SDQ Total Score Research Articles

Behavioral outcomes and exposure to perfluoroalkyl substances among children aged 6–13 years: The TEDDY child study

BackgroundAlthough some studies report that exposure to per- and polyfluoroalkyl substances (PFAS) during pregnancy and early life stages of a child could adversely impact neurodevelopment, literature shows mixed evidence. ObjectivesUsing an ecological framework for human development, we assessed the association of risk factors for environmental PFAS exposure and childhood PFAS concentrations with behavioral difficulties among school-age children exposed to PFAS from birth, while also controlling for the important influence of the parenting and familial environment. MethodsThe study participants included 331 school-age children (6–13 years) born in a PFAS-contaminated area in the Veneto Region (Italy). We study the associations between environmental risk factors of maternal PFAS exposure (residential time, consumption of tap water, residence in Red zone A or B), and breastfeeding duration with parent assessments of children's behavioral problems (using the Strengths and Difficulties Questionnaire [SDQ]), adjusting for socio-demographic, parenting and familial variables. The direct relationships between serum blood PFAS concentrations and SDQ scores was evaluated in a subset of children (n = 79), both with single PFAS and weighted quantile sum (WQS) regressions. ResultsPoisson regression models reported positive associations between high consumption of tap water and externalizing SDQ scores (Incidence Rate Ratio [IRR]: 1.18; 95% confidence interval [CI]: 1.04–1.32) and total difficulty scores (IRR: 1.14; 95% CI: 1.02–1.26). Childhood perfluorooctane sulfonate (PFOS) and perfluorohexane sulfonate (PFHxS) were associated with higher internalizing SDQ scores (4th vs. 1st quartile, PFOS IRR: 1.54, 95% CI: 1.06–2.25), externalizing scores (4th vs. 1st quartile, PFHxS IRR: 1.59, 95% CI: 1.09–2.32), and total difficulty scores (4th vs. 1st quartile, PFOS IRR: 1.37, 95% CI: 1.05–1.71; PFHxS IRR: 1.54, 95% CI: 1.09–1.90). The WQS regressions confirmed the associations reported by single-PFAS analyses. ConclusionsWe observed cross-sectional associations of tap water consumption and childhood PFOS, and PFHxS concentrations with greater behavioral difficulties.

Siblings in lockdown: International evidence for birth order effects on child adjustment in the Covid19 pandemic

AbstractSupportive family relationships may mitigate the impact of the Covid19 pandemic on young children's adjustment, but existing work is limited by its focus on within‐country variation and parental influences. Addressing these gaps, and drawing on reported buffering effects of older siblings on child mental health (Lawson and Mace, 2010), the current international study examined whether child adjustment problems were, on average, elevated by the pandemic and whether this buffering effect of older siblings would be maintained. In the first wave of the Covid19 pandemic (April to July 2020), 2516 parents of 3‐ to 8‐year‐old children living in Australia, China, Italy, Sweden, United Kingdom, and United States of America—six countries with contrasting governmental responses to the pandemic—completed an online survey about family experiences and relationships and child adjustment, as indexed by ratings on the Strengths and Difficulties Questionnaire (SDQ: R. Goodman, 1997). As expected, child SDQ total difficulty scores were elevated in all sites except Sweden (which notably did not enforce mass school closures). Compared to children without siblings, children with one or more older siblings showed fewer adjustment problems. Children from lone‐parent households displayed more adjustment problems, as did those whose parents reported increased sibling conflict. Finally, child adjustment problems were negatively associated with family socio‐economic status, but positively related to the indices of Covid‐19 family disruption and government stringency. We discuss these findings in relation to existing work on asymmetric effects of older versus younger siblings, and siblings as sources of support.

Sleep and Behavioral Problems Among Preschool Children: Correlations from Pakistan Urbanhttps://www.rsisinternational.org/journals/ijriss/articles/sleep-and-behavioral-problems-among-preschool-children-correlations-from-pakistan-urban/

The study was undertaken to explore patterns, habits, and problems for sleep in preschool children of urban Karachi, Pakistan. Two schools participated with a sample size of 297 preschool children. A cross-sectional study design was implemented. The mean age of children was 4.6 ± 0.71 years, and the male/female ratio was 49:51. The average daily sleep duration (nocturnal + daytime nap) was 9.51 ± 1.21 hours. At least one sleep problem was reported in 73% of children, the most frequently found sleep problems were, bedtime and wakeup resistance (25.6%), sleepy or tired during the day (46%), complains of growing pains in the legs (25%), nocturnal enuresis (19%) and nighttime fears (18%). Sleep problems were found significantly correlated with: child clinging to an adult (r = 0.134, p value 0.021), whining (r = 0.213, p value <0.001), fussing (r = 0.136, p value 0.019), prosocial behavior (r = -0.137, p value 0.019), peer problems (r = 0.151, p value 0.009), hyperactivity (r = 0.216, p value <0.001), conduct problems (r = 0.313, p value <0.001), emotional problems (r = 0.346, p value <0.001) and SDQ total difficulty score (r = 0.398, p value < 0.001). Sleep inconsistencies begin during early years; sleep disorders result from poor sleep habits and poor sleep habits results in insufficient sleep. The findings confirmed raising parental awareness on sleep hygiene to recognize and seek appropriate healthcare as and when needed. It is however recommended to introduce interventions involving schools, healthcare practitioners and parents to improve the situation. Another important recommendation is to plan future research involving objective measures to capture sleep duration in children, such as actigraph or sleep diaries maintained by parents for more accurate ways to measure sleep duration.

Conversation difficulties rather than language deficits are linked to emotional problems in school children with hearing loss

BackgroundSocial communication difficulties are often associated with neurodevelopmental disorders such as language disorder, intellectual development disorder, attention deficit hyperactivity disorder and autism spectrum disorder, which impedes the investigation of the specific role of social communication problems in mental health outcomes.AimsWe investigated the association between conversation difficulties and increased risk of mental health problems in schoolchildren with hearing loss. It can be assumed of this sample that conversation difficulties are primarily due to limited auditory access to language rather than neurobiological deficits.MethodsFive complete birth cohorts of Carinthian children (n = 53) with significant hearing loss and an intelligence quotient over 70 were assessed in terms of language abilities in standardized tests and in terms of their conversation skills by use of a short teacher checklist developed by the authors. Mental health problems were assessed by means of the Strengths and Difficulties Questionnaire by parents and teachers.ResultsConversation deficits were significantly correlated with lower SDQ emotional problems and total problem scores as rated by parents and lower peer problems scores as rated by teachers. Controlling for degree of hearing loss, maternal education and language skills, confirmed the specific value of conversation skills as a predictor of emotional problems (p = 0.010).ConclusionWith regard to mental health, our results suggest a focus on the assessment of conversation skills in addition to language abilities.

Course of School Absenteeism 1.5-3 Years After Initial Evaluation: Symptoms, Psychosocial Functioning, and Help-Seeking Behavior

Course of School Absenteeism 1.5-3 Years After Initial Evaluation: Symptoms, Psychosocial Functioning, and Help-Seeking Behavior Abstract. Objective: To explore the course of patients with school absenteeism 1.5-3 years after their initial evaluation, including symptoms, school attendance, psychosocial functioning, and help-seeking behavior. Method: Of the 237 patients from specialized psychiatric units for youths displaying school absenteeism, we successfully contacted 108 of them 1.5-3 years after initial admission. We conducted a telephone interview with their parents (SDQ, school situation, help-seeking behavior). Among others, we analyzed the extent of school absenteeism, the scales of the Inventory of School Attendance Problems (ISAP; Knollmann et al., 2019), and the quality of school absenteeism (school refusal vs. truancy vs. mixed group) at admission as possible predictors. Results: The patients had received an extensive amount of youth-welfare measures and inpatient, daycare, and outpatient therapy. 46.3 % had elevated values in the SDQ total score at follow-up, mostly because of emotional problems or problems with peers. Psychosocial functioning, including school attendance, was described as poor for only about 30 %. School attendance problems were significantly predicted by having a conduct disorder and elevated scores on the ISAP-scales Aggression, Teacher Problems, and Peer Problems, though the effect sizes were weak. Conclusions: Externalizing symptoms and associated psychosocial problems seem to be predictive of a negative course of school absenteeism. Implications for prospective longitudinal studies are discussed.

Early Childhood Dietary Intake and Subsequent Socioemotional and Cognitive School Readiness Among Australian Children.

Dietary intake can affect the physical, cognitive, and socioemotional development of young children. Few studies have explored the relationships between dietary intake and the cognitive and socioemotional dimensions of school readiness. This study aimed to investigate the longitudinal associations between children's dietary intake in early childhood, and cognitive and socioemotional school readiness indicators at age 4-5 years using data from the Longitudinal Study of Australian Children. A total of 4,253 children were included in the analysis. Multiple linear regression models were built to investigate whether dietary intake (measured by questionnaire at parent interview) at age 2-3 years predicted school readiness indicators of socioemotional and behavioral functioning (measured by parent-reported Strengths and Difficulties Questionnaire [SDQ total score and pro-social scale]), verbal (assessed by Peabody Picture Vocabulary Test-Third Edition [PPVT-III]) and nonverbal (assessed by "Who Am I" test [WAI] cognitive skills) at age 4-5 years. Furthermore, using cross-sectional data at age 4-5 years, four multiple linear regression models were built to investigate if dietary intake was correlated with the aforementioned school readiness indicators. All models were adjusted for potential confounders. It was found that every one-point increase in child dietary intake score at age 2-3 years led to a decrease in SDQ total score by 0.19 (95% confidence interval [CI] = [0.10, 0.28], and an increase in SDQ pro-social scale, WAI score and PPVT score by 0.07 (95% CI = [0.03, 0.10]), 0.27 (95% CI = [0.13, 0.41]), and 0.20 (95% CI = [0.09, 0.30]), respectively, at age 4-5 years. Children's dietary intake was also a correlate of their school readiness at age 4-5 years. These results add to the limited evidence base suggesting that children's early dietary intake may play an important role in later socioemotional and behavioral development, and the development of cognitive skills, which are critical school readiness indicators.

Adverse childhood experiences (ACEs) and child behaviour problems in KwaZulu-Natal, South Africa.

Adverse childhood events (ACEs) are associated with negative health effects in adulthood. Despite knowledge of these later impacts, little is known about the earlier effect of ACEs on later child behaviour in low- and middle-income countries (LMIC). The population-based Asenze cohort study was implemented in a peri-rural area of KwaZulu-Natal, South Africa, comprising five Zulu tribal areas. Two waves of data were examined: family information and ACEs exposure when children were on average 5years old and child behaviour problems (Strengths and Difficulties Questionnaire [SDQ]) approximately 2 years later (average age 7years). Logistic regression analysis was used to examine unadjusted and adjusted relationships between cumulative ACEs experienced and the SDQ total scores (dichotomized as top 10% vs. the rest) as well as selected SDQ subscales. A significant relationship between increased ACE exposure and SDQ total score was observed. The same relationship was also seen for the SDQ emotional symptoms and conduct problem subscales, but not for hyperactivity. The results of a sensitivity analysis excluding intimate partner violence from the ACEs measure demonstrated similar results. There is an association between exposure to ACEs and later child behaviour problems within this LMIC population demonstrating an early negative impact for ACEs. While previous research has focused on the effects of ACEs on adult health, this study provided evidence for an earlier relationship between ACEs and child behaviour problems that may be a part of the mechanism through which later health effects arise.

Feasibility of low-intensity psychological interventions for emotional and behavioural difficulties in children and young people with genetic conditions: a case series

Abstract Children with genetic conditions may experience significant mental health difficulties such as anxiety and challenging behaviour. However, understanding of the feasibility and effectiveness of psychological interventions for emotional and behavioural problems in the context of genetic conditions is limited. Low-intensity psychological interventions have demonstrated promise in paediatric populations and may be able to address their mental health difficulties. A case series design was used to assess the feasibility of low-intensity interventions for emotional and behavioural difficulties in children and young people with genetic conditions recruited from a mental health drop-in centre at a tertiary hospital. Participants received seven weekly sessions with a trained practitioner. The intervention was based on existing modular treatments and evidence-based self-help materials. Feasibility and treatment satisfaction were assessed, as well as measures of symptoms of anxiety and challenging behaviour, treatment goals and quality of life, at baseline, during treatment and 6-month follow-up. Five participants received treatment for challenging behaviour, one for anxiety, and one for obsessive compulsive disorder. All participants completed treatment. Clinically significant change in the SDQ Total score was found in three participants. All participants demonstrated progress in goals and symptoms of emotional and behavioural difficulties over the course of treatment. Low-intensity psychological interventions for emotional and behavioural difficulties in children and young people with genetic conditions is feasible, acceptable and potentially beneficial. Further research is warranted to examine the effectiveness of the intervention and its use in clinical paediatric settings. Key learning aims (1) To gain a basic understanding of low-intensity psychological intervention in children and young people with genetic conditions. (2) To enhance understanding of the practicalities and acceptability of delivering low-intensity psychological intervention to children and young people with genetic conditions and co-morbid emotional and behavioural difficulties. (3) To learn about the potential clinical benefits of delivering low-intensity psychological intervention to children and young people with genetic conditions in the context of stepped care.

Psychiatric symptoms in children with COVID-19, mothers` psychological resilience and related factors: pandemic hospital inpatient experiences.

Information on psychological problems and affecting factors in children hospitalized with the suspicion or diagnosis of COVID-19 is limited. We aimed to screen the psychiatric symptoms of children hospitalized with COVID-19 in Ankara City Children`s Hospital and evaluate the caregivers` depression, anxiety, stress, and resilience levels during hospitalization. Among the children and adolescents hospitalized in Ankara City Children`s Hospital between 1 May 2020 and 31 May 2020 due to the diagnosis of COVID-19, those who agreed to participate in the study were included. The Strengths and Difficulties Questionnaire (SDQ), the Depression Anxiety Stress Scale-21 (DASS- 21) scale, and the Brief Resilience Scale (BRS) were used to determine the symptoms. The mean age of study group (n = 49) was 8.7 ± 5.0 years, 59.2% (n = 29) were girls. The mean children`s SDQ-externalizing problems scores were higher in the COVID-19 positive mothers group than the COVID-19 negative mothers` group. The SDQ-total score was positively and strongly correlated with the DASS total score, DASS-depression score, and DASS-anxiety score. BRS scale scores were negatively correlated with the SDQtotal, externalizing, and DASS-21scale scores. COVID-19 positivity in mothers could be associated with externalizing problems in children. The high resilience of caregivers of inpatients seems to be related to less psychopathology in children. During hospitalization, caregivers` psychological evaluation and psychosocial support may be important for preventive child mental health.

Prevalence of mental health morbidity among the inmates of childcare homes under Social Justice Department, Government of Kerala

Background: Mental disorders are common, affecting more than 25% of all people at some time during their lives. Worldwide literature has shown that onset of common mental disorders occurs in childhood and adolescence. Children with mental health problems are often first seen and first treated in the education, social justice, or juvenile justice systems. In India, according to Juvenile Justice Act, 2000, such children are institutionalized in children’s and observation homes under Social Justice Department. This study aims at assessing the mental health status and estimating the prevalence of mental health morbidity among these children and adolescents.Methods: This is a cross sectional study conducted among the inmates of childcare homes under the Social Justice Department, Government of Kerala. Each individual district in the state was fixed as clusters. Out of the 14 districts, five districts were randomly selected. The childcare homes in each cluster were included. All the eligible children in the cluster during the visit were studied.Results: The median SDQ total score of the study participants was 15 (11, 21). The prevalence of mental health morbidity was estimated as 33.3% (95% CI: 26.86% - 40.31%) in the study population. There were 32 (15.9%) study participants with borderline SDQ score.Conclusions: The prevalence in the current study was more than that found in the general child population children across the world as well as in India, which in turn suggests the need of special care needed for these children and adolescents, especially in mental health.

ERGENLERDE İNTİHAR DAVRANIŞI İLE ANNEYE BAĞLANMA ÖZELLİKLERİ ARASINDAKİ İLİŞKİ

Objective: Adolescent suicide attempt is a common public health problem all over the world. There are many biological, psychological and social risk factors for suicidal behavior. In adolescent suicides, the relationship between suicidal behaviors and insecure attachment to parents has been shown in various studies. In our country, there are few studies examining the relationship between attachment and suicide attempt in adolescents. In this study, we aimed to investigate other factors related to mother attachment and suicidal behavior in adolescents with and without suicidal behavior. Methods: Of 49 adolescents who admitted to a training and research hospital for suicide attempt were included in the study group and 47 healthy adolescents whose no history of suicide attempt were included. All participants were applied a sociodemographic data form, Children's Depression Inventory (CDI), Inventory of Parents and Peer Attachment-Short Form (IPPA-SF), Suicidal Behavior Scale (SBS), Strengths and Difficulties Questionnaire-Adolescent Form (SDQ-A) and Kiddie Schedule for Affective Disorders and Schizophrenia-Present and Lifetime (K-SADS). Results: Psychopathology was found in 81.6% of the suicide attempts group. The mean scores of all the subscales (emotional, behavioral, hyperactivity, expression and introductory) of the group attempting suicide except the GGA peer problems subscale, the mean scores of CDI, the total score of SBS and SBS-1, SBS-2 and SBS-4 subscale scores were significantly higher and the median IPPA-SF scale was significantly lower than that of the healthy control group. There was a positive correlation between total score of SBS, SBS-1, SBS-2, SBS-4, CDI, SDQ total score and its all subscale scores whereas a negative correlation was found with IPPA-SF maternal attachment subscale score. In the logistic regression analysis, the IPPA-SF mother attachment scale scores was predicted by SBS total score and SBS-4 subscale score. Discussion: The low attachment scores to the mother in the suicide group are consistent with the literature that insecure attachment may be an important risk factor for suicidal behavior. In adolescents with suicide attempts, attachment to the mother predicts the seriousness of suicide and the intention of future suicide. Approaches to improve parent-adolescent attachment may play an important role in preventing suicide. Further studies are needed in this field.

Emotional and behavioral difficulties in children growing up homeless in Paris. Results of the ENFAMS survey

PurposeChildren growing up in homeless families are disproportionately more likely to experience health and psychological problems. Our objective was to describe social, environmental, individual and family characteristics associated with emotional and behavioral difficulties among homeless children living in the Paris region. MethodsFace-to-face interviews with a representative sample of homeless families were conducted by bilingual psychologists and interviewers between January and May 2013 (n=343 children ages 4-13 years). Mothers reported children's emotional and behavioral difficulties (Strength and Difficulties Questionnaire [SDQ]), family socio-demographic characteristics, residential mobility, and parents’ and children's physical and mental health. Children were interviewed regarding their perception of their living arrangements, friendships and school experiences. We studied children's SDQ total score in a linear regression framework. ResultsHomeless children had higher SDQ total scores than children in the general population of France, (mean total score=11.3 vs 8.9, P<0,001). In multivariate analyses, children's difficulties were associated with parents’ region of birth (beta=1.74 for Sub-Saharan Africa, beta=0.60 for Eastern Europe, beta=3.22 for other countries, P=0.020), residential mobility (beta=0.22, P=0.012), children's health (beta=3.49, P<0.001) and overweight (beta=2.14, P=0.007), the child's sleeping habits (beta=2.82, P=0.002), the mother's suicide risk (beta=4.13, P<0.001), the child's dislike of the family's accommodation (beta=3.59, P<0.001) and the child's experience of bullying (beta=3.21, P=0.002). ConclusionsChildren growing up homeless experience high levels of psychological difficulties which can put them at risk for poor mental health and educational outcomes long-term. Access to appropriate screening and medical care for this vulnerable yet underserved group are greatly needed.

Tobacco smoking during pregnancy and risk of adverse behaviour in offspring: A follow-up study.

This study examines associations between prenatal exposure to tobacco smoking and adverse behaviour in the offspring. We included 1016 pregnant women from Greenland and Ukraine (526 from Greenland and 490 from Ukraine). Serum cotinine measurements were used to identify smoking pregnant women. When the children were from five to nine years of age, the parents assessed the child's behaviour using the Strength and Difficulties Questionnaire (SDQ). Overall, smoking in pregnancy was not associated with a higher probability of adverse behaviour assessed by the total SDQ score. However, in the crude analysis smoking was associated with a higher mean difference of SDQ-total score. In Greenland the SDQ-total mean difference (MD) was (MD (95% CI)=1.31 points (0.42; 2.19)) and in Ukraine (MD (95% CI)=0.18 points (-1.2; 0.91)), whereas the adjusted mean differences were statistically non-significant. In utero exposure to tobacco smoking was not associated with a significant higher risk of adverse behaviour in the offspring, but elevated risk of adverse behaviour among children prenatally exposed to smoking cannot be excluded.

Sequential population study of the impact of earthquakes on the emotional and behavioural well-being of 4-year-olds in Canterbury, New Zealand.

Exposure to a large natural disaster can lead to behavioural disturbances, developmental delay and anxiety among young children. Although most children are resilient, some will develop mental health problems. Major earthquakes occurred in Canterbury, New Zealand, in September 2010 and February 2011. A community screening tool assessing behavioural and emotional problems in children, the Strengths and Difficulties Questionnaire, has been reported by parents (SDQ-P) and teachers (SDQ-T) of all 4-year-olds in the region since 2008. Mean total and subtest scores for the SDQ-P and SDQ-T were compared across periods before, during and after the earthquakes in sequential population cohorts of children. Comparisons across the periods were made in relation to the proportions of children defined by New Zealand norms as 'abnormal'. Results were also compared between zones considered to have been exposed to higher or lower impact from the earthquakes. Parent mean total SDQ scores did not change between periods before, during and after the earthquakes. Teacher mean SDQ total scores significantly reduced (improved) when compared between baseline and post-earthquake periods. Mean SDQ pro-social scores from both teachers and parents increased (strengthened) when compared between baseline and post-earthquake periods. Results did not significantly vary according to a measure of impact from the earthquakes. The main finding that a population-based measure of behavioural and emotional problems among children was not deleteriously impacted by the earthquakes is surprising and is not consistent with other research findings. Further work is needed to explore the health needs of children in Canterbury based on methodological improvements.

Knowledge of Emotion Regulation Strategies, Problem Behavior, and Prosocial Behavior in Preschool Age

The present study examines the relation between knowledge of emotion regulation strategies and social behavior in preschoolers. Knowledge of emotion regulation strategies of 210 children (mean age 55 months) was assessed. Teachers rated children's social behavior with SDQ. Linear regression analysis examined how knowledge of emotion regulation strategies influenced social behavior of children. Significant effects of gender on SDQ scales "prosocial behavior", "hyperactivity", "behavior problems", and SDQ total problem scale were identified. Age was a significant predictor of SDQ scales "prosocial behavior", "hyperactivity", "problems with peers" and SDQ total problem scale. Knowledge of emotion regulation strategies predicted SDQ total problem scores. Results suggest that deficits in knowledge of emotion regulation strategies are linked with increased problem behavior.

Pregnancy serum concentrations of perfluorinated alkyl substances and offspring behaviour and motor development at age 5-9 years--a prospective study.

BackgroundIn animal studies, perfluorinated alkyl substances affect growth and neuro-behavioural outcomes. Human epidemiological studies are sparse. The aim was to investigate the association between pregnancy serum concentrations of perfluorooctanoate (PFOA) and perfluorooctane sulfonate (PFOS) and offspring behaviour and motor development at 5–9 years of age.MethodsMaternal sera from the INUENDO cohort (2002–2004) comprising 1,106 mother-child pairs from Greenland, Kharkiv (Ukraine) and Warsaw (Poland) were analysed for PFOS and PFOA, using liquid-chromatography-tandem-mass-spectrometry. Exposures were grouped into country specific as well as pooled tertiles as well as being used as continuous variables for statistical analyses. Child motor development and behaviour at follow-up (2010–2012) were measured by the Developmental Coordination Disorder Questionnaire 2007 (DCDQ) and Strength and Difficulties Questionnaire (SDQ), respectively. Exposure-outcome associations were analysed by multiple logistic and linear regression analyses.ResultsIn the pooled analysis, odds ratio (OR) (95% confidence interval (CI)) for hyperactivity was 3.1 (1.3, 7.2) comparing children prenatally exposed to the highest PFOA tertile with those exposed to the lowest PFOA tertile. Comparing children in the highest PFOS tertile with those in the lowest PFOS tertile showed elevated but statistically non-significant OR of hyperactivity (OR (95% CI) 1.7 (0.9, 3.2)). In Greenland, elevated PFOS was associated with higher SDQ-total scores indicating more behavioural problems (β (95% CI) =1.0 (0.1, 2.0)) and elevated PFOA was associated with higher hyperactivity sub-scale scores indicating more hyperactive behaviour (β (95% CI) = 0.5 (0.1, 0.9)). Prenatal PFOS and PFOA exposures were not associated with motor difficulties.ConclusionsPrenatal exposure to PFOS and PFOA may have a small to moderate effect on children’s neuro-behavioural development, specifically in terms of hyperactive behaviour. The associations were strongest in Greenland where exposure contrast is largest.Electronic supplementary materialThe online version of this article (doi:10.1186/1476-069X-14-2) contains supplementary material, which is available to authorized users.

The validity of the Child Health Utility instrument (CHU9D) as a routine outcome measure for use in child and adolescent mental health services.

BackgroundFew cost-utility studies of child and adolescent mental health services (CAMHS) use quality adjusted life years (a combination of utility weights and time in health state) as the outcome to enable comparison across disparate programs and modalities. Part of the solution to this problem involves embedding preference-based health-related quality of life (PBHRQOL) utility instruments, which generate utility weights, in clinical practice and research. The Child Health Utility (CHU9D) is a generic PBHRQOL instrument developed specifically for use in young people. The purpose of this study was to assess the suitability of the CHU9D as a routine outcome measure in CAMHS clinical practice.MethodsTwo hundred caregivers of children receiving community mental health services completed the CHU9D alongside a standardised child and adolescent mental health measure (the Strengths and Difficulties Questionnaire – SDQ) during a telephone interview. We investigated face validity, practicality, internal consistency, and convergent validity of the CHU9D. In addition, we compared the utility weights obtained in this group with utility weights from other studies of child and adolescent mental health populations.ResultsParticipants found the CHU9D easy and quick to complete. It demonstrated acceptable internal consistency, and correlated moderately with the SDQ. It was able to discriminate between children in the abnormal range and those in the non-clinical/borderline range as measured by the SDQ. Three CHU9D items without corollaries in the SDQ (sleep, schoolwork, daily routine) were found to be significant predictors of the SDQ total score and may be useful clinical metrics. The mean utility weight of this sample was comparable with clinical subsamples from other CHU9D studies, but was significantly higher than mean utility weights noted in other child and adolescent mental health samples.ConclusionsInitial validation suggests further investigation of the CHU9D as a routine outcome measure in CAMHS is warranted. Further investigation should explore test-retest reliability, sensitivity to change, concordance between caregiver and child-completed forms, and the calibration of the utility weights. Differences between utility weights generated by the CHU9D and other utility instruments in this population should be further examined by administering a range of PBHRQOL instruments concurrently in a mental health group.

SY37-3 * MENTAL HEALTH AND ADAPTATION IN 7/8 YEAR-OLD CHILDREN PRENATALLY EXPOSED TO METHADONE AND BUPRENORPHINE (OMT)

Introduction. Children exposed to OMT prenatally are at risk of cognitive and behavior problems, particularly evident when children enter school. We here present follow-up data from a national Norwegian cohort of 32 children prenatally exposed to OMT, and 22 general population controls. Method. Cognitive level was assessed with WASI, behavioral symptoms with SDQ, and diagnostic assessment was performed online with the DAWBA. Results. Full scale IQ was lower for exposed children than for controls (102 vs 113), but still within the normal range. Exposed children also had 2-3 times higher mean SDQ Total difficulties and subscale scores (except for emotional problems and parent reported impact). DSM-IV disorders were seen in 17 exposed children (53.1%); 10 ADHD, 6 oppositional, 5 emotional, 4 attachment, and 3 tic disorders. Only one control child (4.5%) met criteria for a mental disorder (within the emotional domain). Conclusion. In spite of a normal mean cognitive level, exposed children had high levels of behavior symptoms, and a very high prevalence of mental disorders. Being the first study of mental disorders in children prenatally exposed to OMT, this study needs replication in larger longitudinal studies, where other contributing factors during development may be controlled for.

Sleep problems, strengths and difficulties in elementary school children

Aim: To assess behavioral and sleep disturbances in childhood, it is necessary to implement standardized brief questionnaires for children and their parents. Especially complaints of insomnia often are underdiagnosed in pediatric medicine. Methods: We developed a sleep questionnaire (K?SI-KJ) and used it together with German versions of the SDQ (parent and child reports) for epidemiologic studies in Cologne. The sleep questionnaire obtains 33 items for parents and 28 items for children. Ratings were dichotomized for this analysis in “sometimes/ often present” versus “not present”. The German versions of SDQ contain 5 subscales each with 5 items. Data from a sample of 1490 children of fourth grade in elementary schools inCologne(age ranged from 8 to 11 years) are shown. Results: Children indicate signs of sleep disturbances in higher frequency than their parents do. Concerning gender and ethnical group, there no significant differences can be shown. Children with signs of insomnia, dyssomnia, daytime sleepiness or restless sleep showed significantly higher scores for all relevant SDQ subscales in parental and children's reports. Children with signs of parasomnia showed higher scores concerning emotional problems and the SDQ total score. Children with enuresis showed higher scores for all SDQ subscales and the total score.

974 – Psychological health and quality of life of children and adolescents with short stature

Findings regarding impairments in quality of life of children and adolescents with short stature are not unequivocal. The present paper examines prevalence of such impairments, their mutual relationship, potential determinants and differences between patient self-report and parent report. Children and adolescents (n=218) with short stature (idiopathic short stature and growth hormone deficit) and their parents provided assessments of psychological health (Strengths and Difficulties Questionnaire - SDQ) and health related quality of life (KIDSCREEN Questionnaire). Variance and regression analysis were used to identify group differences and potential determinants of quality of life. Child-reported SDQ total score was in the normal range in over 80% of cases, while 7.8% were identified as borderline impaired and 8.2% were classified as abnormal. Parents ratings were 76% normal, 8.6% borderline and 17.8% abnormal. Impairments were found for young children, for boys and for very short patients. Analysis of variance showed higher KIDSCREEN scores in the SDQ normal group. SDQ and KIDSCREEN correlated significantly. Half of the variance in KIDSCREEN scores was explained by a combination of SDQ scores, clinical status and sociodemographic data in child and parent samples. Parents reported higher impairments in psychological health than children. SDQ related differences in KIDSCREEN scores and the proportion of variance in QoL explained by the SDQ suggest that mental health should be routinely assessed in children with short stature as a part of the diagnostic process. Psychological interventions should be considered when clinically indicated.