Making behaviour visible: data-based behaviour support in schools. Evidence from 20 experimental single-case studies

Emotional and Behavioral Problems among Diabetic Children

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.

ObjectiveThis 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 designWe 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.ResultsThe 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).ConclusionThe 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.

BackgroundIdentification of children at risk for psychosocial problems is important to be able to provide supportive and tailored care at an early stage. Due to its brevity and wide age range, the Strengths and Difficulties Questionnaire (SDQ) Parent Form is an appropriate instrument for use in paediatric clinical practice as it facilitates assessment of psychosocial functioning from young childhood into adulthood. The aim of the present study was to provide Dutch normative data for the SDQ Parent Form.MethodsA sample of 1947 parents with children aged 2–18 years was drawn from a large panel of a Dutch research agency, stratified on Dutch key demographics of the parents.The SDQ Parent Form assesses the child’s Emotional symptoms, Conduct problems, Hyperactivity-Inattention, Peer problems and Prosocial behaviour. Summary scores can be calculated: Internalising, Externalising and Total difficulties.Internal consistency (Cronbach’s alpha coefficient) and normative scores (mean, median, clinical cut-off scores) of the SDQ- Parent Form were calculated in four age-groups 2–3, 4–5, 6–11 and 12–18 years. Gender differences were tested with independent t-tests.ResultsA total of 1174 parents (60.3%) completed the SDQ. In the age-groups 2–3 and 4–5, norm scores are not available for Conduct problems and Peer problems due to insufficient internal consistency. In addition, in age-group 2–3, norm scores for Emotional symptoms and Internalising are not available because of insufficient internal consistency. In the age-groups 6–11 and 12–18, norm scores are available for all scales, with Cronbach’s alpha coefficients 0.53–0.86. The comparison by gender revealed that boys had more behavioural problems than girls (0.000 < p < 0.048), most prevalent for Hyperactivity-Inattention, Peer Problems, Prosocial behaviour, Externalising and Total Difficulties.ConclusionsDutch normative data by age-group and gender are now available for parent-reported SDQ scores in children aged 2–18 years. Due to insufficient internal consistency, normative scores for 2–5 year-old children could not be presented for several SDQ scales. Yet, the SDQ Total score provides a reliable indication of the psychosocial functioning of younger children. In case of high Total scores in children younger than 6 years, alternatively to scale scores, the answers on the individual items could yield useful clinical information about the child’s problems.

Knowledge on the validity of the Strengths and Difficulties Questionnaire (SDQ) among adolescents is limited but essential for the interpretation of SDQ scores preceding the diagnostic process. This study assessed the predictive and discriminative value of adolescent- and parent-rated SDQ scores for psychiatric disorders, diagnosed by professionals in outpatient community clinics, in a sample of 2753 Dutch adolescents aged 12–17. Per disorder, the predictive accuracy of the SDQ scale that is contentwise related to that particular disorder and the SDQ impact scale was assessed. That is, 24 logistic regression analyses were performed, for each combination of DSM-IV diagnosis [4: Attention-Deficit/Hyperactivity Disorder (ADHD), Conduct/Oppositional Defiant Disorder (CD/ODD), Anxiety/Mood disorder, Autism Spectrum Disorder (ASD)], informant (3: adolescent, parent, both), and SDQ scale(s) (2; related scale only, related scale and impact scale). Additional logistic regression analyses were performed to assess the discriminative strength of the SDQ scales. The results show both fair predictive strength and fair discriminative strength for the adolescent- and parent-reported hyperactivity scales, the parent-reported conduct scale, and the parent-reported social and prosocial scales, indicating that these scales provide useful information about the presence of ADHD, CD/ODD, and ASD, respectively. The SDQ emotional scale showed to be insufficiently predictive. The findings suggest that parent-rated SDQ scores can be used to provide clinicians with a preliminary impression of the type of problems for ADHD, CD/ODD, and ASD, and adolescent for ADHD.

Using the strengths and difficulties questionnaire with adults with Down syndrome

BackgroundChild and adolescent mental health in Africa remains largely neglected. Quick and cost-effective ways for early detection may aid early intervention. The Strengths and Difficulties Questionnaire (SDQ) is globally used to screen for mental health problems, but little is known about its use in Africa. We set out to perform a scoping review to examine existing studies that have used the SDQ in Africa.MethodsA comprehensive scoping review methodology was used to identify all peer-reviewed studies ever published that have used the SDQ in Africa. Data were extracted and analysed to assess the countries, languages and SDQ versions used, the purpose of the SDQ studies, psychometric properties of the SDQ, and to consider knowledge gaps for future in-country and cross-country studies.ResultsFifty-four studies from 12 African countries were identified, most from South Africa. Many different languages were used, but authorized SDQs in those languages were not always available on the SDQinfo website. Authors frequently commented on challenges in the translation and backtranslation of mental health terminology in African languages. The SDQ was typically used to investigate internalisation/externalization disorders in different clinical populations, and was most frequently used in the evaluation of children and adolescents affected by HIV/AIDS. Sixteen studies (29.6%) administered the SDQ to participants outside the intended age range, only 4 (7.4%) used triangulation of all versions to generate assessments, and eight studies (14.8%) used only subscales of the SDQ. Only one study conducted thorough psychometric validation of the SDQ, including examination of internal consistency and factor analysis. Where ‘caseness’ was defined in studies, UK cut-off scores were used in all but one of the studies.ConclusionsThe SDQ may be a very useful tool in an African setting, but the scoping review suggested that, where it was used in Africa researchers did not always follow instrument guidelines, and highlighted that very little is known about the psychometric properties of the SDQ in Africa. We recommend comprehensive evaluation of the psychometric properties of the SDQ in various African languages, including internal consistency, factor structure, need for local cut-off values and ensuring cultural equivalence of the instrument.

Although children residing in statutory out-of-home care and those adopted from care are more likely than not to have mental health difficulties requiring clinical intervention or support, their difficulties often remain undetected. Children’s agencies have a duty of care to identify those child clients who require therapeutic and other support services, without regard to the availability of such services. The present article proposes a first-stage mental health screening procedure (calibrated for high sensitivity) for children and adolescents (ages 4–17) in alternative care, which children’s agencies can implement without clinical oversight using the Strengths and Difficulties Questionnaire (SDQ) and Brief Assessment Checklists (BAC). The screening procedure was derived from analyses of BAC, SDQ, and “proxy SDQ” scores obtained in three national studies of children and adolescents residing in alternative care (Australia, the Netherlands, and England). The SDQ and BAC demonstrated moderate to high screening accuracy across a range of clinical case criteria—the SDQ being slightly better at predicting general mental health problems and the BAC slightly better at predicting attachment- and trauma-related problems. Accurate first-stage screening is achieved using either the SDQ or the BAC alone, with recommended cut points of 10 (i.e., positive screen is 10 or higher) for the SDQ and 7 for the BAC. Greater accuracy is gained from using the SDQ and BAC in parallel, with positive screens defined by an SDQ score of 11 or higher or a BAC score of 8 or higher. Agencies and post-adoption support services should refer positive screens for comprehensive mental health assessment by clinical services.

Whilst children in child welfare suffer more psychopathology than their community peers, only a small percentage of them actually receive mental health care. Previous literature suggested that all children entering child welfare should be screened. This study evaluated whether the Strengths and Difficulties Questionnaire (SDQ) could be used for this purpose. The extended version of the SDQ and the Achenbach System of Empirically Based Assessment (ASEBA) questionnaire were administered to parents and caregivers of 292 children in child welfare. Children older than 11 years also completed the SDQ self-report and the Youth Self Report (YSR). Furthermore, the child's history of service use was recorded and informants were asked if the actual care was sufficient. Inter-informant correlations for the scores from the SDQ and ASEBA were high and comparable or favoured the use of the SDQ (for parents and caregivers). Internal consistency was satisfactory to good. For all informants, high correlations were found between SDQ and ASEBA. Despite high scores on the SDQ, only 29% of the children had received mental health care. Service use was only correlated with the parent SDQ and the CBCL and TRF. Additional help, as requested by 21% of the parents and 37% of the caregivers, correlated moderately with the SDQ and ASEBA scores. Compared to the total difficulties score, the impact supplement is a better predictor of service use and the informant's request for additional help. This study illustrates that the Dutch version of the SDQ, similar to the English and German versions, has equal validity as the Dutch ASEBA for screening children. Caution is warranted when the SDQ is the only source of information for referrals to specialized care.

ObjectiveThe Strengths and Difficulties Questionnaire (SDQ) was developed for clinicians and researchers as a brief screening instrument for behavioural and emotional problems in children. Administered in its traditional pen‐and‐paper format, the SDQ has demonstrated sound psychometric properties. The SDQ is increasingly being administered online, despite there being little evaluation of the psychometric properties and norms of the instrument in this new administrative context, and none in an Australian (or English‐speaking) sample. Therefore, the aim of the current study was to explore the psychometric properties and present normative data for the online administration of the parent‐report version of the SDQ in an Australian sample.MethodsParticipants were parents (n = 1,070) of Australian primary school‐aged children (5 to 12 years) who completed the SDQ online via a web‐based software program.ResultsResults demonstrate sound psychometric properties for the SDQ in its online administrative format that are comparable to previous Australian studies utilising the traditional pen‐and‐paper format of the SDQ. Moreover, we provide normative data on the SDQ subscales, as well as the impact supplement when administered online.ConclusionsTogether, the results support the use of the SDQ online, and provide emerging evidence that the psychometric properties and the norms for the parent‐report SDQ in an English‐speaking sample are similar regardless of online versus pen‐and‐paper administration.

PurposeThe Strengths and Difficulties Questionnaire (SDQ) is a behavioural screening tool for children. The SDQ is increasingly used as the primary outcome measure in population health interventions involving children, but it is not preference based; therefore, its role in allocative economic evaluation is limited. The Child Health Utility 9D (CHU9D) is a generic preference-based health-related quality of-life measure. This study investigates the applicability of the SDQ outcome measure for use in economic evaluations and examines its relationship with the CHU9D by testing previously published mapping algorithms. The aim of the paper is to explore the feasibility of using the SDQ within economic evaluations of school-based population health interventions. MethodsData were available from children participating in a cluster randomised controlled trial of the school-based roots of empathy programme in Northern Ireland. Utility was calculated using the original and alternative CHU9D tariffs along with two SDQ mapping algorithms. t tests were performed for pairwise differences in utility values from the preference-based tariffs and mapping algorithms.ResultsMean (standard deviation) SDQ total difficulties and prosocial scores were 12 (3.2) and 8.3 (2.1). Utility values obtained from the original tariff, alternative tariff, and mapping algorithms using five and three SDQ subscales were 0.84 (0.11), 0.80 (0.13), 0.84 (0.05), and 0.83 (0.04), respectively. Each method for calculating utility produced statistically significantly different values except the original tariff and five SDQ subscale algorithm.ConclusionInitial evidence suggests the SDQ and CHU9D are related in some of their measurement properties. The mapping algorithm using five SDQ subscales was found to be optimal in predicting mean child health utility. Future research valuing changes in the SDQ scores would contribute to this research.

The strengths and difficulties questionnaire (SDQ) is a brief screening instrument that addresses negative and positive behavioural attributes of children and adolescents in the age range of 4-16 years and can be completed by parents, teachers, and as a self-report. Furthermore, the impact supplement of the extended SDQ surveys for perceived problems, impact, and burden. This paper aims to examine the psychometric properties of the parent form and to investigate differences in the SDQ scores for sociodemographic and socioeconomic subgroups. Patterns of association with other measures of mental health and descriptive comparison with the first normative sample are also reported. Within the BELLA study module of the German Health Interview and Examination Survey for Children and Adolescents (KiGGS), a total of 2,406 children and adolescents aged 7-16 years as well as their parents answered the items of the SDQ and the additional impact supplement. The internal consistency of scale responses was assessed via Cronbach's alpha (alpha). Likert scale assumptions of sufficient and similar item-total correlation and item variance were investigated. The factorial validity of the SDQ measurement model was tested by means of exploratory and confirmatory factor analysis. Mean score differences between males and females, age groups (7-10 years vs. 11-16 years), and socioeconomic status groups (Winkler index) were examined via ANOVA. Factor analysis provided an exact replication of the original five-factor SDQ subscale structure. All subscales were sufficiently homogeneous. The mean total difficulties and SDQ subscale scores of the BELLA sample did not differ from the first German normative data. Younger children were more impaired on various SDQ scales than older children, girls were more emotionally affected, and boys showed more externalising problems. The present study confirmed the validity and reliability of the parent-reported SDQ scale structure. The SDQ was found to be a valid and helpful questionnaire for use in the framework of an epidemiological survey.

BackgroundChildren born to parents with severe mental illness are at increased risk of mental and behavioral difficulties during childhood. We aimed to investigate the occurrence of clinically significant behavioral difficulties in 7-year-old children of parents diagnosed with schizophrenia or bipolar disorder as well as in control children by using the Strengths and Difficulties Questionnaire (SDQ). Further, we aimed to determine if the SDQ could function as a screening instrument for clinically relevant behavioral problems of children at high risk of these severe mental illnesses.MethodsBy means of the Danish National Registers, we established a cohort of 522 7-year old children stratified by familial high risk for schizophrenia spectrum disorder (N = 202), bipolar disorder (N =120), and controls (N = 200). The child's primary caregiver completed the SDQ parent version and the Child Behavior Checklist (CBCL) while the schoolteacher completed the SDQ teacher version and the CBCL teacher equivalent; the Teachers Report Form (TRF). Finally, global functioning was assessed with the Children's Global Assessment Scale (CGAS).ResultsChildren with familial high risk of schizophrenia spectrum disorder or bipolar disorder have a significantly increased risk (OR = 3.8 and 2.3) of suffering clinically significant behavioral difficulties at age 7-years according to SDQ parent ratings. The SDQ discriminates with moderate to high sensitivity and high specificity between familial high-risk children with and without a psychiatric diagnosis and has overall compelling discriminatory abilities in line with the more time consuming CBCL/TRF.Conclusions Familial high-risk children have more behavioral difficulties and more frequently at a level indicative of mental illness compared to control children as measured by the SDQ. The SDQ works well as a screening instrument for clinically relevant behavioral problems in high-risk children.

BackgroundMental health problems is frequent among children and psychopathology in early childhood seems to predict mental disorders in adulthood. All Danish children are offered seven free well-child visits at their General Practitioner (GP) during their first 5 years of life. GPs have a unique position to address mental health problems at the well-child visits, but they lack a systematic approach when assessing children’s mental health. The purpose of this study was to investigate if the Strengths and Difficulties Questionnaire (SDQ) is a usable way to address preschool children’s mental health in general practice.MethodsA qualitative study of feasibility. Parents completed an online version of the SDQ at home. At the well-child visit, the GP used the SDQ results as a basis for a talk about the child’s mental health. Afterwards the author JS conducted semistructured interviews with both the parent and the GP over the phone. The interviews were descriptively analyzed using the Framework Approach.ResultsFive primary care centres with 22 general practitioners in both Copenhagen and Region Zealand participated. Twenty four parents completed the SDQ and were interviewed. Participating parents and GPs agreed, that the SDQ introduced mental health as a natural and important part of the well-child visit. Online access had clear advantages: time for reflection at home and preparation, plus a clear result summary for the GP. Some of the GPs were worried that the questionnaire would be too time consuming, and might compromise the individualistic style of general practice. Some parents were worried if children with minor problems would be diagnosed.ConclusionsThe online SDQ was well-accepted and feasible in daily practice. Implementing the SDQ into the well-child visit could strengthen the focus on the child’s mental health. However, before the SDQ can be generally implemented a guideline on how to utilize it in the well-child visit is needed, as well as studies of efficacy in this setting.Trial registrationNot relevant.

To compare CBCL (Child Behaviour Check Llist) Urdu, with the validated Urdu version of Strengths and Difficulties Questionnaire (SDQ) used as "gold standard" among school children in Karachi, Pakistan, and to develop local cutoffs for CBCL using SDQ as a gold standard. A cross-sectional study. Schools of Karachi metropolitan area from January to December 2006. The Strengths and Difficulties Questionnaire (SDQ) and Child Behaviour Check List (CBCL) was completed by parents of 5-11 years old primary school children in Karachi. Appropriate cutoff points for total problem, internalizing and externalizing scales were obtained for CBCL. A total of 556 parents filled out both the SDQ Urdu version as well as CBCL. Scores from the parent rated total SDQ scores were highly correlated with the total CBCL scores (r=0.589). The local cutoffs derived for CBCL were considerably lower than USA norms. Slightly higher cutoff for males was found as compared to females for the total CBCL scores. Like the original English version, the Urdu version of CBCL and SDQ are both equally valid assessment tools to be used for both clinical and research purpose in Pakistani settings, where Urdu is widely spoken and understood.