Abstract
ObjectiveExpressions of emotional and behavioral symptoms in preschool age can predict mental health problems in adolescence and adulthood. The Ages and Stages Questionnaires: Social-Emotional (ASQ:SE) has been successful in detecting social and emotional problems in young children in some countries but had not been tested in Sweden. The objective of this study was to determine the optimal cut-off for the ASQ:SE instrument when administered to 3-year-old children in a northern Swedish setting, using the Strengths and Difficulties Questionnaire (SDQ) as the reference.MethodsThe ASQ:SE (36-month interval, first edition) was administered at routine 3-year-olds' visits to Child Health Care centers in Region Västerbotten, Sweden. During the study period (September 2017 to March 2018) parents were invited to also fill out the SDQ (2–4 year version). In the final analyses 191 children fulfilled the criteria for inclusion in the study sample. Non-parametric Receiver Operating Characteristic analysis was performed to quantify the discriminatory accuracy of ASQ:SE based on SDQ.ResultsThe Pearson correlation between ASQ:SE and SDQ indicated strong correlation between the two instruments. The Receiver Operating Characteristic curve showed good accuracy of ASQ:SE in relation to SDQ. However, our results suggest that the existing ASQ:SE cut-off score of 59 was not optimal in the Swedish context. Changing the cut-off from 59 to 50 would allow us to detect 100% (n = 14) of children with problems according to SDQ, compared to 64% (n = 9) when the cut-off was 59. However, the proportion of false positives would be higher (9% compared to 3%).ConclusionThe main finding was that for 3-year-olds in Sweden a decreased ASQ:SE cut-off score of 50 would be optimal. This would increase the detection rate of at-risk children according to SDQ (true positive), thus prioritizing sensitivity. Our conclusion is that, although this change would result in more false positives, this would be justifiable.
Highlights
Expressions of emotional and behavioral symptoms in preschool age children can predict mental health problems in adolescence [1] and adulthood [2]
The ASQ:SE is used as part of a staff–parent dialogue aimed at increasing awareness of children’s social and emotional development and identifying children who might benefit from extra support
Among the 3-year-olds, 7.3% had indications of social-emotional problems based on ASQ:SE when using the United States (US) cut-off (≥59), and many (7.3%) had indications of behavior problems based on Strengths and Difficulties Questionnaire (SDQ) (≥13), they were not exactly the same children
Summary
Expressions of emotional and behavioral symptoms in preschool age children can predict mental health problems in adolescence [1] and adulthood [2]. Research shows that supporting early social-emotional development can lead to positive outcomes in mental health, education, and employment, and a lower likelihood of criminal activity and substance abuse in later life [3]. These findings highlight the need for methods which can detect vulnerabilities in children’s social and emotional functioning. Developmental screening tools are designed to identify children with potentially delayed or atypical development. There is no universally accepted screening tool appropriate for all populations and all ages. A screening tool requires well-established psychometric properties, including validity and reliability, so that researchers, providers, and care takers can have confidence in what is being measured. A cutoff resulting in false positives can waste resources and lead to unnecessary stigmatization [6]
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