Screening for Persistent Psychopathology in 4-Year-Old Children

Area of Science:

• Child and Adolescent Psychiatry
• Developmental Psychology
• Public Health Screening

Background:

• Preschool-onset psychiatric disorders can be persistent or transient, impacting long-term outcomes.
• Effective screening tools are needed for early identification and intervention in primary care.

Purpose of the Study:

• To evaluate the screening efficiency of the parent version of the Strengths and Difficulties Questionnaire (SDQP4-16) for persistent versus transient psychiatric disorders in young children.
• To assess the SDQP4-16's ability to differentiate between persistent and transient disorders.

Main Methods:

• A population-based cohort study of 1038 Norwegian children assessed at ages 4 and 6.
• Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition (DSM-IV) diagnoses were established using the Preschool Age Psychiatric Assessment Interview.
• Receiver operating characteristics (ROC) analysis was employed to compare SDQP4-16 performance against established diagnoses.

Main Results:

• The SDQP4-16 demonstrated higher screening efficiency for persistent disorders (AUC=0.85) than transient disorders.
• The tool could discriminate persistent from transient disorders with an AUC of 0.71.
• A high negative predictive value (99.6%) was observed, but the positive predictive value was low (9.5%) due to low prevalence (1.8%) of persistent disorders.

Conclusions:

• The SDQP4-16 is a sensitive instrument for detecting persistent psychiatric disorders in preschoolers.
• A significant proportion of positive screens represent non-persistent cases, indicated by a high false-positive rate.
• The clinical utility of the SDQP4-16 for primary care screening of persistent disorders is uncertain, especially in low-prevalence populations.