Screening foster children for mental disorders: properties of the strengths and difficulties questionnaire.

Stine Lehmann,Odd E Havik,Einar R Heiervang,Toril Havik

doi:10.1371/journal.pone.0102134

Abstract

BackgroundHigh prevalence of mental disorders among foster children highlight the need to examine the mental health of children placed out of home. We examined the properties of the Strengths and Difficulties Questionnaire (SDQ) in screening school-aged foster children for mental disorders.MethodsFoster parents and teachers of 279 foster children completed the SDQ and the diagnostic interview Developmental and Well-Being Assessment (DAWBA). Using the diagnoses derived from the DAWBA as the standard, we examined the performance of the SDQ scales as dimensional measures of mental health problems using receiver operating characteristic (ROC) analyses. Recommended cut-off scores were derived from ROC coordinates. The SDQ predictive algorithms were also examined.ResultsROC analyses supported the screening properties of the SDQ Total difficulties and Impact scores (AUC = 0.80–0.83). Logistic regression analyses showed that the prevalence of mental disorders increased linearly with higher SDQ Total difficulties scores (X2 = 121.47, df = 13, p<.001) and Impact scores (X2 = 69.93, df = 6, p<.001). Our results indicated that there is an additive value of combining the scores from the Total difficulties and Impact scales, where scores above cut-off on any of the two scales predicted disorders with high sensitivity (89.1%), but moderate specificity (62.1%). Scores above cut-off on both scales yielded somewhat lower sensitivity (73.4%), but higher specificity (81.1%). The SDQ multi-informant algorithm showed low discriminative ability for the main diagnostic categories, with an exception being the SDQ Conduct subscale, which accurately predicted the absence of behavioural disorders (LHR− = 0.00).ConclusionsThe results support the use of the SDQ Total difficulties and Impact scales when screening foster children for mental health problems. Cut-off values for both scales are suggested. The SDQ multi-informant algorithms are not recommended for mental health screening of foster children in Norway.

Highlights

The high prevalence and comorbidity of mental disorders in foster children [1,2,3] highlight the need to examine the mental health of children entering foster homes
The Impact score has been found to be a strong predictor of mental disorders in community samples (n = 4,479, where 7% had a mental disorder) [9], service use in child welfare samples (n = 292, where 29% of these had contact with mental health care) [10], and to discriminate well between a community (n = 467) and clinical sample (n = 232) [11]
The parent version of the Impact scale consists of 5 items, providing a total score range of 0– 10, whereas the teacher version consists of 3 items, providing a total score range of 0–6

Summary

Introduction

The high prevalence and comorbidity of mental disorders in foster children [1,2,3] highlight the need to examine the mental health of children entering foster homes. The SDQ is a brief mental health questionnaire measuring symptoms and impairments in the child’s daily life Both a Total difficulties scale and an Impact scale may be considered dimensional measures of mental health [5]. Used this way, the SDQ Total difficulties score has shown good predictive ability in community samples in Britain (n = 18,415, of whom 983 had a mental disorder) [5], Sweden (n = 478, of whom 221 were clinical cases) [6], and the US (n = 1.0,367, where 9% were high scorers) [7], and in British looked-after children (n = 1391, of whom 38.6% had a mental disorder) [8]. High prevalence of mental disorders among foster children highlight the need to examine the mental health of children placed out of home. We examined the properties of the Strengths and Difficulties Questionnaire (SDQ) in screening school-aged foster children for mental disorders

Methods

Results

Conclusion