School-based screening for psychiatric disorders in Moroccan-Dutch youth

Background: While ethnic diversity is increasing in many Western countries, access to youth mental health care is generally lower among ethnic minority youth compared to majority youth. It is unlikely that this is explained by a lower prevalence of psychiatric disorders in minority children. Effective screening methods to detect psychiatric disorders in ethnic minority youth are important to offer timely interventions. Methods: School-based screening was carried out at primary and secondary schools in the Netherlands with the Strengths and Difficulties Questionnaire (SDQ) self report and teacher report. Additionally, internalizing and psychotic symptoms were assessed with the depressive, somatic and anxiety symptoms scales of the Social and Health Assessment (SAHA) and items derived from the Kiddie-Schedule for Affective Disorders and Schizophrenia (K-SADS). Of 361 Moroccan-Dutch youths (ages 9 to 16 years) with complete screening data, 152 children were diagnostically assessed for psychiatric disorders using the K-SADS. The ability to screen for any psychiatric disorder, and specific externalizing or internalizing disorders was estimated for the SDQ, as well as for the SAHA and K-SADS scales. Results: Twenty cases with a psychiatric disorder were identified (13.2 %), thirteen of which with externalizing (8.6 %) and seven with internalizing (4.6 %) diagnoses. The SDQ predicted psychiatric disorders in Moroccan-Dutch youth with a good degree of accuracy, especially when the self report and teacher report were combined (AUC = 0.86, 95 % CI = 0.77-0.94). The SAHA scales improved identification of internalizing disorders. Psychotic experiences significantly predicted psychiatric disorders, but did not have additional discriminatory power as compared to screening instruments measuring non-psychotic psychiatric symptoms. Conclusions: School-based screening for psychiatric disorders is effective in Moroccan-Dutch youth. We suggest routine screening with the SDQ self report and teacher report at schools, supplemented by the SAHA measuring internalizing symptoms, and offering accessible non-stigmatizing interventions at school to children scoring high on screening questionnaires. Further research should estimate (subgroup-specific) norms and optimal cut-offs points in larger groups for use in school-based screening methods

Teacher Ratings of Children's Behavior Problems and Functional Impairment Across Gender and Ethnicity:Construct Equivalence of the Strengths and Difficulties Questionnaire

The present study examined construct equivalence of the teacher Strengths and Difficulties Questionnaire and compared mean scores in an ethnically diverse sample of children living in the Netherlands. Elementary schoolteachers completed the Strengths and Difficulties Questionnaire for 2,185 children aged 6 to 10 years of the four largest ethnic groups in the Netherlands, namely native Dutch (n = 684) and Moroccan (n = 702), Turkish (n = 434), and Surinamese (n = 365) immigrant children. Multigroup confirmatory factor analysis suggested the factor structure of the Strengths and Difficulties Questionnaire to be invariant across children's ethnicity and gender. Additionally, the factor structure appeared to be similar for Dutch and Surinamese teachers. However, mean scores on emotional problems, hyperactivity, conduct problems, prosocial behavior, and impairment varied significantly according to ethnicity and gender. Mean scores on peer problems differed significantly for boys and girls, but not across ethnicity. Whether mean differences reflect a method bias or actual differences in classroom behaviors is discussed and needs further research

Externalizing disorders among children of different ethnic origin in the Netherlands

The overall aim of the current study was to extend the knowledge of externalizing problems in non-Western immigrant children in Europe. More specifically, the research was aimed at assessing whether the expression, treatment rates, prevalence estimates, parental detection and screening validity of externalizing disorders differed between native Western and non-Western immigrant children in the Netherlands. In general, the results show the expression, the prevalence and the screenings validity of externalizing disorders to be similar across ethnicity, whereas the rates of parental detection and treatment are lower for Moroccans, Turks and Surinamese, as compared to Dutch. The study consisted of two stages. In the first phase, teachers completed the Strengths and Difficulties Questionnaire (SDQ) (Goodman 1994, Goodman 1997) for 2185 children enrolled in grade 3 through 5 of mainstream schools in low SES inner-city areas in Amsterdam and Utrecht. In the second phase, a subsample of 270 children were administered the Semi-structured Interview for Children and Adolescents (SCICA) (McConaughy & Achenbach 2001), while their parents were interviewed using the Diagnostic Interview Schedule for Children-Parent Version (DISC-P). In addition, teachers completed a short questionnaire which consisted of 10 DSM-IV items (American Psychiatric Association 1994). The same two factor model of Hyperactivity-Inattention and Conduct Problems as assessed by the teacher version of the SDQ appeared to be valid in all ethnic groups. Moreover, it was shown that only four items on these scales were needed to predict an externalizing disorder with a discriminative power of 0.84 (95%CI: 0.79-0.89), which was similar across all ethnic groups. The results of current study also confirm the expectation that non-Dutch immigrant children in the Netherlands are less likely to be treated for externalizing disorders than Dutch children. As the detection rate of externalizing disorders was lower among non-Dutch parents, the observed discrepancy in treatment rates may partly be explained by a difference in detection rate between Dutch and non-Dutch parents. Several explanations may account for the lower detection rate among non-Dutch parents, among which are: 1) differences in social desirability; 2) differences in monitoring children’s behaviour, or 3) differences in the discrepancy between children’s indoors and outdoors behaviour. Future research should clarify the mechanisms underlying this underdetection by non-Dutch parents. Whereas teachers reported more problem behaviour for Moroccan boys and less for Turkish boys than for Dutch boys, the prevalence of psychiatric disorders in general and externalizing disorders in particular as assessed by the best-estimate procedure was similar across ethnicity. An explanation for this divergence in findings may be that Moroccan boys display more problem behaviour at school than in other situations, whereas the opposite is true for Turkish boys. Although the higher problem scores for Moroccan boys at school may also be explained by a teacher bias in ratings, it seems unlikely that teacher ratings were strongly biased, as Turkish boys obtained lower problems scores than Dutch boys

Developing a brief cross-culturally validated screening tool for externalizing disorders in children.

Contains fulltext : 69876.pdf (publisher's version ) (Closed access)OBJECTIVE: Most screening instruments for externalizing disorders have been developed and validated in Western children. We developed and validated a brief screening instrument for predicting externalizing disorders in native Dutch children as well as in non-Dutch immigrant children, using predictors that can be easily obtained from teachers. METHOD: Teachers completed the Strengths and Difficulties Questionnaire for an ethnic diverse sample of 2,185 children ages 6 to 10 years. In a stratified subsample, 254 children and their parents were additionally interviewed regarding psychiatric disorders and sociodemographic data. In this group, stepwise logistic regression was used to derive a score from sex and all items of the Hyperactivity and Conduct Problems Scale of the Strengths and Difficulties Questionnaire, for predicting a best-estimate diagnosis of any externalizing disorder. The accuracy of the score was compared between native Dutch and non-Dutch immigrant children. RESULTS: Ninety-one cases of externalizing disorders were identified. An externalizing disorder could be predicted by the items restless, obeys, lies, and concentrates. Sex and ethnicity did not contribute to a prediction of an externalizing disorder. The area under the receiver operating characteristic was 0.84 (95% confidence interval 0.79-0.89), indicating good discriminatory power with no substantial differences between native Dutch and non-Dutch immigrant children. CONCLUSIONS: Externalizing disorders in both native Dutch and non-Dutch immigrant children can be predicted with a scoring rule, based on only four items that can be easily assessed by teachers. Before this internally validated prediction tool can be implemented, external validation in another sample is necessary

Ethnic differences in parental detection of externalizing disorders.

Contains fulltext : 49959.pdf (publisher's version ) (Closed access)BACKGROUND: Previous research has reported lower treatment rates for externalizing disorders among non-Western children as compared to Western children. Ethnic differences in parental detection may be an explanation for this discrepancy. AIMS: In a cross-sectional study among the four largest ethnic groups in the Netherlands, namely Dutch, Moroccan, Turkish and Surinamese, we examined the influence of ethnicity on parental detection of behavioural disorders. METHOD: A total of 270 children (aged 6-10 years) and their parents were interviewed regarding psychiatric disorders and socio-demographic data. Sensitivity and specificity were calculated by using standard definitions, with adjustment for parental educational level. RESULTS: Sensitivity to detect any externalizing disorder and ADHD in particular was significantly lower among Moroccan and Surinamese parents when compared to Dutch parents. Sensitivity to detect ADHD tended to be lower among Turkish parents. Specificity to detect any externalizing disorder was higher among Moroccan and Turkish parents. Specificity to detect ADHD was higher among Moroccan parents and tended to be higher among Turkish parents. CONCLUSIONS : The detection rate of externalizing disorders is markedly lower among non-Dutch parents than among Dutch parents. This finding emphasizes the importance of taking parents' cultural context into account when appraising their report on possible externalizing disorders in their children