How do schools influence the emotional and behavioural health of their pupils? A multi-level analysis of 135 schools in the Born in Bradford inner city multi-ethnic birth cohort

The Strengths and Difficulties Questionnaire (SDQ) is widely used to measure emotional and behavioural problems in typically developing young people, although there is some evidence that it may also be suitable for children with intellectual disability (ID). The Developmental Behaviour Checklist - Parent version (DBC-P) is a measure of emotional and behavioural problems that was specifically designed for children and adolescents with an ID. The DBC-P cut-off has high agreement with clinical diagnosis. The aim of this study was to estimate the relationship between DBC-P and SDQ scores in a sample of children with ID. Parents of 83 young people with ID aged 4-17years completed the parent versions of the SDQ and the DBC-P. We evaluated the concurrent validity of the SDQ and DBC-P total scores, and the agreement between the DBC-P cut-off and the SDQ cut-offs for 'borderline' and 'abnormal' behaviour. The SDQ total difficulties score correlated well with the DBC-P total behaviour problem score. Agreement between the SDQ borderline cut-off and the DBC-P cut-off for abnormality was high (83%), but was lower for the SDQ abnormal cut-off (75%). Positive agreement between the DBC-P and the SDQ borderline cut-off was also high, with the SDQ borderline cut-off identifying 86% of those who met the DBC-P criterion. Negative agreement was weaker, with the SDQ borderline cut-off identifying only 79% of the participants who did not meet the DBC-P cut-off. The SDQ borderline cut-off has some validity as a measure of overall levels of behavioural and emotional problems in young people with ID, and may be useful in epidemiological studies that include participants with and without ID. However, where it is important to focus on behavioural profiles in children with ID, a specialised ID instrument with established psychometric properties, such as the DBC-P, may provide more reliable and valid information.

Introduction Evidence suggests that Looked after children are nearly 5 times more likely to have a mental illness than their peers. Over the last decade the concept of well-being has developed, especially within public policy. There is a hypothesis that improving an individuals well-being improves their mental health and reduces any associated mental illness. Aims To assess the relationship between well-being and mental health problems in looked after children. Methods From January 2014, the Warwick-Edinburgh Mental Well-Being Scale (WEMWBS) was added to the Strengths and Difficulties Questionnaire (SDQ) completed by all Looked After Children in Birmingham aged 14 years old and above. In August 2014, we retrieved data on all children with completed SDQ and WEMWBS scores. Results 101 children were identified as having a completed WEMWBS and SDQ score. 32 of the children’s SDQ scores were >17 reflecting the child having substantial risk of clinically significant mental health problems. 64 of the children with completed WEMWBS scored average scores of 40–59, 14 children scored below average, and the remaining 23 children scored above average. Figure 1 shows the WEMWBS and SDQ scores. 4 children scored 55 (an average score) on the WEMWBS and their SDQ scores ranged from 8–35 (from low to high risk of clinically significant mental health problems). Conclusion There is no clear relationship between mental health problems and well-being scores for Looked After Childern in this cohort. This finding supports the statement in the Chief Medical Officer Annual Report 2013 that ‘mental illness and ‘well-being’ are not ends of the same continuum: it is possible to have high levels of subjective well-being despite having a mental illness, and vice versa’.

Background The Strengths and Difficulties Questionnaire (SDQ) is a screening instrument for emotional and behavioural problems. Swedish reference values based on large-scale national data are lacking for mid- and late adolescents. Also, there is a scarcity of longitudinal studies about the development of strengths and difficulties from middle to late adolescence. The study aims were 1) to report on Swedish adolescents’ assessment of their strengths and difficulties and to present joint and gender-specific reference values for identifying risk groups; 2) to examine the continuity and change of strengths and difficulties and to what extent this differs by gender. Methods Data was based on a national Swedish sample of adolescents aged 15-16 years in 2017 (n = 5338) who were surveyed again in 2019 (n = 3973). Mean values and reference values for “close to average” (0th-80th percentile), “slightly raised” (>80th-90th percentile) and “high” (>90th percentile) SDQ scores were calculated. Comparison in SDQ scores by gender and across time was approached using inferential statistics. Results Girls reported higher levels of emotional problems (p = <0.001), whereas boys showed higher levels of conduct problems (p = <0.001) at t1 and t2. Hyperactivity slightly prevailed in girls (p = 0.007), and peer problems were slightly higher in boys (p = 0.027) at t2. Prosocial behaviour was higher in girls than boys (p = <0.001) at t1 and t2. Changes in SDQ scores across time were in general small. Yet, analyses focusing on risk groups showed that among those who scored >80th or > 90th percentile at t1 about half scored above the same threshold at t2. Conclusions This study provided joint and gender-specific reference values for mid- and late adolescents in Sweden, and found some gender differences in SDQ scores and degree of change. Reported national gender-specific reference values may facilitate identifying adolescents at risk and potentially increasing timely mental health intervention measures. Key messages • Among the subscales indicating difficulties, the highest was level of emotional problems in girls and hyperactivity in boys; the largest increase over time was in emotional problems for both genders. • Analyses of changes in SDQ mean scores showed only minor changes between t1 and t2, while analyses of movement between categories defined by cutoffs presented a more noticeable degree of change.

BackgroundA valid screening tool for behavioral and emotional problems in children and adolescents is needed to promote psychological wellbeing and to prevent mental disorders in China's children.AimAssess the use of the Chinese version of the internationally recognized Strengths and Difficulties Questionnaire (SDQ) – which assesses emotional symptoms, conduct problems, hyperactivity/inattention, peer relationship problems and prosocial behaviors – in a large sample of urban and rural children from different parts of China.MethodsThe Chinese version of the parent-reported SDQ was administered to legal guardians (primarily parents) of a stratified random sample of 22,108 primary school children 5 to 13 years of age from eight provinces in China. The association between SDQ scores and socio-demographic characteristics was assessed and the percentile cutoff scores for ‘abnormal’, ‘borderline’ and ‘normal’ results in China were compared with those for Japan and the United Kingdom.ResultsThe internal consistency of the 4 of the 5 SDQ subscales were satisfactory but that for the ‘peer relationships problems’ subscale was quite poor (alpha=0.22). Guardians reported that boys were more likely than girls to have hyperactivity/inattention problems and that girls were more likely than boys to have problems with emotional symptoms. For both boys and girls hyperactivity/inattention problems decreased with age while peer relationship problems increased with age. Emotional symptoms, conduct problems and peer relationship problems were more common in children from rural areas and in children whose identified guardian was not a parent (i.e., a grandparent or other relative). The 90th percentile cutoff score for abnormal results was higher in Chinese children than the cutoff scores reported for children in Japan and the United Kingdom.ConclusionsThis study suggests that prevention programs for hyperactivity/inattention problems in boys need to start before the age of 10 and that training in methods of reducing the stress associated with peer relationships should start in early adolescence. Further work is needed to improve the cultural validity of the SDQ in China and to determine its sensitivity and specificity for identifying children who are in need of mental health services.

BackgroundAlcohol, substance use, and mental health disorders constitute major public health issues worldwide, including in low income and lower middle-income countries, and early initiation of use is an important predictor for developing substance use disorders in later life. This study reports on the existence of childhood alcohol abuse and dependence in a sub-study of a trial cohort in Eastern Uganda.MethodsThe project SeeTheChild—Mental Child Health in Uganda (STC) included a sub-study of the Ugandan site of the study PROMISE SB: Saving Brains in Uganda and Burkina Faso. PROMISE SB was a follow-up study of a trial birth cohort (PROMISE EBF) that estimated the effect that peer counselling for exclusive breast-feeding had on the children’s cognitive functioning and mental health once they reached 5–8 years of age. The STC sub-study (N = 148) used the diagnostic tool MINI-KID to assess mental health conditions in children who scored medium and high (≥ 14) on the Strengths and Difficulties Questionnaire (SDQ) in the PROMISE SB cohort N = (119/148; 80.4%). Another 29/148 (19.6%) were recruited from the PROMISE SB cohort as a comparator with low SDQ scores (< 14). Additionally, the open-ended questions in the diagnostic history were analysed. The MINI-KID comprised diagnostic questions on alcohol abuse and dependence, and descriptive data from the sub-study are presented in this paper.ResultsA total of 11/148 (7.4%) children scored positive for alcohol abuse and dependence in this study, 10 of whom had high SDQ scores (≥ 14). The 10 children with SDQ-scores ≥ 14 had a variety of mental health comorbidities of which suicidality 3/10 (30.0%) and separation anxiety disorder 5/10 (50.0%) were the most common. The one child with an SDQ score below 14 did not have any comorbidities. Access to homemade brew, carer’s knowledge of the drinking, and difficult household circumstances were issues expressed in the children’s diagnostic histories.ConclusionsThe discovery of alcohol abuse and dependence among 5–8 year olds in clinical interviews from a community based trial cohort was unexpected, and we recommend continued research and increased awareness of these conditions in this age group.Trial registration Trial registration for PROMISE SB: Saving Brains in Uganda and Burkina Faso: Clinicaltrials.gov (NCT01882335), 20 June 2013. Regrettably, there was a 1 month delay in the registration compared to the commenced re-inclusion in the follow-up study: https://clinicaltrials.gov/ct2/show/NCT01882335?term=saving+brains&draw=2&rank=1

To examine the psychometric properties of the French version of the strengths and difficulties questionnaire (SDQ), compare estimates of child mental health problems and SDQ scores across France, US and UK. The French version of the parent-reported SDQ was administered to the parents of a representative sample of 1,348 French children aged 6-11 years old. The response rate was 57.6%. We performed three scoring methods and examined their association with socio-demographic data. French SDQ scores were compared with SDQ scores from US and UK national surveys. The French cut-off points for the scoring bands were similar to those of the UK and US, with a few exceptions (peer relationship problems, prosocial behaviour). The internal consistency of the SDQ subscales was acceptable with Cronbach alpha coefficients ranging from 0.46 for peer relationship problems to 0.74 for hyperactivity/inattention. Known socio-demographic risk factors were associated with SDQ scoring method. For most SDQ scores, differences between France and the UK were smaller (5%) than those between France and the US. The study provided good support for the validity of the parent-reported SDQ in France as well as evidence for the usefulness of the SDQ as a promising screening instrument for epidemiological research and clinical purposes.

INTRODUCTION: The Strengths and Difficulties Questionnaire (SDQ) is an internationally recognised psychometric and behavioural screening tool. The Ministry of Social Development (MSD) have endorsed the SDQ as the primary behavioural screening and client outcome evaluation tool for the Social Workers in Schools (SWiS) service in 2018. The usefulness of the SDQ in social work practice and in evaluating client outcomes, however, remains unclear. This study explored two years of aggregated Youth Workers in Secondary Schools (YWiSS) SDQ scores to understand what client outcomes could be evidenced. This study further reflects on SDQs as a contractually mandated practice tool and their appropriateness in social work practice.METHOD: Data were collected from the Family Works Northern (FWN) YWiSS database.Data modelling and analysis tested what aggregated client, parent and teacher SDQ scorescommunicated for changes in clients’ behavioural difficulties at service entry, mid-point and exit. FINDINGS: Analysis of two years of YWiSS client, parent and teacher SDQ scores aggregated at a service level provided inconsistent evidence of client need and outcomes by SDQ thematic categories. A number of factors, including the SDQ being voluntary, clients exiting service early and the challenge of asking the same teachers and parents to complete an SDQ, meant that there were very few SDQ scores completed by all parties at the service exit point, following a two-year intervention.CONCLUSION: The findings in this research suggest that the SDQ as a standalone behavioural screening and outcome evaluation tool within social work is limited. Aggregated YWiSS SDQ results provided limited insights about the complexity of client needs or any intervention outcomes to practitioners, social service providers and funders. The use of SDQ in social work requires further scrutiny to test its ability to communicate a client’s level of need and any intervention outcomes to these stakeholders.

ObjectivesThe distribution of asylum-seekers and resettled refugees is highly uneven across the UK, with North-East England hosting most asylum-seekers per head of population [1].Exposure to adverse childhood experiences (ACEs), conflict...

BackgroundOf all the adolescents in India, 7.3% are suffering from some form of mental disorder. They frequently use tobacco to cope with these problems, but get stuck in a vicious cycle of deteriorating mental health. Our study aimed to determine the effect of tobacco on the mental health status of adolescents studying in the 9th to 12th standards in 10 high schools in urban and rural areas near Patna, Bihar.MethodologyAn analytical cross-sectional study was conducted among 360 school-going adolescents recruited using stratified random sampling. Selected adolescents were given the Indian Adolescent Health Questionnaire. The mental health status was calculated from the Strengths and Difficulties Questionnaire (SDQ) score. Information on sociodemographic characteristics and tobacco use was also obtained. Independent t-test, analysis of variance, and multiple linear regression analysis were used for predicting the significant factors. Significance was set at p-values <0.05.ResultsIn this study, 40 (11.1%) adolescents had abnormal whereas 55 (15.3%) had borderline overall SDQ scores. The majority of those affected had peer problems (40%) and conduct problems (24.7%). All SDQ components of conduct (F = 2.94, p = 0.013), hyperactivity (F = 2.90, p = 0.014), emotional problems (F = 1.14, p = 0.001), and peer pressure (F = 3.06, p = 0.010), as well as the overall SDQ score (F = 5.74, p < 0.001), were significantly associated with increasing age. The adolescents attending rural schools (13.28 ± 5.22, p = 0.047) had significantly higher SDQ scores than those attending urban schools (12.08 ± 5.60). Hyperactivity scores were significantly higher in those studying in class 10 compared to other classes and in those attending rural rather than urban schools. Emotional problems score was significantly higher in 16-17-year-old students than in 14-15-year-old students, in females than in males, and in class 10 than in class 9 students. Only 24 (6.7%) adolescents had a history of tobacco consumption at least once which was significantly associated with the SDQ score (17.71 ± 5.69; t = 4.95, df = 358, p < 0.001). Around 79.4% of adolescents were exposed to passive smoking from close friends which deteriorated their overall mental health status (14.50 ± 5.99; F = 6.29, df = 2,357, p = 0.002). Those who had smoked for more than 10 days had significantly greater conduct problems and lesser pro-social behavior. Overall, 96.1% agreed that tobacco is harmful to health, and 76.1% had seen anti-smoking messages in the media. Female gender, increasing class and age, and history of smoking or chewing tobacco at least once also led to a significant increase in emotional problems. Age, area of the school, history of tobacco consumption, and exposure to cigarette smoke by either a close friend or male guardian had a significant impact on the conduct, hyperactivity, peer problems, and overall mental health status of school-going adolescents.ConclusionsPredicting risk factors such as age, area of the school, and the history of tobacco consumption by self or by close friends is important for decision-making by school administration regarding counseling for mental health and preventing tobacco use.

Emotional and behavioral problems in children and adolescents with lower urinary tract dysfunction: a population-based study

Objective: To identify psychosocial problems and self-esteem in children with growth hormone deficiency (GHD) and define the role of some clinical and sociodemographic determinants in the conceptualization of internalizing and externalizing problems as criteria for psychosocial functioning.Materials and Methods: A GHD sample (46 prepubescent children) was selected and compared to a matched control group (80 healthy children). Psychosocial functioning in children with GHD was investigated using Goodman's “Strengths and Difficulties Questionnaire (SDQ).” The study of children's self-esteem was carried out by the Dembo–Rubinstein method.Results: This study reveals that the GHD sample has more internalizing problems and lower self-esteem. Higher score and frequency of assessment in the abnormal score for “total difficulties,” “emotional problem,” and “peer problem” were found in children with GHD. The SDQ score and the frequency of assessment in the abnormal score for all SDQ scales in children with more pronounced growth deficit (height SDS < −3) did not exceed the same indicators in children with less growth retardation (−3 < height SDS < −2). A comparison of psychosocial features in children with isolated growth hormone deficiency and multiple pituitary hormones deficiency did not reveal differences in SDQ score and the frequency of assessment in the abnormal score for all SDQ scales. It was found that children with GHD have a reduced level of assertions, low self-esteem, and a weak discrepancy between the level of assertions and self-esteem. Some sociodemographic determinants (male gender, age < 9 years, and low family income) and clinical determinants (low compliance and suboptimal growth response after 1 year of rGHh therapy) have an impact on the overall assessment of psychological problems in children with GHD. The internalizing difficulties are associated with certain clinical determinants (growth status and treatment status) and sociodemographic determinants (female gender, age < 9 years).Conclusions: The identification of low self-esteem and the high SDQ score for scales “total difficulties,” “emotional problems,” and “peer problems” indicates psychosocial maladjustment and conceptualization of internalizing problems in children with GHD.

Disruptive behavior and emotional problems are common in children and often reduce quality of life. This study aimed to screen for these problems and to examine the effectiveness of child-based indicated prevention. N = 3231 children`s disruptive behavior and emotional problems were screened using the Strengths and Difficulties Questionnaire (SDQ) during routine pediatric health check-ups for usually 5- to 10-year old's. We examined the prevalences of disruptive behavior and emotional problems (n = 2825) and its association with quality of life (KINDL; n = 1104). If indicated, children were recommended to participate in the prevention program "Baghira training" (nine 90min group sessions and one parents' evening) or "Tiger training" (two one-on-one and nine group sessions of 60min each). To evaluate the training effectiveness of the two indicated prevention programs, SDQ and KINDL scores were followed-up for 6 and 12 months post screening and compared between the Training group (SDQ n = 337; KINDL n = 334; additionally divided into Baghira and Tiger), children not participating despite indication (NoTraining; SDQ n = 595; KINDL n = 146; additionally divided into NoBaghira and NoTiger), healthy children (SDQ n = 1928; KINDL n = 907), and children with clinical symptom levels (SDQ n = 85; KINDL n = 54) using mixed effect models. 37.0% of the children exhibited disruptive behavior or emotional problems, which were associated with impaired quality of life. The Training group perceived greater symptom reduction in emotional problems than NoTraining, and quality of life increases compared to decreases in NoTraining. The Tiger group showed improvement in symptomatology and quality of life compared to deterioration in NoTiger. The Baghira group also improved, though improvement was similar to NoBaghira apart from symptom reduction in emotional problems in Baghira compared to a symptom increase in NoBaghira. Effects sizes were predominantly small to medium. Disruptive behavior and emotional problems in children are frequent and impair quality of life. Indicated prevention may improve symptomatology and quality of life. Specifically, the Tiger training is verifiably effective; for the Baghira training, effectiveness is implicated but needs further empirical evaluations.

BackgroundAlthough characterised by motor impairments, children with Developmental Coordination Disorder (DCD) also show high rates of psychopathology (anxiety, depression, low self-esteem). Such findings have led to calls for the screening of mental health problems in this group. AimsTo investigate patterns and profiles of emotional and behavioural problems in children with and without DCD, using the Strengths and Difficulties Questionnaire (SDQ). Methods and proceduresTeachers and parents completed SDQs for 30 children with DCD (7–10 years). Teacher ratings on the SDQ were also obtained from two typically-developing (TD) groups: 35 children matched for chronological age, and 29 younger children (4–7 years) matched by motor ability. Outcomes and resultsGroup and individual analyses compared parent and teacher SDQ scores for children with DCD. Teacher reports showed that children with DCD displayed higher rates of emotional and behavioural problems (overall, and on each subscale of the SDQ) relative to their TD peers. No differences were observed between the two TD groups. Inspection of individual data points highlighted variability in the SDQ scores of the DCD group (across both teacher and parent ratings), with suggestions of elevated hyperactivity but comparably lower levels of conduct problems across this sample. Modest agreement was found between teacher and parent ratings of children with DCD on the SDQ. Conclusions and implicationsThere is a need to monitor levels of emotional and behavioural problems in children with DCD, from multiple informants.

To examine the psychometric properties of the Strengths and Difficulties Questionnaire (SDQ) parent version and to determine the effects of age, gender, country and investigator type (paediatrician, child psychiatrist, other physician) on the SDQ scores in the prospective, non-interventional ADORE study. The SDQ was completed for 1,459 children with ADHD (aged 6-18 years) in 10 European countries. Factor analysis provided an exact replication of the original 5-factor SDQ subscale structure. All subscales were sufficiently homogeneous. The mean total difficulties and SDQ subscale scores of the ADORE sample clearly differed from UK normative data. Younger children were more impaired on different SDQ scales than older children, and girls were more emotionally affected than boys. Differences between countries were found for each SDQ scale, but the investigator type had no significant effect. Correlation coefficients between SDQ scales and other scales used in ADORE ranged from low (r<0.30) to high (r>0.50). The present study confirmed the validity and reliability of the parent-reported SDQ scale structure and showed that the scale scores are dependent on age and gender. In contrast to investigator type, different cultures had a significant effect on SDQ scores. Correlations with other scales used in the ADORE study underline both separate domains and meaningful associations.

The typically developing siblings of children with disabilities are vulnerable to behavioral problems as they grow up in an environment of considerable stress. Yet, the needs and behavior problems of these siblings are often neglected especially in Pakistan. In this cross-sectional study, we assessed the behavior problems among siblings of children with developmental disabilities. The strength and difficulties questionnaire (SDQ) was administered on 250 siblings (aged 6–17 years) of children with a developmental disability (Autism, Intellectual disability (ID), Down Syndrome (DS), and Attention Deficit Hyperactive Disorder (ADHD)) attending special education institutions in Karachi, Pakistan. Multiple linear regression was applied to assess the relationship between SDQ scores and other demographic, parental, and disability-related factors. Adjusted beta coefficients were reported along with a 95% confidence interval. The average SDQ score was found to be 14 ± 6 among the siblings of children with developmental disabilities. Multivariable analysis showed that the estimated mean SDQ score was almost twice among siblings of children with ADHD (95% CI: 0.73–3.48) and ID (95% CI: 0.64–3.16) than siblings of children with Down syndrome. Also, the mean SDQ score was 8 units higher among siblings of children with a severe developmental disability compared to mild disability (95% CI: 6.79–9.47). The findings of the current study emphasize the need for appropriate mental health services, using a family-focused approach from therapeutic and counseling platforms to the siblings, parents, and disabled brother/sister for early identification and management of behavior issues. Abbreviations: ADHD: Attention Deficit Hyperactive Disorder; AKU: Aga Khan University; β: Beta Coefficient (Slope); βo: Intercept; CHS: Community Health Sciences; DS: Down syndrom; ERC: Ethical Review Committee; ID: Intellectual Disability; MLR: Multiple Linear Regression; SDQ: Strengths and Difficulties Questionnaire; SES: Socioeconomic Status; TD: Typically Developing