Feasibility of the Strengths and Difficulties Questionnaire in assessing children's mental health in primary care: Finnish parents', teachers' and public health nurses' experiences with the SDQ.

BACKGROUND: The aim of the study was to evaluate the feasibility of the Strengths and Difficulties Questionnaire (SDQ). METHOD: Following the administration of the SDQ in medical check-ups of 4-9 year-old children (n = 2 682) the involved parents, teachers and public health nurses were asked to complete a feedback questionnaire of the SDQ. RESULTS: Parents took a maximum of 10-15 minutes to complete the SDQ, and only the public health nurses reported that its use was rather burdensome. The SDQ was an age-appropriate method and it was helpful in increasing information and agreement about the child's mental health and need for support. Using the SDQ was a positive experience for parents, but they expected more dialogue with the professionals about the child's situation. The respondents criticised the questionnaire somewhat for being difficult to interpret and complete. CONCLUSIONS: The SDQ was found to be a feasible method for screening children's mental health in primary health care together with parents, teachers and public health nurses. Using the SDQ was a positive experience for parents. However, they reminded the professionals of the importance of sensitive dialogue when assessing the mental health of the child.

Finnish norms for young children on the Strengths and Difficulties Questionnaire.

BACKGROUND: Early recognition of children's mental health problems is crucial. Although the Strengths and Difficulties Questionnaire (SDQ) is a commonly used screening method, further research is needed on its validity and norms for young children. AIMS: The aims of the study were to confirm the adjusted lower (normal/borderline) and upper (borderline/abnormal) cut-offs for the SDQ in a Finnish community sample of 4-9-year-old children, and to explore the SDQ's ability to identify the children with mental health problems. METHODS: Parents and teachers completed the SDQs (n = 2666). The Development and Well-Being Assessment (DAWBA) was administered to parents and teachers of 646 children. RESULTS: The overall participation rate was 57%. The suggested cut-offs for the SDQ total difficulties scale rated by parents and teachers were 2-5 points lower than the corresponding published British norms. The sensitivity for the total score normal/borderline cut-off (9/10) was 76% in the parent and 66% in the teacher reports and for the borderline/abnormal cut-off (11/12) 90% and 70% respectively. The respective specificity values were 69%, 63%, 74% and 66%. The area under curve (AUC) values of the higher cut-offs were good for parent (0.87) and satisfactory for teacher rated (0.76) total scores. The presence of a DAWBA-rater assigned diagnosis in the abnormal group compared with the normal group was sixfold in the parent and threefold in the teacher reported SDQs. CONCLUSIONS: The suggested cut-offs were clearly lower than the British norms. Yet the properties of the method's discriminative validity were acceptable. Population specific norms, taking into account both the culture and children's age, seem necessary for screening and for international comparisons of the method's validity properties.

Cutting a long story short? The clinical relevance of asking parents, nurses, and young children themselves to identify children's mental health problems by one or two questions.

BACKGROUND AND AIMS: Assessing young children's mental health is a crucial and challenging task. The aim of the study was to evaluate the clinical relevance of asking parents, nurses, and young children themselves to identify children's mental health problems by only one or two questions. METHODS: In regular health check-ups of 4- to 9-year-old children (n = 2682), parents and public health nurses assessed by one question whether the child had any emotional or behavioral difficulties. The child completed a self-evaluation enquiry on his/her emotional well-being. A stratified proportion of the participating parents were invited to a diagnostic interview. RESULTS: Sensitivities were fairly good for the parents' (68%), nurses' (65%), and their combined (79%) one-question screens. Difficulties identified by parents and nurses were major risks (OR 10-14) for any child psychiatric disorders (P < 0.001). The child's self-evaluation was related to 2-fold to 3-fold risks (P < 0.05) for any psychiatric diagnosis, for any emotional diagnosis, and for negative situational factors. CONCLUSION: The one-question screen for parents and public health nurses together quite adequately identified the young children with mental health problems. The child's self-evaluation provided relevant and complementary information on his/her mental health and especially emotional problems.

Reliability of the strengths and difficulties questionnaire among Finnish 4-9-year-old children.

BACKGROUND: Early recognition of children's mental health problems calls for structured methods in front line services. The Strengths and Difficulties Questionnaire (SDQ) is a commonly used short questionnaire in screening child's mental difficulties. AIM: To test the reliability and descriptive properties of the SDQ in a community sample of Finnish 4-9-year-old children (n = 4178). METHODS: Both parents, two teachers in day-care or a teacher at school completed the SDQ. To control for possible bias, public health nurses rated their concern about every child's mental health, including non-participants. RESULTS: The internal consistencies of the SDQ total score in all informants' reports were satisfactory to good. Agreement (Spearman rho) in total scores between parents was 0.65, between parent and teacher 0.43 and between two teachers in day-care 0.81. The stability in parent's reports over 12 weeks was good. The distributions of the informant-rated scores indicated significant and clinically important gender differences, and the 80th and 90th percentiles were generally below the international cut-off points. Public health nurses reported emotional or behavioural difficulties more commonly in non-participants (12%) than in participants (7%; p < 0.001). CONCLUSIONS: The results supported earlier findings of good internal consistency, inter-rater and cross-informant agreements and test-retest of the method. However, the gender and age of the child, the number of informants and cultural differences in reporting styles affected the results and thus confirmed the need to re-evaluate the SDQ in the culture and population in question.