U.S. children with emotional and behavioral difficulties: data from the 2001, 2002, and 2003 National Health Interview Surveys.

OBJECTIVE: This report presents selected prevalence estimates for children ages 4-17 years with difficulties in emotions, concentration, behavior, or being able to get along with others using data from the 2001, 2002, and 2003 National Health Interview Surveys (NHIS). METHODS: Data for the U.S. civilian noninstitutionalized population were collected using computer-assisted personal interviews (CAPI). In 2001, a total of 10,367 interviews were completed about sample children ages 4-17 years by the member of the household most knowledgeable about the child's health. The number of completed interviews about sample children ages 4-17 years was 9,512 in 2002 and 9,399 in 2003. Questions on children's emotional and behavioral difficulties from the Strengths and Difficulties Questionnaire (SDQ) were first asked in the NHIS in 2001. SUDAAN software was used to tabulate statistics shown in this report. RESULTS: In 2001, 2002, and 2003, approximately 5% of U.S. children ages 4-17 years had emotional or behavioral difficulties, and for approximately 80% of these children, there was an impact on their functioning. Children with difficulties in emotions, concentration, behavior, or being able to get along with others varied by sex, age, race, family structure, poverty status, and health insurance status. About 50% of these children were upset or distressed by their emotional or behavioral difficulties, and about 80% had difficulties that impacted their family life, friendships, learning, or leisure activities.

The Strengths and Difficulties Questionnaire: U.S. normative data and psychometric properties.

OBJECTIVE: To evaluate the Strengths and Difficulties Questionnaire in a U.S. national population sample of children and adolescents, develop normative scoring bands, and test the association of high-scoring groups with service contacts or use for mental health reasons. METHOD: An Americanized version of the Strengths and Difficulties Questionnaire parent report was administered to parents of 10,367 4- to 17 -year-olds in the 2001 National Health Interview Survey. Scoring bands were developed to differentiate low, medium, and high levels of emotional or behavioral difficulties. Children at high risk of serious difficulties were identified by three different scoring methods: (1) high symptom scores, (2) parental perception of definite or severe difficulties, and (3) high symptoms plus impairment. These ratings were validated against service contact or use and other well-established demographic and broader risk factors for child emotional and behavioral problems. RESULTS: Results indicated good acceptability and internal consistency. Normative scoring bands were similar, though not identical, to the original British bands. Results of each scoring method had a strong association with service contact/use. CONCLUSIONS: This study supports the usefulness of the Strengths and Difficulties Questionnaire as an effective and efficient screener for child and adolescent mental health problems in the United States.