Abstract
The Strengths and Difficulties Questionnaire (SDQ) is widely used, based on evidence of its value for screening. This evidence primarily regards the single informant total difficulties scale and separate difficulties subscales. We assessed to what degree adolescents’ SDQ profiles that combined all self- and parent-rated subscales were associated with use of care and psychiatric diagnoses, and examined the added value thereof over using only a single informant and the total scale. Cluster analysis was used to identify common SDQ profiles based on self- and parent-reports among adolescents aged 12–17 in mental healthcare (n = 4282), social care (n = 124), and the general population (n = 1293). We investigated associations of the profiles with ‘care use’ and ‘DSM-IV diagnoses’, depending on gender. We identified six common SDQ profiles: five profiles with varying types and severities of reported difficulties, pertaining to 95% of adolescents in care, and one without difficulties, pertaining to 55% of adolescents not in care. The types of reported difficulties in the profiles matched DSM-IV diagnoses for 88% of the diagnosed adolescents. The SDQ profiles were found to be more useful for predicting care use and diagnoses than SDQ scores reported by the adolescent as single informant and the total difficulties scale. The latter indicated the presence of problems among 42–63% of the adolescents in care, missing a substantial number of adolescents with reported emotional difficulties and borderline problem severity. These findings advocate the use of combined self- and parent-rated SDQ score profiles for screening.
Highlights
15–25% of adolescents experience psychiatric problems [1, 2]
Parent ratings were consistently found to be useful for predicting Attention-Deficit/ Hyperactivity Disorder (ADHD), Conduct/Oppositional Defiant Disorder (CD/ODD) [14,15,16], and Autism Spectrum Disorder (ASD) [16]
Adolescents diagnosed with multiple disorders, the results of the algorithm and the profile approach are much harder to compare as the algorithm results in predictions for specific disorders and not for comorbidity of disorders, whereas half of the profiles identified in this study indicate the presence of multiple types of difficulties
Summary
15–25% of adolescents experience psychiatric problems [1, 2]. To receive adequate mental healthcare, these problems need to be effectively detected and diagnosed. The validity of the adolescent self- and parent-rated SDQ versions for screening is typically investigated by assessing their usefulness for two purposes. The second purpose is predicting the presence of specific disorders regarded to be content-wise related to the constructs measured by the SDQ [12, 13] among adolescents from mental healthcare populations. Most studies focused on either the adolescent or the parent as informant, therewith providing limited information to inform clinical practice about the usefulness of the recommended multi-informant ratings for screening.
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