Comparing three short questionnaires to detect psychosocial problems among 3 to 4-year olds

Background: Validated questionnaires help community pediatric services to identify psychosocial problems. Our aim was to assess which of three short questionnaires was most suitable for this identification among pre-school children. Methods: We included 1,650 children (response 64 %) aged 3-4 years undergoing routine well-child health assessments in 18 services across the Netherlands. Child healthcare professionals (CHPs) interviewed and examined children and parents. Parents were randomized regarding filling out the Strengths and Difficulties Questionnaire (SDQ) or the KIPPPI, a Dutch-origin questionnaire. In addition, all filled out the Ages and Stages Questionnaires: Social-Emotional (ASQ:SE) and the Child Behavior Checklist (CBCL). We assessed the internal consistency and validity of each questionnaire, with CBCL and treatment status as criteria, and the degree to which each questionnaire could improve identification based solely on clinical assessment. Results: The internal consistency of the total problems scale of each questionnaire was satisfactory, Cronbach's alphas varied between 0.75 and 0.98. Only the SDQ discriminated sufficiently between children with and without problems as measured by the CBCL (sensitivity = 0.76 at a cut-off point with specificity = 0.90), in contrast to the other two questionnaires (with sensitivity indices varying between 0.51-0.63). Similar results were found for the treatment status criterion, although sensitivity was lower for all questionnaires. The SDQ seemed to add most to the identification of psychosocial problems by CHPs, but the differences between the SDQ and the ASQ: SE were not statistically significant. Conclusions: The SDQ is the best tool for the identification of psychosocial problems in pre-school children by community paediatric services

Computerized adaptive testing to screen children for emotional and behavioral problems by preventive child healthcare

BACKGROUND: Questionnaires to detect emotional and behavioral problems (EBP) in Preventive Child Healthcare (PCH) should be short which potentially affects validity and reliability. Simulation studies have shown that Computerized Adaptive Testing (CAT) could overcome these weaknesses. We studied the applicability (using the measures participation rate, satisfaction, and efficiency) and the validity of CAT in routine PCH practice. METHODS: We analyzed data on 461 children aged 10-11 years (response 41%), who were assessed during routine well-child examinations by PCH professionals. Before the visit, parents completed the CAT and the Child Behavior Checklist (CBCL). Satisfaction was measured by parent- and PCH professional-report. Efficiency of the CAT procedure was measured as number of items needed to assess whether a child has serious problems or not. Its validity was assessed using the CBCL as the criterion. RESULTS: Parents and PCH professionals rated the CAT on average as good. The procedure required at average 16 items to assess whether a child has serious problems or not. Agreement of scores on the CAT scales with corresponding CBCL scales was high (range of Spearman correlations 0.59-0.72). Area Under Curves (AUC) were high (range: 0.95-0.97) for the Psycat total, externalizing, and hyperactivity scales using corresponding CBCL scale scores as criterion. For the Psycat internalizing scale the AUC was somewhat lower but still high (0.86). CONCLUSIONS: CAT is a valid procedure for the identification of emotional and behavioral problems in children aged 10-11 years. It may support the efficient and accurate identification of children with overall, and potentially also specific, emotional and behavioral problems in routine PCH

The Strengths and Difficulties Questionnaire Parent Form:Dutch norms and validity

OBJECTIVE: This study provides Dutch national norms for the parent-reported Strengths and Difficulties Questionnaire (SDQ) for children aged 3-14 years, and assesses the test performance of the SDQ Total Difficulties Scale (TDS) and impairment Scale. We further compared Dutch SDQ norms with those of the United Kingdom (UK), to determine potential variation in country-specific norms. STUDY DESIGN: We analyzed data of 3384 children aged 3 to 14 years. The data were obtained in schools, and in the context of Preventive Child Healthcare. Parents completed the SDQ parent form and the Child Behavior Checklist (CBCL). We determined clinical (10% elevated scores) and borderline (20% elevated scores) SDQ TDS norms. We assessed the test performance (validity) of the SDQ TDS and Impairment Score using the CBCL as criterion. RESULTS: The clinical SDQ TDS norms varied between > 10 and > 14 depending on the age group. The SDQ TDS discriminated between children with and without problems, as measured by the CBCL, for all age groups (AUCs varied from 0.92 to 0.96). The SDQ Impairment Score had added value (beyond the SDQ TDS) only for the age group 12-14 years. For the Netherlands we found lower clinical SDQ TDS norms than those previously reported for the UK (i.e. > 16). CONCLUSION: The clinical SDQ TDS norms varied between > 10 and > 14 depending on the age groups. We found good test performance at these proposed norms. Dutch norms differed somewhat from UK norms. In the Netherlands, the SDQ performed better with Dutch-specific norms than with UK-specific norms

Punishment and reward in parental discipline for children aged 5 to 6 years: prevalence and groups at risk

OBJECTIVE: In this study we examined the use and predictors of different discipline practices by parents of children aged 5 to 6 years. METHODS: We obtained cross-sectional data for a nationally representative Dutch sample of children aged 5 to 6 years within the setting of routine well-child visits provided to the entire population. A total of 1630 children participated (response rate, 84%). Before the visit, parents completed a questionnaire with questions about their approach to discipline (punishment and rewards). Chi-square tests and logistic regression analyses were used to examine associations between discipline practices and child, parent, and family factors. RESULTS: Parental punishment prevalence was 21.9% for spanking and 80.3% for other punishment practices, such as time-outs. The prevalence of rewards as a discipline strategy was 32.2% for granting privileges and 86.3% for cuddling/complimenting. Multivariate logistic regression analyses showed that spanking was more likely in families in which the mothers have low and medium levels of education and in families of non-Dutch ethnicity. Other punishment practices (eg, time-outs, verbal reprimands, and holding) were more likely in families of Dutch ethnicity. Granting privileges was more likely in families of non-Dutch ethnicity, who lived in large cities, whose income was below the poverty level, in unemployed families, and in small families. Cuddling and complimenting were more likely in families with a high maternal educational level, in families of Dutch ethnicity, and in small families. CONCLUSIONS: These findings show the importance of considering social and economic factors when identifying and supporting parents with parenting/rearing challenges

Developmental monitoring: benefits of a preventive health care system

This study aims to assess the identification rates in a developmental monitoring system (i.e., preventive child healthcare, PCH system) regarding identification of emotional, behavioral (EB) problems, cognitive developmental and family problems in children, and the contribution of such a system to referral to (specialized) mental health and social care services. Over a predetermined period of 6 months, we retrieved data from a random sample of 1370 children aged 0 to 18 years from the registries of two PCH organizations in the Netherlands. We assessed the degree to which PCH professionals identify EB and cognitive developmental and family problems and invite children with these problems for follow-up PCH assessments or refer them to (specialized) mental health and social care services. Among preschool-aged children, we identified 22% with EB problems, cognitive developmental and/or family problems (mainly EB and family problems). Among school-aged children, numbers varied from 10 to 14% (mainly EB). PCH invited 3 to 10%, varying in proportions of child age, for a follow-up assessment, and referred 0 to 4% of the children to external services. CONCLUSION: A developmental monitoring system with only preventive tasks may help to identify children with EB, cognitive developmental, and/or family problems. This can lead to early support for most of these children, with low referral rates to (more specialized) mental health and social care services. Our findings deserve validation in comparable settings and in other countries. WHAT IS KNOWN: • Well-child care requires monitoring of the health and development of children for timely identification of problems and subsequent intervention. • The Dutch Preventive Child Healthcare system is an example of a developmental monitoring system with only preventive tasks. WHAT IS NEW: • A developmental monitoring system with only preventive tasks may help to identify children with problems, resulting in early support for the majority. • This may reduce referral rates to (more specialized) mental/social health services

A study on the applicability of the Strengths and Difficulties Questionnaire among low- and higher-educated adolescents

AIM: The Strengths and Difficulties Questionnaire self-report (SDQ-SR) is a valid instrument for detection of emotional and behavioral problems. The aim of this study was to compare the psychometric properties of the SDQ-SR for low and higher educated adolescents, and to explore its suitability.METHODS: We included 426 adolescents. We compared internal consistency for low-educated, i.e., at maximum pre-vocational secondary education, and higher educated adolescents and assessed whether the five-factor structure of the SDQ holds across educational levels. We also interviewed 24 low-educated adolescents, and 17 professionals.RESULTS: On most SDQ subscales the low-educated adolescents had more problematic mean scores than the higher educated adolescents. Findings on the invariance factor analyses were inconsistent, with some measures showing a bad fit of the five factor model, and this occurring relatively more for the low-educated adolescents. Professionals and adolescents reported that the SDQ included difficult wordings.DISCUSSION: Our findings imply that the scale structure of the SDQ-SR is slightly poorer for low educated adolescents. Given this caveat, psychometric properties of the SDQ-SR are generally sufficient for use, regardless of educational level.</p

Three questionnaires to detect psychosocial problems in toddlers: a comparison of the BITSEA, ASQ:SE, and KIPPPI

OBJECTIVE: Validated questionnaires can improve the identification of psychosocial problems in community pediatric services. Our aim was to assess which of 3 short questionnaires the Brief Infant-Toddler Social and Emotional Assessment (BITSEA), the Ages and Stages Questionnaires: Social-Emotional (ASQ:SE), and the KIPPPI (Brief Instrument Psychological and Pedagogical Problem Inventory) was most suitable as a routine screening tool for identification among toddlers. METHODS: We included 2106 parents (response rate 81%) of children aged 6, 14, or 24 months at routine well-child visits in 18 services across the Netherlands. Child health care professionals interviewed and examined children and parents. Parents were randomized to complete either the BITSEA or the KIPPPI; all filled out the ASQ:SE and the Child Behavior Checklist. For each questionnaire, we assessed the internal consistency, validity with Child Behavior Checklist Total Problems Score (CBCL-TPS) as a criterion, and added value to identification compared to clinical assessment alone. RESULTS: Cronbach's alphas of the total scales varied between 0.46 to 0.91. At the ages of 6 and 14 months, none of the instruments studied had adequate validity. At the age of 24 months, only the BITSEA discriminated sufficiently between children with and without problems (sensitivity = 0.84 at specificity = 0.90), but not the other 2 questionnaires (with sensitivity indices varying between 0.53 and 0.60 at similar specificity). The BITSEA at this age offered slightly higher added value to the identification of psychosocial problems by child health care professionals. CONCLUSIONS: For toddlers aged 6 and 14 months, no questionnaire is sufficiently valid to support the identification of psychosocial problems. The BITSEA is the best short tool for the early detection of psychosocial problems in 2-year-old children

Characteristics of the Strengths and Difficulties Questionnaire in Preschool Children

<p>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.</p><p>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.</p><p>RESULTS: The internal consistency of the SDQ total difficulties score was good (Cronbach's alpha, 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.</p><p>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. Pediatrics 2013;131:e446-e454</p>

Emotional and behavioural problems in young children with divorced parents

This study examines the link between divorce or separation and emotional and behavioural problems (EBP) in children aged 2-4 years. We obtained cross-sectional data for a nationally representative Dutch sample of children aged 2-4 years within the setting of the national system of routine visits to well-child clinics. A total of 2600 children participated (response rate: 70%). Before the visit, parents completed the Child Behaviour Checklist and a questionnaire with questions about divorce or separation. We assessed the associations of children's EBP with a divorce either in the previous year or at any time in the past after adjustment for other child and family factors. Four percent of the children had parents who had divorced before the child reached the age of 2-4 years, and 3.4% of these parents had divorced in the previous year. EBP (and particularly behavioural problems) were more likely in children aged 2-4 years old in cases of lifetime divorce or separation. This association was weaker after adjustment for relevant child and family characteristics: it may be partly due to confounding factors such as paternal education level, ethnicity and family size. A divorce in the previous year was not linked to child EBP. These findings show the importance of identifying care needs and providing care for pre-school children whose parents have divorced since they suggest that there may be negative effects in the longer term