP) in middle childhood (9-13 years of age) and includes the potential impact of clinical and psychosocial characteristics.

METHOD

The data set was available from the BELLA study on mental health and well-being in children and adolescents, which is the mental health module of the German Health Interview and Examination Survey for Children and Adolescents (KiGGS). A representative epidemiological sample of 564 children living in Germany was examined at three assessment points over 2 years (data collection 2003-2006). The SDQ-DP of children aged 9-13 years was evaluated using Latent Class Growth Analysis (LCGA).

RESULTS

For both genders three trajectories with low (girls 67.0% and boys 59.5%), moderate (girls 28.0% and boys 31.7%) and high SDQ-DP (girls 5.0% and boys 8.8%) scores were detected. The courses of low and moderate subgroups were stable, while in the high SDQ-DP subgroup boys showed a decreasing and girls an increasing trend in symptom severity on a descriptive level. The results of the multinomial logistic regression analyses revealed a significant influence of mainly externalising but also internalising problems both increasing the risk of moderate and high SDQ-DP in both genders. Good quality of life was a protective factor for the SDQ-DP course in all subgroups.

CONCLUSION

In addition to the known clinical and scientific value of the SDQ-DP, three distinguishable trajectories of SDQ-DP in boys and girls could be found. High externalising problems at the beginning of the trajectory were associated with an undesirable course of SDQ-DP. These findings might be helpful for better psychoeducation, counselling and monitoring in clinical cases and public health.

[Utilization of Physiotherapy Services by Children and Adolescents - Results of the KiGGS- Baseline Survey]

Aim of the study: The use of physical therapy in German children and adolescents has so far solely been analyzed on the basis of health insurance data, which can neither consider case history nor social factors. Using the KiGGS-baseline survey it is possible to examine the use of physical therapy on the basis of parental reported health problems and social factors. Methodology: Identifiable determinants for the use of physical therapy in the last 12 months in the KiGGS-baseline survey were examined bivariate and multivariate in logistic regression models with mutual adjustment. The following determinants were considered: social factors, somatic disorders and psychological abnormalities. The proportion of the use of physical therapy, which can be explained by these determinants, was estimated using population-attributable risk fraction. Results: The frequency of the use of physical therapy in the last 12 months in the 0 to 17-year-olds in the KiGGS-baseline survey was 6,4% with higher use during infancy and adolescence. The socio-economic status of parents was not associated with the use of physical therapy. A migration background decreased the probability of the use of physical therapy, for example, among children aged 0 to 2 years (OR_adjusted: 0,5 [95% CI: 0,2-1,0]). In those with scoliosis, the use of physical therapy was almost twice as frequent in infancy as in adolescence (58,4 vs. 34,4%). A maximum of 15% of all children and adolescents with back pain reported the use of physical therapy. When ADHD was diagnosed at preschool age, the probability of using physical therapy was increased (OR_adjusted: 5,1 [95% CI: 1,4-18,6]). The health problems, which were assessed in the KiGGS-baseline survey and considered for this analysis could explain 37% of the use of physical therapy in the 0 to 2-year-olds. In the other age groups, 59 to 62% could be explained. Conclusion: Comparison of the KiGGS-baseline survey with health insurance data shows similar frequencies and patterns of the use of physical therapy and can therefore be used for the analysis of healthcare questions on the use of physical therapy. The data point to potential deficits in treatment in population segments and for some conditions. An examination of these hypotheses based on analyses of health insurance data seems to be reasonable.

[Mental health in adolescents in Germany: A comparison with regard to migration background and country of origin]

Many children and adolescents in Germany grow up in families with a migration background. Different cultural, religious, and linguistic backgrounds have an influence on their behavior in various ways. Health status can be affected both negatively and positively by a migration background. The aim of this study was to analyze associations between migration background and self-reported psychological problems. In addition, it was tested whether country of origin had a differential effect on the associations found. Because of its migration-specific approach, the baseline survey (2003-2006) of the nationwide German Health Interview and Examination Survey for Children and Adolescents (KiGGS) offers a solid basis for migrant-specific analyses. Self-reported mental health problems were assessed using the Strengths and Difficulties Questionnaire (SDQ), which was completed by 6,719 adolescents aged 11-17 years. Adolescents with a two-sided migration background (i.e., both parents) reported higher SDQ total difficulties scores compared with adolescents without a migration background (16.9 vs 11.5%) or those with a one-sided migration background (16.9 vs 11.3%). Adolescents with a Turkish background had higher odds (boys: OR 2.0; 95%CI 1.3-3.2; girls: OR 2.0; 95%CI 1.2-3.4) of reporting mental health problems than adolescents without a migration background. Also, girls with a migration background from Western Europe, the USA or Canada had higher odds (OR 2.2; 95%CI 1.3-3.6). In some cases, adjusting for socioeconomic status led to insignificant associations with regard to the country of origin. The findings underline the importance of migrant-specific and culture-sensitive prevention, which also takes the environment and culture-specific characteristics into account.

Nationwide Survey on the Health of Offspring from Former Childhood Cancer Patients in Germany

BACKGROUND

Increased risk for infertility from cancer treatment and fear of health impairment in their offspring may prevent survivors of childhood cancer from having own children. Even though most studies report no increased risk for malformations, in our German fertility study 2008 a higher occurrence of cleft lip and palate was found in offspring of former patients.

METHODS

Since 2010 we assess offspring's health in a survey-based multicenter study, comparing diseases, well-being, healthcare utilization and health-related behavior between offspring from survivors, siblings or the general population. Within a first nationwide survey wave survivors who were known to have at least one child by previous fertility studies, received a questionnaire supported by the German Childhood Cancer Registry. Questionnaires were based on the KiGGS study on children's health in the German general population conducted by the Robert-Koch Institute (n=17,641).

RESULTS

Questionnaires on 418 children were answered by 65% (254/393) of survivors contacted to participate in the first nationwide offspring study wave. Participants were more likely to be female (p<0.01), to have achieved higher educational levels (p<0.05) and to be a survivor of a soft tissue tumor (p<0.05). Former patients expressed moderate to high anxiety for the occurrence of cancer in 74% and feared other diseases in their children in 20%.

CONCLUSION

Offspring health is a topic of major relevance to former patients. Our offspring study is currently being extended to ~1500 offspring of childhood cancer survivors in Europe.

[Psychopathological problems and psychosocial impairment in children and adolescents aged 3-17 years in the German population: prevalence and time trends at two measurement points (2003-2006 and 2009-2012): results of the KiGGS study: first follow-up (KiGGS Wave 1)]

Child and adolescent mental health problems burden not only the individual, but also their families and their social environment and may, therefore, be regarded as a highly relevant public health issue. The data on mental health problems of children and adolescents from the KiGGS Wave 1 study (sample period 2009-2012) make it possible to report on both current prevalence rates and time trends over the 6-year period beginning with the KiGGS baseline survey (2003-2006). The assessment of emotional and behavioral problems in KiGGS Wave 1 was carried out with the symptoms questionnaire of the Strengths and Difficulties Questionnaire (SDQ) in a telephone interview with 10,353 guardians of children and adolescents aged 3-17 years. Moreover, using the SDQ impact supplement, the KIGGS Wave 1 data provide information on psychosocial impairment following child and adolescent mental health problems. Subjects with a borderline or abnormal SDQ score, according to German normative data, were considered at risk. A total of 20.2% (95% CI: 18.9-21.6%) of the study subjects were identified as being at risk for a mental health disorder, compared with 20.0% (19.1-20.9%) during the KiGGS baseline study (age-standardized based on population from 12 December 2010). Thus, no significant changes over time in the prevalence of mental health problems were detected. Also, there were no statistically significant differences in prevalence by sex, age group, or socioeconomic status between the KiGGS baseline survey and KiGGS Wave 1. The statistical comparison of the subscale mean values for both girls and boys showed higher values with respect to the subscales for emotional problems, behavioral problems, and prosocial behavior and lower mean values for the peer problems subscale in KiGGS Wave 1. These partly small temporal trends, however, may be due to possible mode effects (written questionnaire in the KiGGS baseline study versus telephone interview in KiGGS Wave 1). The hyperactivity subscale remained stable across the two sample periods. Regarding impairments following mental health problems at the second sample period, boys were more affected in the areas of chronicity, family burden, and impact score. The high and stable prevalence rates and magnitude of emotional and behavioral problems should prompt increased preventive efforts.

[Frequency and distribution of sleep problems and insomnia in the adult population in Germany: results of the German Health Interview and Examination Survey for Adults (DEGS1)]

Sleep disturbances are associated with a variety of physical and mental health disorders and cause high direct and indirect economic costs. The aim of this study was to report the frequency and distribution of problems of sleep onset and maintaining sleep, sleep quality, effective sleep time, and the consumption of sleeping pills in the adult population in Germany. During the 4 weeks prior to the interview, about one third of the respondents reported potentially clinically relevant problems initiating or maintaining sleep; about one-fifth reported poor quality of sleep. When additionally considering impairments during the daytime such as daytime fatigue or exhaustion, a prevalence of 5.7 % for an insomnia syndrome was found. Women were twice as likely to be affected by insomnia-syndrome as men. Significant age differences were not seen. Persons with low socioeconomic status had an increased risk of insomnia (OR: 3.44) as did people residing in West Germany (OR: 1.53). Women with low socioeconomic status (OR: 4.12) and West German men (OR: 1.79) were more affected. The results illustrate the considerable public health relevance of insomnia-related sleep disturbances. An English full-text version of this article is available at SpringerLink as supplemental.

Screening of disordered eating in 12 year old girls and boys: Psychometric analysis of the German versions of SCOFF and EAT-26

To detect eating disorders and risky eating behaviour in early stages, screening tests are used. In order to examine as many adolescents as possible, these tests should be economic, i. e. as short as possible but at the same time they should fulfil the psychometric quality criteria. We compared the German version of the Eating Attitudes Test (EAT-26D) and the German version of the SCOFF test (which contains only five Yes-no questions) in a sample of 425 twelve year old girls and 382 boys from Thuringia, Germany. Although the EAT-26D reached higher psychometric properties, the SCOFF has been proved as a useful screening tool with a test-retest reliability of rtt = .73 and a maximum accuracy of 82% (area under the ROC curve). In reference to the EAT-26D (20 point cut-off) the sensitivity of the SCOFF was 78%, specificity 75%, positive predictive value 28%, and the negative predictive value, which is more relevant for screenings, was 96%. The construct validity reached r = .52.

Impact of a family-oriented rehabilitation programme on behavioural and emotional problems in healthy siblings of chronically ill children

OBJECTIVE

To evaluate the impact of a family-oriented inpatient rehabilitation programme on behavioural and emotional problems in healthy siblings of chronically ill children and to assess the association between these problems and quality of life.

METHODS

A total of 259 healthy children (4-16 years, M = 8.6 years, SD = 3.3) with a chronically ill sibling were enrolled in the study. Parents filled in the Strengths and Difficulties Questionnaire, while the children answered a self-report quality of life instrument (LQ-KID) at the time of admission and discharge from the clinic and at a 6-month follow-up. Comparisons were performed with a matched control group from the German general population (n= 777).

RESULTS

Significant behavioural or emotional symptoms were found in 30.5% of the healthy siblings, the relative risk of having elevated scores being 2.2 compared with the control group. Symptoms were inversely correlated with quality of life (r=-0.42). During the inpatient rehabilitation, symptoms decreased significantly to a normal level. Similarly, quality of life significantly improved, except in the dimension family relations.

CONCLUSIONS

Family-oriented inpatient rehabilitation is a promising approach to improve the mental health of children with a chronically ill sibling.

Psychotropic medication in children and adolescents in Germany: prevalence, indications, and psychopathological patterns

OBJECTIVE

The aim of this study was to identify the "real-life" prevalence of psychotropic medications in children and adolescents in Germany and related behavioral and emotional problems. Data from the nationwide representative National German Health Interview and Examination Survey for Children and Adolescents (KiGGS) were analyzed.

METHOD

A total of 17,450 subjects aged 0-17 years from 167 communities were examined as part of the KiGGS in Germany between 2003 and 2006 to determine their use of antidepressants, antipsychotics, anxiolytics, and sedatives within the 7 days prior to being interviewed. Medication use was assessed by a medical doctor who conducted a computer-assisted personal interview (CAPI) with the parents, and related emotional and behavioral problems were assessed using the Strength and Difficulties Questionnaire (SDQ).

RESULTS

The overall prevalence for these medications was moderate (4.81/1000; 95% confidence interval [CI], 3.70-6.26), but prevalence varied across the different classes of drugs (sedatives > antipsychotics > antidepressants > anxiolytics). Rates of off-label use were high for antipsychotics and antidepressants. About 30% of the medication, especially sedatives, was used without prescription. Subjects using psychotropic medication obtained higher scores in the screening for emotional or behavioral problems than the total sample, but 40% of the children did not show abnormal scores.

CONCLUSION

The indication for antipsychotics was mostly behavioral symptomatology, while antidepressants were used for a wide variety of symptoms. The high proportion of children and adolescents using psychotropic medication with normal scores in the emotional and behavioral screening was remarkable. It cannot be determined whether in these cases low scores were related to improvement in symptoms or whether medication was being misused.

[Use of electronic media in adolescence. Results of the German Health Interview and Examination Survey for Children and Adolescents (KiGGS)]

The use of electronic media is playing an ever greater role in adolescents' recreational behaviour. From the point of view of the health sciences, one question which arises is the extent to which intensive media use is detrimental to physical activity and adolescents' health development. The data from the German Health Interview and Examination Survey for Children and Adolescents (KiGGS), which were evaluated with a focus on 11-17-year-olds, confirm this heavy use of electronic media. However, there are distinct group-specific differences. For example, boys spend more time than girls on computers, the internet and games consoles, whereas girls more often listen to music and use their mobile phones. Watching television and videos is equally popular among girls and boys. Adolescents of low social status or a low level of school education use electronic media far more frequently and for longer times, especially television and video, games consoles and mobile phones. The same is true of boys and girls from the former states of the GDR and for boys (but not girls) with a background of migration. A connection to physical activity has been established for adolescents who spend more than five hours a day using electronic media. Moreover, this group of heavy users is more often affected by adiposity. The results of the KiGGS study, which are in line with earlier research findings, thus demonstrate that the use of electronic media is also of relevance from the point of view of public health and should be included in investigations into the health of children and adolescents.

[Prevalence of somatic diseases in German children and adolescents. Results of the German Health Interview and Examination Survey for Children and Adolescents (KiGGS)]

In the German Health Interview and Examination Survey for Children and Adolescents (KiGGS), which was conducted from 2003 to 2006, data on acute/infectious and chronic diseases were collected from a population-based sample of 17,641 subjects aged 0 to 17 years. The annual prevalence rates among acute diseases vary widely. Children and adolescents are most frequently affected by acute (infectious) respiratory conditions. 88.5 % of the surveyed children and adolescents experienced at least one episode of common cold within the last 12 months. Among the other acute respiratory infections, bronchitis and tonsillitis were the most frequently encountered conditions with 19.9 % and 18.5 %, respectively. The 12-month prevalence of otitis media and pseudocroup was 11 % and 6.6 %, respectively. 1.5 % of the children and adolescents experienced an episode of pneumonia. Apart from respiratory infections, gastrointestinal infections were very frequently stated as reasons for acute illness. Furthermore, 12.8 % of the children and adolescents experienced a herpetic infection, 7.8 % a conjunctivitis and 4.8 % a urinary tract infection. Lifetime prevalence rates of infectious diseases were as follows: pertussis 8.7 %, measles 7.4 %, mumps 4.0 %, rubella 8.5 %, varicella 70.6 %, scarlet fever 23.5 %. The various chronic somatic diseases in children and adolescents had different lifetime prevalence rates. Most frequently, children and adolescents were affected by obstructive bronchitis (13.3 %), neurodermatitis/atopic eczema (13.2 %) and hay fever (10.7 %). Scoliosis and asthma had been diagnosed by a doctor in 5.2 % and 4.7 % of subjects aged 0-17 years, respectively. The lifetime prevalence rates of the remaining diseases varied between 0.14 % for diabetes mellitus and 3.6 % for convulsions/epileptic fits. For the first time ever, these survey results provide nationwide representative information on the prevalence rates of acute/infectious and chronic diseases in children and adolescents which is based on a population-representative sample.

[Children's and adolescents' experiences of violence based on subjective self-reporting. First results of the German Health Interview and Examination Survey for Children and Adolescents (KiGGS)]

Experiences of violence in childhood and adolescence are connected with potentially serious consequences for physical and psychological health. Children and adolescents can experience violence as the perpetrator, the victim or the perpetrator/victim. As part of the German Health Interview and Examination Survey for Children and Adolescents (KiGGS) 3382 boys and 3237 girls answered questions on the prevalence of experiences of violence over 12 months, divided into experiences as a perpetrator and as a victim. There were also questions on people's views on the propensity to instrumental and expressive violence. Altogether, 82.5% of girls (G) and 67.2% of boys (B) had not been involved in an act of violence in the last 12 months. 19.6% (B) and 9.9% (G) had been perpetrators; 5.2% (B) and 3.9% (G) had been victims and 7.6% (B) and 3.6% (G) had been perpetrators/victims of an act of violence. The amount of violence suffered by respondents with a high socioeconomic status (SES) was the lowest, with 81.0% never having been involved in acts of violence, compared with those with a lower SES (68.3%) and a medium SES (76.4%). Pupils at Hauptschule (school at lower secondary level providing a basic general education) and Gesamtschule (comprehensive school) as well as adolescents with a migrant background are more often affected by experiences of violence and have more permissive attitudes towards violence than those at Gymnasium (high school) or Realschule (school at lower secondary level providing more extensive general education) and children of non-migrants. Social disadvantage and a migrant background are associated with adolescents having more exposure to and a higher propensity for violence. Intervention programmes and improvements to basic social conditions may have a preventative effect. As no distinction can be made between familial violence and other forms of violence using the KiGGS data, care should be taken in interpreting it. Its significance lies in identifying risk groups.

[The German Health Interview and Examination Survey for Children and Adolescents (KiGGS): risks and resources for the mental development of children and adolescents]

Along with the salutogenetic approach in health sciences, the quest for factors exerting a protective effect on mental development and health has increasingly gained importance, complementing the study of risk factors. A total of 6,691 children and adolescents aged 11 to 17 years answered questionnaires on personal, social and family resources as part of the German Health Interview and Examination Survey for Children and Adolescents (KiGGS). Children with low socioeconomic status (SES) more frequently show deficits in their personal, social and family resources. Similarly, in children with migration background a higher percentage with poorly developed personal and social protective factors is found. Older children report less family resources but more social resources than younger children; in comparison to boys, girls have more social but less personal resources at their disposal. Clear connections are observed between protective factors and health-related risk-taking behaviour. Deficits in personal and family resources are associated with an increased risk for smoking. Although an increased percentage of smoking and alcohol consuming children and adolescents is found to be associated with well-developed social resources, the risk for drug experiences is not increased. The results prove the necessity to build up protective factors as a preventative measure. Especially in children and adolescents with weak protective factors, an increased risk of mental health problems can be expected in the presence of stressful events.

Der Kinder- und Jugendgesundheitssurvey (KiGGS): Studienmanagement und Durchführung der Feldarbeit

From May 2003 to May 2006, the Robert Koch Institute conducted the German Health Interview and Examination Survey for Children and Adolescents (KiGGS). Nationwide data collection in 167 cities and municipalities was carried out by 4 survey teams, each consisting of a physician, centre interviewer, examiner, medical laboratory technician, environmental interviewer. Regional and seasonal factors were excluded by systematised route planning. Invitation of the participants and appointments for examinations were handled by a survey office with subsidised service telephone. Data processing in the survey office was performed using an SQL data base system programmed in the RKI. One central and several regional members of staff performing preparatory field visits were responsible for finding suitable examination rooms and for subject recruitment respectively. To further increase the response rate, continuous public relation actions were established. The survey involved questionnaires filled in by parents and parallel questionnaires for children from the age of 11 years onwards, physical examinations and tests and a computer assisted personal interview performed by the physician. The wide range of blood and urine testing carried out at central laboratories required standardised transport logistics. To achieve a high degree of standardisation of the survey, the examination teams were initially trained and then underwent continuous further training. The concept of quality management covered action of internal and independent external quality control monitoring each data collecting and data processing step as well as the training courses.

CONCLUSION

Dedicated public relations activities and the deployment of staff performing preparatory field visits increased the willingness of the subjects to participate. Intensive personnel care and continuous quality checks contribute to increased job satisfaction and data quality. By bindingly defining all laboratory diagnostic processes as well as transport logistics, high-quality laboratory test results are ensured. The conduct of the study from design via conduct to data processing and analysis by one institution guarantees complete control of all steps of the survey.

Die Prävalenz der Aufmerksamkeitsdefizit-/Hyperaktivitätsstörung (ADHS) bei Kindern und Jugendlichen in Deutschland

The cardinal symptoms of attention-deficit/hyperactivity disorder (ADHD) are inattention, hyperactivity and impulsivity. Etiologically, ADHD is mainly put down to genetic causes; it entails a considerable range of psychosocial problems for those affected and their social environment. The parents of a total of 7,569 boys (B) and 7,267 girls (G) aged 3-17 who took part in the German Health Interview and Examination Survey for Children and Adolescents (KiGGS) answered a self-administered questionnaire including an ADHD diagnosis question and the Strengths and Difficulties Questionnaire (SDQ). In addition behavioural observations of 7,919 children (aged 3-11) were carried out during the medical and physical tests. Participants whose parents reported that they had ever been given an ADHD diagnosis by a doctor or psychologist were classified as ADHD cases. Participants were classified as suspected cases of ADHD if they had a value of > or =7 on the SDQ inattention/hyperactivity scale. ADHD had ever been diagnosed in 4.8 % of the children and adolescents altogether (B: 7.7 %, G: 1.8 %). Another 4.9 % of the participants can be considered as suspected cases. Already 1.8 % of the preschoolers had been given an ADHD diagnosis. At primary school age (7-10 years old) the frequency of diagnosis rises sharply. At age 11-17, ADHD had ever been diagnosed in 1 in 10 boys and 1 in 43 girls. ADHD had been diagnosed significantly more frequently among participants of low socio-economic status (SES) than among participants of high SES. A diagnosis of ADHD is reported less often for migrants, they rank more frequently among the suspected cases. The discrepancy between confirmed and suspected cases of ADHD among migrants may point to lower diagnosis rates or lower utilization of medical services. The short- and long-term medical, social and health-economic effects of ADHD illustrate the major public health relevance of the disorder. As for prevention, the high share of genetic factors in ADHD etiology primarily suggests secondary prevention (early support and early diagnosis) and tertiary prevention measures. Further analysis of the KiGGS data could prospectively identify risk groups more precisely and refine preventional approaches.

Verhaltensauffälligkeiten bei Kindern und Jugendlichen

Mental health problems in children and adolescents constitute health impairments with major implications regarding individual wellbeing as well as daily and social functioning. In addition, these problems often burden the social partners of the individual. Within the German Health Interview and Examination Survey for Children and Adolescents (KiGGS), the parents of 14478 children and adolescents aged 3-17 answered the Strengths and Difficulties Questionnaire (SDQ) which assesses behavioral problems and strengths in the areas emotional problems, hyperactivity, behavioral problems, peer problems and prosocial behavior. According to the results of the Total Difficulties Score (SDQ) 11,5 % girls (G) and 17,8 % boys (B) are classified borderline or abnormal, respectively. 92,5 % (G) and 86,3 % (B) display an adequate pro social behavior. Most prevalent problem areas are behavioral problems (G = 11,9 %, B = 17,9 %), emotional problems (G = 9,7 %, B = 8,6 %) and hyperactivity problems (G = 4,8 %, B = 10,8 %). The test-data of approximately 8,1 % of the respondents with high socio-economic status (SES), 13,4 % of those with middle SES and 23,2 % of those with low SES hinted at mental health problems. Migrants are more frequently affected than non-migrants. Results point at the need for early detection and prevention of commencing mental health problems. Especially the noneasily accessible groups like those with low socioeconomic status or migrants have to be considered.

Essstörungen im Kindes- und Jugendalter

Eating disorders are included in the category of mental and behavioural disorders (ICD 10). They are among the most common chronic health problems encountered in children and adolescents. A total of 7,498 children and adolescents (weighted) aged 11 to 17 years answered the SCOFF questionnaire, a screening instrument to identify cases of suspected eating disorder. Parallel to the SCOFF questionnaire, further factors for possible eating disorders, such as the Body Mass Index (BMI), information on abnormal behaviour (using the Strengths and Difficulties Questionnaire, SDQ) smoking, sexual and body self-image assessment, were gathered to substantiate the results. In total, 21.9 % of the children and adolescents in Germany aged 11 to 17 years showed symptoms of eating disorders. With 28.9%, girls are more frequently affected than boys (15.2 %); this difference is highly significant. In the presence of almost identical initial values, the rate of subjects with abnormal SCOFF scores increases, starting from age 11 years, in girls as they age, while it drops in boys. Children and adolescents with low socioeconomic status (SES) are, with 27.6 %, almost twice as often affected than those with high SES (15.6 %). Migrants have an approx. 50 % higher rate compared to non-migrants. A 2.5-fold increase in the percentage of individuals with normal weight who perceive themselves as too fat is found among those with abnormal SCOFF scores. Individuals with abnormal SCOFF scores smoke more and report more frequently about sexual harassment. Because of the severity, the tendency to chronification and the protracted therapy of the clinically apparent disorders, effective concepts for prevention should be developed.