Higher Total Difficulties Scores Research Articles

Mental health and associated risk factors of Dutch school aged foster children placed in long-term foster care

More than 20,000 children in the Netherlands live in foster families. The majority are in long-term foster family placements, which are intended to provide a stable rearing environment until the children reach adulthood. International studies have shown, however, that compared to children in the general population, foster children have more mental health problems and more negative developmental outcomes in their later life. Less is known about Dutch foster children, however. To fill this knowledge gap, the present study focused on the mental health of 239 foster children (aged 4–12) living in long-term placements in the Netherlands. Their behavior was assessed with the Strengths and Difficulties Questionnaire, which was completed by their foster parents. The results revealed a wide range of problem behavior (ranging from none to very serious problem behavior), and showed that a third of the children have total difficulty scores (TDS) in the clinical range. Higher TDS appear to have a positive univariate association with age of the foster child, age upon entering the current foster family, number of prior foster placements, non-kinship placement, and fostering experience of the foster parents. The more risk factors, the higher the TDS. These findings suggest the importance of the early detection of problems and potential risk factors in foster families, and the need to support a substantial number of foster children and foster families.

Associations of endogenous melatonin and sleep-related factors with behavioral problems in preschool Japanese children

PurposeWe aimed to investigate the associations of sleep disturbance and sleep time with behavioral problems and to assess whether endogenous melatonin was associated with sleep-related factors and behavioral problems. MethodsSubjects were 234 boys and 203 girls, aged 3–6 years, in a cross-sectional study in Japan in 2006. Information related to children's sleep disturbance, sleep time, and behavioral problems was obtained from parent-administered questionnaires. Children's behavioral problems were assessed by the Strengths and Difficulties Questionnaire. The 6-sulfatoxymelatonin levels in first-void morning urine were measured by radioimmunoassay. ResultsAfter multiple adjustments for covariates, children who often snore at night (P = .011), awake at night (P = .019), and looked tired in the daytime (P = .041) had a higher total difficulties score. Earlier time of waking (trend P = .021) and earlier time for bed (trend P = .014) were associated with a lower total difficulties score. Children with higher creatinine-corrected 6-sulfatoxymelatonin had lower total difficulties scores (trend P = .011). There were no associations between creatinine-corrected 6-sulfatoxymelatonin and sleep-related factors. ConclusionsSleep disturbance, later times of sleeping and waking up, and lower melatonin levels might be involved in the development of pediatric behavioral disorders.

Higher Prevalence of Psychopathological Symptoms in Adolescents With Headache. A Population‐Based Cross‐Sectional Study

Headache is commonly voiced by adolescents and is known to be associated with reduced quality of life. Otherwise, there are only limited data regarding associations between different types of headache and psychopathological symptoms in adolescents. Aim of the present study in adolescents was to assess the impact of headache on psychopathological symptoms and whether these differ between types of headache. Data were derived from a population-based sample (n = 1047, ages 13-17 years). Type of headache (ie, migraine, tension-type headache, miscellaneous headache) was ascertained for subjects reporting headache episodes at least once per month. Psychopathological symptoms were assessed with the Strengths and Difficulties Questionnaire. The following dimensions were taken into account: emotional symptoms, conduct problems, hyperactivity/inattention, peer problems (these 4 add to the total difficulties score), and prosocial behavior. Associations were estimated with logistic regression models with adjustment for age group, sex, and family situation. Headache at least once per month was reported by 47.8% of the adolescents. Subjects with any headache were found to be at higher risk for emotional symptoms (odds ratio 1.5; 95% confidence interval 1.0-2.2) and hyperactivity/inattention (1.4; 1.0-1.9), resulting in a higher total difficulties score (1.6; 1.1-2.4). While the risk for psychopathological symptoms was not significantly increased in subjects with tension-type headache compared with subjects without headache, significant associations with emotional symptoms were found in subjects with migraine (2.9; 1.3-6.2; total difficulties score: 3.1; 1.4-6.8). Miscellaneous headache was associated with a broad spectrum of psychopathological symptoms: emotional symptoms (1.8; 1.0-3.3), conduct problems (1.6; 1.0-2.6), hyperactivity/inattention (1.9; 1.2-3.1), total difficulties score (2.7; 1.6-5.6). Previously reported associations between headache and psychopathological symptoms in adolescents could be confirmed, but might vary with type of headache. As psychopathological symptoms may be a precursor for manifest psychiatric disorders, adolescents particularly with migraine and miscellaneous headache appear to be a vulnerable population.

Strengths and Difficulties Questionnaire as a Dimensional Measure of Child Mental Health

ObjectiveTo provide the first explicit evaluation of the dimensionality of the total difficulties score of the Strengths and Difficulties Questionnaire (SDQ), a widely used measure of child mental health. We do so by validating the SDQ across its full range against the prevalence of clinical disorder. MethodWe use two large (n = 18,415) nationally-representative surveys of children and adolescents aged 5 to 16 years in the general British population. Strengths and Difficulties Questionnaires were completed separately by parents, teachers, and children aged 11 to 16 years, and children also received a multi-informant clinician-rated clinical diagnosis. Approximately 7,912 children from the baseline survey were also reassessed for clinical diagnosis at 3-year follow-up. ResultsAcross the full range of the parent, teacher, and youth SDQ, children with higher total difficulty scores have greater psychopathology as judged by the prevalence of clinical disorder. This was true cross-sectionally and also in predicting to disorder status 3 years later. There was no evidence of threshold effects for the SDQ at either high or low scores, but rather the odds of disorder increased at a constant rate across the range (odds ratios between 1.14 and 1.28 per 1-point increase in SDQ score). ConclusionsOur findings support the use of the SDQ as a genuinely dimensional measure of child mental health.

Psychological well-being in Black Caribbean, Black African, and White adolescents in the UK Medical Research Council DASH study

It is not known if adolescents from diverse groups of Black African origin experience similar or different psychological well-being. To examine adolescent self-report of psychological well-being among Black African and White UK origin groups and to assess the extent to which family type and social deprivation influence any ethnic differences. The 25-item Strengths and Difficulties Questionnaire (SDQ) was used to assess psychological well-being in a study of 6,632 11-13 year-olds in 51 schools in London. Overall, family type (but not material deprivation) was an important independent correlate of psychological well-being. Nigerian/Ghanaian boys reported the lowest mean Total Difficulties Score (TDS) compared to White boys (regression coefficient (95% CI) -2.09 (-2.83, -1.35) p < 0.001). They also had significantly higher mean pro-social behaviour score, and were at reduced risk of a high (i.e., likely psychological distress) TDS score. TDS was also significantly lower than Whites for other African boys and girls. Other African and mixed ethnicities were protective factors against risk of psychological distress for girls. Black African boys and other African boys and girls reported the most favourable psychological well-being scores. The influence of family type on mental health may operate differently for girls compared to boys and for Africans compared to other ethnic groups.

Behavioral Outcome at 3 Years of Age in Very Preterm Infants: The EPIPAGE Study

Our goal was to compare the prevalence of behavioral problems between very preterm children and term children at 3 years of age and examine the factors associated with behavioral problems in very preterm children. We conducted a prospective population-based cohort study: the EPIPAGE (Etude Epidémiologique sur les Petits Ages Gestationnels) study. All infants born between 22 and 32 weeks of gestation in 9 regions of France in 1997 were included and compared with a control group of infants born at term. Sociodemographic status, obstetric, and neonatal data were collected at birth and in the neonatal units. At 3 years of age, the behavioral problems of 1228 very preterm singleton children without major neurodisabilities, and 447 term children were studied using the Strengths and Difficulties Questionnaire completed by the parents. Very preterm children were more likely than controls to have behavioral difficulties. Among very preterm children, several medical conditions were associated with a high total difficulty score: major neonatal cerebral lesions diagnosed by cranial ultrasonographic studies, hospitalization within the last year, poor health, and psychomotor delay. A high birth order and sociodemographic factors such as young maternal age and low educational level of the mother were also identified as risk factors for behavioral difficulties. The differences between very preterm children and controls remained significant after adjustment for sociodemographic characteristics, neonatal complications, and neurodevelopmental status, for a high total difficulties score, hyperactivity, conduct problems, and for peer problems. For emotional problems, the difference was at the limit of significance. Very preterm children have a higher risk of behavioral problems at 3 years of age compared with term-born children. Health and neurodevelopmental status of the child were significantly associated with behavioral difficulties.

Birthweight and behavioural problems in children: a modifiable effect?

Low birthweight has been shown to predict behavioural problems in children. Less is known about the effect of birthweight, and how this may interact with the social environment in determining behaviour in a general population sample. We have examined the relationship between birthweight and social factors on childhood psychological well-being. Cross-sectional analysis of data on 5181 children aged 4-15 years from a randomly selected household population, the 1997 Health Survey for England. The main outcome measures were behavioural problems as defined by the Strengths and Difficulties Questionnaire (SDQ) in relation to birthweight and social environmental factors. Birthweight was a significant predictor of total difficulties score (odds ratio [OR] = 1.27, 95% CI : 1.07, 1.49), hyperactivity in boys (OR = 1.25, 95% CI : 1.05, 1.51), and peer problems in girls (OR = 1.24, 95% CI : 0.99, 1.53). There was a strong social class gradient in the prevalence of behavioural problems for all birthweight tertiles. Bivariate analysis showed that high total difficulties score was significantly more common in lower birthweight tertiles for social classes III non-manual and III manual (P:-value for trend 0.05 and 0.03, respectively). There were smaller, non-significant effects of birthweight on the prevalence of behavioural problems in social class I and II, and IV and V. Statistical tests for an interaction between birthweight and social class were not significant. Early life factors, such as birthweight and social class have important influences on psychological well-being in children. The birthweight effect is influenced by social factors, with the possibility that an advantaged social environment protects against the development of behavioural problems, and a disadvantaged environment increases the risk of behavioural problems, regardless of birthweight.