Objective To describe the psychometric properties of the Strengths and Difficulties Questionnaire (SDQ), a brief measure of the prosocial behavior and psychopathology of 3–16-year-olds that can be completed by parents, teachers, or youths. Method A nationwide epidemiological sample of 10,438 British 5–15-year-olds obtained SDQs from 96% of parents, 70% of teachers, and 91% of 11–15-year-olds. Blind to the SDQ findings, all subjects were also assigned DSM-IV diagnoses based on a clinical review of detailed interview measures. Results The predicted five-factor structure (emotional, conduct, hyperactivity-inattention, peer, prosocial) was confirmed. Internalizing and externalizing scales were relatively "uncontaminated" by one another. Reliability was generally satisfactory, whether judged by internal consistency (mean Cronbach α: .73), cross-informant correlation (mean: 0.34), or retest stability after 4 to 6 months (mean: 0.62). SDQ scores above the 90th percentile predicted a substantially raised probability of independently diagnosed psychiatric disorders (mean odds ratio: 15.7 for parent scales, 15.2 for teacher scales, 6.2 for youth scales). Conclusion The reliability and validity of the SDQ make it a useful brief measure of the adjustment and psychopathology of children and adolescents.

Psychometric properties of the strengths and difficulties questionnaire.

Background Child psychiatric disorders are common and treatable, but often go undetected and therefore remain untreated.

Aims To assess the Strengths and Difficulties Questionnaire (SDQ) as a potential means for improving the detection of child psychiatric disorders in the community.

Method SDQ predictions and independent psychiatric diagnoses were compared in a community sample of 7984 5- to 15-year-olds from the 1999 British Child Mental Health Survey.

Results Multi-informant (parents, teachers, older children) SDQs identified individuals with a psychiatric diagnosis with a specificity of 94.6% (95% Cl 94.1-95.1%) and a sensitivity of 63.3% (59.7-66.9%). The questionnaires identified over 70% of individuals with conduct, hyperactivity, depressive and some anxiety disorders, but under 50% of individuals with specific phobias, separation anxiety and eating disorders. Sensitivity was substantially poorer with single-informant rather than multi-informant SDQs.

Conclusions Community screening programmes based on multi-informant SDQs could potentially increase the detection of child psychiatric disorders, thereby improving access to effective treatments.

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Using the Strengths and Difficulties Questionnaire (SDQ) to screen for child psychiatric disorders in a community sample

The Strengths and Difficulties Questionnaire (SDQ) is a widely used child mental health questionnaire with five hypothesised subscales. There is theoretical and preliminary empirical support for combining the SDQ's hypothesised emotional and peer subscales into an 'internalizing' subscale and the hypothesised behavioral and hyperactivity subscales into an 'externalizing' subscale (alongside the fifth prosocial subscale). We examine this using parent, teacher and youth SDQ data from a representative sample of 5-16 year olds in Britain (N = 18,222). Factor analyses generally supported second-order internalizing and externalizing factors, and the internalizing and externalizing subscales showed good convergent and discriminant validity across informants and with respect to clinical disorder. By contrast, discriminant validity was poorer between the emotional and peer subscales and between the behavioral, hyperactivity and prosocial subscales. This applied particularly to children with low scores on those subscales. We conclude that there are advantages to using the broader internalizing and externalizing SDQ subscales for analyses in low-risk samples, while retaining all five subscales when screening for disorder.

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When to Use Broader Internalising and Externalising Subscales Instead of the Hypothesised Five Subscales on the Strengths and Difficulties Questionnaire (SDQ): Data from British Parents, Teachers and Children

Mental Health of Children and Young People in Great Britain, 2004

Child psychiatric disorders are common and treatable, but often go undetected and therefore remain untreated. To assess the Strengths and Difficulties Questionnaire (SDQ) as a potential means for improving the detection of child psychiatric disorders in the community, SDQ predictions and independent psychiatric diagnoses were compared in a community sample of 7984 5-15 year olds from the 1999 British Child Mental Health Survey. Multi-informant (parents, teachers, older children) SDQs identified individuals with a psychiatric diagnosis with a specificity of 94.6% (95% Cl, 94.1-95.1%) and a sensitivity of 63.3% (59.7-66.9%). The questionnaires identified over 70% of individuals with conduct, hyperactivity, depressive, and some anxiety disorders, but fewer than 50% of individuals with specific phobias, separation anxiety and eating disorders. Sensitivity was substantially poorer with single-informant rather than multi-informant SDQs. Community screening programmes based on multi-informant SDQs could potentially increase the detection of child psychiatric disorders, thereby improving access to effective treatments.

A computerised algorithm was developed to predict child psychiatric diagnoses on the basis of the symptom and impact scores derived from Strengths and Difficulties Questionnaires (SDQs) completed by parents, teachers and young people. The predictive algorithm generates "unlikely", "possible" or "probable" ratings for four broad categories of disorder, namely conduct disorders, emotional disorders, hyperactivity disorders, and any psychiatric disorder. The algorithm was applied to patients attending child mental health clinics in Britain (N = 101) and Bangladesh (N = 89). The level of chance-corrected agreement between SDQ prediction and an independent clinical diagnosis was substantial and highly significant (Kendall's tau b between 0.49 and 0.73; p < 0.001). A "probable" SDQ prediction for any given disorder correctly identified 81-91% of the children who definitely had that clinical diagnosis. There were more false positives than false negatives, i.e. the SDQ categories were over-inclusive. The algorithm appears to be sufficiently accurate and robust to be of practical value in planning the assessment of new referrals to a child mental health service.

D Renfrew

Papers

Predicting type of psychiatric disorder from Strengths and Difficulties Questionnaire (SDQ) scores in child mental health clinics in London and Dhaka.