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.

The Strengths and Difficulties Questionnaire (SDQ) is a brief behavioral screening questionnaire that can be completed in 5 minutes by the parents or teachers of children aged 4 to 16; there is a self-report version for 11- to 16-year-olds. In this study, mothers completed the SDQ and the Child Behavior Checklist (CBCL) on 132 children aged 4 through 7 and drawn from psychiatric and dental clinics. Scores from the SDQ and CBCL were highly correlated and equally able to discriminate psychiatric from dental cases. As judged against a semistructured interview, the SDQ was significantly better than the CBCL at detecting inattention and hyperactivity, and at least as good at detecting internalizing and externalizing problems. Mothers of low-risk children were twice as likely to prefer the SDQ.

Comparing the Strengths and Difficulties Questionnaire and the Child Behavior Checklist: Is Small Beautiful?

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

Pediatric obstructive sleep apnea (OSA) has become widely recognized only in the last few decades as a likely cause of significant morbidity among children. Many of the clinical characteristics of pediatric OSA, and the determinants of its epidemiology, differ from those of adult OSA. We systematically reviewed studies on the epidemiology of conditions considered part of a pediatric sleep-disordered breathing (SDB) continuum, ranging from primary snoring to OSA. We highlight a number of methodologic challenges, including widely variable methodologies for collection of questionnaire data about symptomatology, definitions of habitual snoring, criteria for advancing to further diagnostic testing, and objective diagnostic criteria for SDB or OSA. In the face of these limitations, estimated population prevalences are as follows: parent-reported “always” snoring, 1.5 to 6%; parent-reported apneic events during sleep, 0.2 to 4%; SDB by varying constellations of parent-reported symptoms on questionnaire, 4 to 11%; OSA diagnosed by varying criteria on diagnostic studies, 1 to 4%. Overall prevalence of parent-reported snoring by any definition in meta-analysis was 7.45% (95% confidence interval, 5.75–9.61). A reasonable preponderance of evidence now suggests that SDB is more common among boys than girls, and among children who are heavier than others, with emerging data to suggest a higher prevalence among African Americans. Less convincing data exist to prove differences in prevalence based on age. We conclude by outlining specific future research needs in the epidemiology of pediatric SDB.

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Epidemiology of pediatric obstructive sleep apnea

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

The estimated prevalence rate of Pervasive Developmental Disorders (PDD) in children is 6 per 1.000. Parenting children who are intellectually impaired and have PDDs is known to be linked to the impaired well-being of the parents themselves. However, there is still little available data on health-related quality of life (HRQL) in parents of children with Asperger Syndrome (AS) and High-Functioning Autism (HFA), or other PDD diagnoses in children of normal intelligence. The present study aimed to evaluate aspects of HRQL in parents of school-age children with AS/HFA and the correlates with child behaviour characteristics. The sample consisted of 31 mothers and 30 fathers of 32 children with AS/HFA and 30 mothers and 29 fathers of 32 age and gender matched children with typical development. Parental HRQL was surveyed by the use of the 12 Item Short Form Health Survey (SF-12) which measures physical and mental well-being. The child behaviour characteristics were assessed using the structured questionnaires: The High-Functioning Autism Spectrum Screening Questionnaire (ASSQ) and The Strengths and Difficulties Questionnaire (SDQ). The mothers of children with AS/HFA had lower SF-12 scores than the controls, indicating poorer physical health. The mothers of children with AS/HFA also had lower physical SF-12 scores compared to the fathers. In the AS/HFA group, maternal health was related to behaviour problems such as hyperactivity and conduct problems in the child. Mothers but not fathers of children with AS/HFA reported impaired HRQL, and there was a relationship between maternal well-being and child behaviour characteristics.

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Health-related quality of life in parents of school-age children with Asperger Syndrome or High-Functioning Autism.

A new English instrument for screening mental health in children and adolescents, the Strengths and Difficulties Questionnaire (SDQ), was translated into Swedish and used for parental ratings of 900 children aged 6-10 years from the general population. The SDQ which comprises 25 items, divided into 5 subscales (prosocial, hyperactivity, emotional symptoms, conduct problems, and peer problems) was developed from the Rutter scales. An earlier English validation study has shown the two instruments to have equal ability to identify child psychiatric cases, but the SDQ also provides screening on empathy and prosocial behaviour which are aspects of child development emphasized in current child psychiatry. The design of the SDQ with both strengths' and difficulties' items supposedly increases acceptability of the instrument on behalf of informants and makes the questionnaire especially suitable for studies of general population where the majority of children are healthy. Our results, which are novel findings on the instrument, confirmed the postulated factor structure and showed significant gender-differences in results on the total scale, prosocial and hyperactivity subscales and on some of the single items. Moreover, our investigation showed that a Swedish translation of the parental version of the SDQ worked well.

Psychometric properties of a Swedish version of the “Strengths and Difficulties Questionnaire”

The Strengths and Difficulties Questionnaire (SDQ) is an internationally widely used, brief screening instrument for mental health problems in children and teenagers. The SDQ probes behaviours and psychological attributes reflecting the child's difficulties as well as strengths, and targets hyperactivity/inattention, emotional symptoms, conduct problems, peer problems and prosocial behaviour. Also, the instrument taps the impact aspect, i.e. whether the child is judged to suffer from emotional or behavioural problems severe enough to cause distress or social impairment. Studies of the original English SDQ, as well as of translations into several other languages, attest to a compelling usefulness and validity of the instrument. In this investigation, the adequacy of the Swedish adaptation of the SDQ (SDQ-Swe) was tested in comparisons between parent reports on 5-15-year-old children drawn from a community sample (n=263) and from a child psychiatric sample (n=230). Results showed that the instrument differentiated well between the community and the psychiatric samples, the latter displaying more symptoms, fewer strengths and more social impairment. Moreover, ROC analyses showed satisfactory sensitivity and specificity of the principal scales of the SDQ-Swe at proposed cut-offs. Hence, results showed adequate validity of the SDQ-Swe, suggesting that this new instrument, an instrument in tune with the ideas of contemporary child psychiatry and psychology, is a useful tool for mental health screening in children and adolescents.

Validity of the Swedish version of the Strengths and Difficulties Questionnaire (SDQ-Swe)

Associations between sleep and behaviour in 635 children, aged six to eight years, were investigated using parental responses to a sleep habits questionnaire, and to a behavioural screening form, the Strengths and Difficulties Questionnaire (SDQ). Global reports of sleep problems in 4.9% of the children were associated with a total SDQ score indicative of behaviour problems in 36% of the cases. Conversely, 15% of children with behaviour problems had global reports of sleep problems. Associations between specific sleeping features and different dimensions of behaviour and emotions were also explored. Hyperactivity was associated with tossing and turning during sleep, and with sleep walking; conduct problems were related to bedtime resistance; and emotional symptoms were associated with night terrors, difficulty falling asleep and daytime somnolence. Peer problems were associated with somewhat shorter total sleep time. Finally, a total SDQ score indicative of behaviour problems was associated with bedwetting, nightmares, tossing and turning during sleep and sleep walking, as well as with a slightly shorter total sleep time. We conclude that sleep and behaviour problems are associated in children, and that characteristic associations exist between particular sleep disturbances and specific dimensions of behaviour.

Associations between disturbed sleep and behavioural difficulties in 635 children aged six to eight years: a study based on parents' perceptions

Sleep patterns of 32 school-age children with Asperger syndrome (AS) and high-functioning autism (HFA) were compared to those of 32 typically developing age- and gender-matched children, using parent survey and one week of diary and actigraphic monitoring. Parents of children with AS/HFA more commonly reported that their children had difficulty falling asleep. One week of sleep recording with diary and actigraphy confirmed that children in the AS/HFA group spent a longer time awake in bed before falling asleep than children in the control group, possibly because the children in the AS/HFA group had earlier bedtimes. Other essential aspects of sleep patterns coincided between the groups. The sleep patterns of children with AS and HFA did not differ.

Hans Smedje

Papers

Health-related quality of life in parents of school-age children with Asperger Syndrome or High-Functioning Autism.

Psychometric properties of a Swedish version of the “Strengths and Difficulties Questionnaire”

Validity of the Swedish version of the Strengths and Difficulties Questionnaire (SDQ-Swe)

Associations between disturbed sleep and behavioural difficulties in 635 children aged six to eight years: a study based on parents' perceptions

Sleep patterns of school-age children with Asperger syndrome or high-functioning autism.