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Characteristics of the strengths and difficulties questionnaire in preschool children
Meinou H C Theunissen1, Anton G C Vogels, Marianne S de Wolff
1TNO Child Health, PO Box 2215, 2301 CE, Leiden, Netherlands. meinou.theunissen@tno.nl
Insights
The Strengths and Difficulties Questionnaire (SDQ) effectively identifies psychosocial problems in preschool children within preventive child healthcare (PCH). While the overall SDQ score is reliable, some subscales need caution for treatment decisions.
Area of Science:
- Child Psychology
- Preventive Healthcare
- Psychometric Validation
Background:
- Validated questionnaires are crucial for identifying psychosocial issues in children.
- Preventive child healthcare (PCH) systems aim to detect these problems early.
- The Strengths and Difficulties Questionnaire (SDQ) is a potential tool for this purpose.
Purpose of the Study:
- To assess the psychometric properties of the SDQ in preschool-aged children.
- To evaluate the added value of the SDQ in identifying psychosocial problems within PCH.
- To determine the SDQ's utility for PCH professionals.
Main Methods:
- Included 839 children aged 3-4 years in routine PCH assessments.
- Parents completed the SDQ and Child Behavior Checklist (CBCL).
- Assessed internal consistency, scale structure, and validity against CBCL and treatment status.
Main Results:
- SDQ total difficulties score showed good internal consistency (Cronbach's α = 0.78).
- High accuracy in identifying psychosocial problems (AUC = 0.94, sensitivity = 0.79, specificity = 0.93) when compared to CBCL.
- SDQ significantly improved identification compared to clinical assessment alone (OR = 36.48).
Conclusions:
- The SDQ is a valid instrument for identifying psychosocial problems in preschool children via PCH.
- Reliability issues in some SDQ subscales limit their use for treatment decisions.
- The SDQ enhances the detection of psychosocial difficulties in early childhood care settings.
Objectives:
Validated questionnaires help the preventive child healthcare (PCH) system to identify psychosocial problems. This study assesses the psychometric properties and added value of the Strengths and Difficulties Questionnaire (SDQ) for the identification of psychosocial problems among preschool-aged children by PCH.
Methods:
We included 839 children (response 66%) 3 to 4 years of age undergoing routine health assessments in 18 PCH services across the Netherlands. Child healthcare professionals interviewed and examined children and parents. Before the interview, parents completed the SDQ and the Child Behavior Checklist (CBCL). We assessed the internal consistency, the scale structure, and validity (correlation coefficients, sensitivity, and specificity), with CBCL and treatment status as criteria, and the degree to which the SDQ could improve identification solely on the basis of clinical assessment.
Results:
The internal consistency of the SDQ total difficulties score was good (Cronbach's α, 0.78), but it was worse for some subscales of the SDQ (range, 0.50-0.74). The area under the receiver operating characteristic curve using the CBCL as a criterion was 0.94 (95% confidence interval 0.91-0.97), and sensitivity and specificity were 0.79 and 0.93, respectively. The SDQ added information to the clinical assessment; the odds ratio was 36.48 for added information by using the CBCL as a criterion.
Conclusions:
The SDQ is a valid tool for the identification of psychosocial problems in preschool-aged children by PCH. However, the low reliability of some SDQ subscales does not justify use of these subscales for decisions about further treatment.
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