ABSTRACT
Objectives: Approximately 18% of preschoolers have significant mental health problems, yet there is no agreed-upon standard of care for routine identification of psychiatric problems in young children. This study evaluated the screening test accuracy and reliability of the parent-report Preschool SDQ (P-SDQ) in primary care settings. Method(s): A total of 183 healthy children, 2 to 4 years old, enrolled in a longitudinal cohort through a multisite primary care research network. Parents completed the P-SDQ at baseline and at 2 and 12 weeks later. At 12 weeks, 107 parents participated in a semi-structured diagnostic phone interview, the Preschool Age Psychiatric Assessment (PAPA);criterion validity between the P-SDQ scores at baseline and the presence of psychiatric diagnoses (Dx) at 12 weeks was evaluated using area under the receiver operating characteristic curve (AUC), 95% CI. We assessed the test-retest reliability using the interclass correlation coefficient (ICC 2,1) and internal consistency using Cronbach's alpha for the total difficulties score (TDS), and internalizing (INT) and externalizing (EXT) subscales using data at baseline and 2 weeks. Result(s): Of 183 parents (child mean age 39.3 months;46.4% male), 120 completed the P-SDQ at 2 weeks. Among the 107 (58.4%) who participated in the PAPA, 26 (24.3%) children had any diagnosis (Dx), 22 (21%) had INT Dx, and 9 (8%) had EXT Dx. The TDS performed satisfactorily against any Dx with AUC = 0.67 (0.55-0.79). The AUC for an EXT Dx and INT Dx were 0.77 (0.60-0.94) and 0.61 (0.47-0.74), respectively. A threshold of >10 for the TDS had 50% sensitivity and 78% specificity to identify any Dx. A threshold of >7 for the INT scale had 18% sensitivity and 99% specificity to identify an INT Dx. A threshold of >6 for the EXT scale had 78% sensitivity and 71% specificity to identify an EXT Dx. ICC (2,1) for TDS, INT, and EXT scores were 0.72, 0.62, and 0.79, respectively. Internal consistency of the TDS was good (Cronbach's alpha = 0.72). Conclusion(s): The screening test accuracy and reliability of the P-SDQ total difficulties score supports its use to identify young children at risk for psychiatric diagnoses, and in particular externalizing diagnoses, in primary care. Limitations include the small sample size and adjustments to recruitment during COVID-19. DIAG, PSC, ADMIN Copyright © 2022