Strengths And Difficulties Questionnaire Scores Research Articles

Assessing emotional and behavioral symptoms among South African youth living with HIV: a psychometric analysis of IsiZulu SDQ scale

Introduction Evaluating emotional and behavioral challenges in perinatally HIV-infected youth necessitates culturally tailored tools. While the Strengths and Difficulties Questionnaire (SDQ) gauges psychological traits through 25 items, the isiZulu version’s suitability among this cohort remains uncertain. Methods Conducted in South Africa, the study engaged 316 caregiver-youth pairs in the VUKA program and 37 in VUKA_E across six HIV clinics. Results The overall SDQ score reliability was acceptable, yet all five sub-scales fell below 0.7 (ranging from 0.26 to 0.59). The peer relationships subscale exhibited the lowest reliability (Cronbach’s α = 0.26). Confirmatory factor analysis revealed poor fits in both 5-factor and 3-factor models, notably in peer problems and hyperactivity constructs. Discussion Caution is warranted when using the current Zulu SDQ measurement in a cross-cultural context. An updated version rectifying translation issues is recommended, particularly in hyperactivity and peer problem sub-scales.

The “supercompensation” effect of children’s lockdown during COVID-19: based on the analysis of changes in physical activity, sleep, and psychology

ObjectiveTo investigate the “supercompensation” effect of preschoolers during the coronavirus disease 2019 lockdown by comparing the changes in physical activity (PA), psychological, and sleep indicators before and after the lockdown.MethodsA total of 127 children (aged 3–6 years) were recruited. Before and after the lockdown, the children’s PA levels were measured using the ActiGraph GT3X+, and their psychological and sleep indicators were measured using the Strengths and Difficulties Questionnaire (SDQ) and Child Sleep Habit Questionnaire (CSHQ), respectively.ResultsRegarding PA, the children’s total physical activity, low-intensity physical activity, and medium-intensity physical activity (MVPA) were higher after the lockdown than before the lockdown, with significant differences in MVPA (p < 0.05). Regarding psychology, the children’s SDQ and multidimensional scores were better after the lockdown than before the lockdown, with a significant difference in SDQ scores (p < 0.05). Regarding sleep, the children’s CSHQ scores were better after the lockdown than before the lockdown, with a highly significant difference in CSHQ scores (p < 0.01).ConclusionAfter lockdown, children’s PA, psychological, and sleep effects were “supercompensated.” In particular, the PA of preschoolers before, during, and after the lockdown may show a “baseline-inhibition-supercompensation” process.

The inequity of education, health and care plan provision for children and young people with intellectual and developmental disabilities.

Children and young people (CYP) with intellectual and developmental disabilities (IDDs) have significant additional educational needs compared with the general population. In England, the government has established a system of education, health and care plans (EHCPs) to support children with special educational needs and disabilities, but disparities exist between the degree of need and the availability of support. We conducted a prospective UK national cohort study (IMAGINE) of children with rare pathogenic genomic variants, all of which are associated with IDD, to investigate associated neuropsychiatric risk. Subsequently, we obtained information from the UK's National Pupil Database on their educational progress through the state school system. We aimed to identify whether they had received EHCP provision and whether that support was associated with their family's socioeconomic status, region of domicile, ethnicity, sex, primary special educational needs (SEN) type, academic performance and mental health well-being. We recruited 2738 CYP from England into the IMAGINE study between 2014 and 2019. The educational histories of the participants (6-28years old, mean±standard deviation= 14±4years, 56% male) were obtained from the Department for Education's National Pupil Database in 2021. Educational data included attainment scores from the Early Year Foundation Stage (<5years) to key stage 4 (15-16years). Each family was assigned an index of multiple deprivation (IMD) score based on their home address postcode. Parents or carers rated their child's emotional and behavioural adjustment on the Strengths and Difficulties Questionnaire (SDQ). The association between receiving an EHCP and the child's IMD score, eligibility for free school meals, English region of domicile, ethnicity, sex, primary SEN type, academic attainment and SDQ score was investigated. In this cohort, 78% of participants had received an EHCP. CYP living in the most deprived IMD deciles were substantially less likely to receive EHCP support than those in the least deprived decile, irrespective of their degree of intellectual developmental disability, academic performance or associated mental health problems. There were no sex differences. Children of Asian heritage were more likely to have been granted an EHCP than White children from equivalent IMD deciles. There were striking regional disparities. Participants living in London were significantly more likely to have been awarded an EHCP than participants living anywhere else in England, regardless of their IMD decile; those in the least deprived decile had almost 100% EHCP provision. This study found evidence for nationwide regional inconsistencies in the awarding of EHCP to CYP with significant intellectual impairments of known genetic aetiology. Disparities in funds available to education authorities could be a contributory factor. EHCP support was potentially influenced by how strongly a parent advocates for their child.

Executive dysfunction as a possible mediator for the association between excessive screen time and problematic behaviors in preschoolers.

Excessive screen time in children is a growing concern for parents and healthcare providers worldwide because it frequently leads to behavioral problems. Although executive dysfunction is proposed to be one of the contributing factors to maladaptive behaviors, little is known about the link between screen time and behaviors. This study aimed to identify whether executive dysfunction contributes to the negative behaviors of children exposed to excessive screen time. A cross-sectional study was conducted on preschool-aged children from public and private schools in Chiang Mai, Thailand. The parents/guardians of each child completed the questionnaires regarding clinical characteristics and screen time use, the Behavior Rating Inventory for Executive Function-Preschool (BRIEF-P), and the Strengths and Difficulties Questionnaire (SDQ). Children with more than one hour of media exposure per day were considered to have excessive screen time. Multivariable Gaussian regression was analyzed to compare the BRIEF-P and SDQ scores between the excessive and appropriate screen time groups. Causal mediation analysis was performed to examine the effects of total screen time on increasing behavioral problems with executive functioning as a mediator. A total of 1,126 preschoolers were included in the analyses. After controlling for age, sex, socioeconomic status, and maternal education, the excessive screen time group had significantly higher BRIEF-P global executive composite score than the appropriate screen time group (mean difference of global executive composite score = 1.49, 95% CI [0.12, 2.86], and p = 0.033). Concurrently, there were significant differences in externalizing behavior subscales and SDQ total difficulties scores between the excessive and appropriate screen time groups (mean difference of total difficulties score = 0.90, 95% CI [0.29, 1.50], and p = 0.004). A significant average causal mediation effect (ACME) of screen time on behavioral problems mediated through executive functioning was β = 0.28, 95% CI [0.13-0.44], which was more than half of the total effect (54.9%, 95% CI [37.4-100%]). The current study suggests that the increase in behavioral issues in preschoolers might be partly explained by the direct effect of excessive screen time and the mediating effect of impaired executive functioning. Our results may raise concerns about the necessity to limit screen time and monitor for executive function deficits and behavioral problems in young children with high screen time.

School Closures and the Impact on Screen Time and Behavior during the Pandemic

Objective: The objective of the study is to examine the impact of school closures on recreational screen time, emotional, and behavioral functioning of school-going children and adolescents during the imposition of social containment measures and school closure in India. Methodology: The survey utilized a Google Form that was sent to parents of children aged 6–14 years through e-mails and social media platforms. Parents were asked to report on the child’s duration of recreational screen time and whether the child’s overall behavioral functioning had changed since the school closures. The child’s emotional and behavioral functioning was assessed by the Strength and Difficulties Questionnaire (SDQ). The scores on the SDQ and screen time use were compared by overall parental behavioral rating to identify the areas of concerns for children whose functioning was reported to have worsened after the closing of schools. Results: The mean recreational screen time was reported to be 2.65 h (standard deviation = 1.89). A significantly higher proportion of children whose behavior worsened after school closures, relative to those who improved or were same, had scores in the abnormal range of functioning on three of the subscales of SDQ including emotional problems (χ ² = 29.03, P = 0.0001), hyperactivity/inattention (χ² = 24.67, P = 0.0001), conduct problems (χ² = 22.01, P = 0.0001), and overall total SDQ score (χ² = 41.20, P = 0.0001). Conclusions: Interventions should be aimed at encouraging outdoor physical activity while respecting government restrictions, healthy routines, pursuing hobbies, and promoting responsible use of electronic devices during the pandemic and crisis recovery period.

Exposure to Violent Contexts and Psychosocial Functioning of Adolescents: A Cross-sectional Study

Objective: The aim is to examine the relationship between exposure to violence at home and at school on the psychosocial functioning of school-going adolescents. Materials and Methods: A total of 306 adolescents (mean = 15.28 years, standard deviation = 1.04) were recruited from two schools (one government and one private) in a North Indian city. A semi-structured form elicited information on demographic and socioeconomic variables and the extent to which students were exposed to violence at home and school. Based on the students’ responses to the victimization questions at home and school, they were categorized into four groups: those who faced overt and/or covert violence at both home and school; overt and/or covert violence only at home; overt and/or covert violence only at school; and those who faced no violence (control group). The preadolescent adjustment scale (PAAS) was used to assess the student’s self-reported adjustment at home, school, and with teachers, and peers. The main outcome measure was the self-reported total score on the Strengths and Difficulties Questionnaire (SDQ). Results: Nearly one-fifth (20.3%) of the students’ total score on the SDQ was in the borderline or abnormal range. The students who had been exposed to one or more contexts of violence were significantly more likely to report higher total SDQ scores (χ² = 33.94, P = 0.0001) and show scores in the abnormal range on the subdomains of hyperactivity/inattention (χ² = 15.75, P = 0.015) and conduct problems (χ² = 27.70, P = 0.0001) on the SDQ. Stepwise multivariate linear regression analyses indicated that overall, 17.4% of the variance in the SDQ total difficulties score was explained by the total score on the index of violence score, adjustment score on the teacher subdomain of PAAS, and the age of the adolescent (F = 20.88, P = 0.0001). Conclusions: Exposure to violence in different settings plays a critical role in determining the mental health of adolescents. Professionals need to be sensitive to the issues of parenting, disciplining practices, and school connectedness with school teachers while working with adolescents.

BEEC psychosocial screening at Royal Manchester Children's Hospital

Bladder Exstrophy and Epispadias Complex (BEEC) is associated with psychosocial difficulties. Screening questionnaires, alongside consultation with a clinical psychologist, can help identify children/young people for further assessment and track trends over time to improve service delivery. To screen paediatric BEEC patients for a range of general psychosocial difficulties in a multi-disciplinary out-patient clinic setting and compare these results with our previous study and against published norms. The current service evaluation collected data at outpatient BEEC clinic appointments between 2016 and 2022 (2016-2022 sample). Children aged 4-5, 10-11 and 14-15 years and their parents/proxy were asked to complete two standardised psychosocial questionnaires: Paediatric Quality of Life Inventory (PedsQL 4.0 Generic Core and Family Impact Module) and the Strengths and Difficulties Questionnaires (SDQ). 79 children (CYP) and 93 parent/proxy (P/P) responses were recorded. The sample included paired CYP and P/P responses for the PedsQL (n=67) and SDQ (n=35). The mean age for CYP was 9.9 years (SD 3.99, range 2-17), 69.8% (n=120) of responses for male children. The percentage of total CYP scores falling within the 'At Risk' category on the PedsQL increased in the 2016-2022 sample compared to our 2015 sample, indicating the prevalence of greater difficulties. Differences between P/P and CYP responses on both the PedsQL and SDQ favoured CYP. Age, gender, and diagnosis appeared to influence certain questionnaire responses, depending on respondent (CYP or P/P). A significant difference between P/P and CYP in the emotional domain of the PedsQL for those aged 13-18 was observed (p=0.020), with P/P reporting greater difficulties, but this was not seen in the younger age ranges. Physical Health on the PedsQL were significantly lower for children with a cloacal exstrophy diagnosis, in comparison to bladder exstrophy and epispadias. P/P SDQ scores for boys were significantly higher in several domains. The results demonstrate the need for psychosocial screening, providing benchmarking for psychosocial difficulties within this patient group. Results indicate that patients accessing our clinic are reporting a higher level of challenge across psychosocial domains in recent years reflected by the percentage within the 'At Risk' category for psychosocial difficulty. Linked questionnaire data with condition specific information and surgical history would improve service evaluations. CYP reaching clinical thresholds are offered further psychological assessment within the service.

Parental Perception of Children's Mental Health During the Pandemic: Insights From an Italian Cross-Sectional Study.

This study explores the impact of the pandemic on children's mental health. It examined the understanding of parents regarding their children's mental condition and their ability to identify issues, 2 years post the outbreak of the COVID-19 pandemic. Using a cross-sectional design, 507 Italian parents reported on their youngest child aged between 2 and 17, totaling 507 children. The outcomes focused on were parental perception of children's mental health deterioration, scores on the Strengths and Difficulties Questionnaire (SDQ) above the clinical cut-off, and parental under-recognition of mental health issues. Descriptive analyses and multivariable logistic regression models were executed (significance at p < .05). Parents were 88.1% women (median age 41 years, interquartile range [IQR] = 36-47). Their children were 50.3% female [median age 6 years (IQR = 4-11)]. The data revealed 21.1% of parents perceived a deterioration in their children's mental health, while 44.2% had SDQ scores above the cut-off. Parental under-recognition of mental issues was found in 20.1% of cases. Significant correlations were found between parental perception of deterioration, SDQ scores, and factors like parental mental distress and children's sleep issues. The findings suggest that schools and verified websites can serve as critical conduits for providing parents with reliable information. By promoting early identification and intervention, such mechanisms can help ensure mental health equity for children. The research highlights the effect of the pandemic on children's mental health and the issue of parental under-recognition. The results underscore the importance of public health initiatives that enhance mental health information accessibility and reliability for parents.

Predictors of Adolescent Internalizing and Externalizing Mental Health Symptoms: A School-Based Study in Southern India.

Mental illnesses are one of the major contributors to the overall burden of disease among the young. We investigated the predictors of emotional and behavioral problems among in-school adolescents in the Indian context. Using stratified sampling, 1441 adolescents were recruited to participate in the study in Udupi taluk. The study instruments included a socio-demographic pro forma and the adolescent self-reporting version of the Strengths and Difficulties Questionnaire (SDQ) to assess the emotional and behavioral problems among them. We explored the predictors of total difficulties, as well as externalizing and internalizing problems and gender differences. SPSS version 25 was used to analyze the data. Descriptive statistics, a Chi-square test for associations, an independent t-test to explore the gender differences, correlation analysis, and backward stepwise logistic regression for the predictors were used. The mean age of the participants was 15.31 ± 0.76. An almost equal percentage of male (49.6%) and female (50.4%) participants provided data. Abnormal scores were highest under conduct problems (8.5%), and the total difficulties reached 5.1%. The male participants had higher levels of conduct, hyperactivity, peer relationship, and externalizing problems the while the female participants experienced higher levels of emotional and internalizing problems. It was observed that there was a significant positive relationship between age and emotional problems, conduct problems, hyperactivity, peer problems, and total SDQ score. An older age predicted an abnormal total difficulties score and externalizing and internalizing behaviors, while the type of school predicted the total difficulties and internalizing behaviors. The age of the adolescent, their gender, and the type of school they attended emerged as predictors of the emotional and behavioral problems among them.

Is psychological resilience associated with changes in youth sport participants’ health-related quality of life during the COVID-19 pandemic?

Objectives: This study investigated the quality of life of youth sport participants over the COVID-19 pandemic as moderated by psychological resilience. Methods: Participants included 93 high school sport participants (53.76% female, mean age = 15.59 ± 0.74) in a three-year longitudinal cohort study (SHRed Concussions) who completed the Connor–Davidson Resilience Scale (CD-RISC), Pediatric Quality of Life Scale (PedsQL), and Strengths and Difficulties Questionnaire (SDQ) at Year 1 (pre-pandemic, 2019–2020) and Year 2 (pandemic, 2020–2021). Change in quality of life and mental health symptoms from Year 1 to Year 2 was examined using paired t-tests and Year 1 resilience was examined as a predictor of Year 2 quality of life and mental health symptoms using linear regression. Results: Among participants with Year 1 scores before the pandemic onset, mean PedsQL (n = 74, t = −0.26 [−2.63, 2.03], p = 0.80) and SDQ (n = 74, t = 0.030 [−0.90, 0.93], p = 0.98) scores did not significantly change between Year 1 and Year 2. In unadjusted analyses, Year 1 CD-RISC scores were positively associated with predicted Year 2 PedsQL scores when Year 1 scores were controlled (β = 0.31 [0.0062, 0.61], ΔR 2 = 0.02) but not with residual change in SDQ scores (β = 0.035 [−0.11, 0.18], ΔR 2 = 0.001). Conclusions: Quality of life did not change significantly after the pandemic onset, and resilience was modestly protective.

Children's behavioural and emotional wellbeing during the COVID-19 pandemic: Findings from the Born in Bradford COVID-19 mixed methods longitudinal study.

The COVID-19 pandemic led to a multitude of immediate social restrictions for many across the world. In the UK, the lives of children and young people were quickly impacted when COVID-19 restrictions led to school closures for most children and restrictions on social interactions. The Born in Bradford COVID-19 longitudinal research study explored the impact of the COVID-19 pandemic on the lives of children and their families living in Bradford. Surveys were administered during the first wave of the pandemic (March to June 2020) and compared to findings from before the pandemic. The current study examined the social and emotional wellbeing of children from before to during the pandemic, measured using the parent completed Strengths and Difficulties questionnaire (SDQ). Regression analyses looked at associations between a range of social determinants of health and changes in SDQ scores. The results showed that those children most likely to experience difficulties during the pandemic were boys, younger children, those from White British ethnicity (compared to Pakistani heritage children) and those living in the most deprived areas. There were associations between experiencing difficulties and: food insecurity; financial worry; getting below recommended levels of physical activity; and having less than the recommended amount of sleep. The effect of COVID-19 restrictions are likely to have had negative consequences on children that could, in time, have long-lasting impacts on the health, wellbeing and development of children in the UK.

The Psychosocial Effects of Lockdown Due to the COVID-19 Pandemic on Children in 2021.

Objectives The COVID-19 pandemic led to a nationwide lockdown that isolated numerous children and adolescents, significantly affecting their mental well-being. Therefore, this study aimed to assess the challenges faced by children during the pandemic and identify the potential contributing factors. Additionally, given the existing concerns surrounding the mental health of female children and adolescents, our study aimed to investigate the presence of sex-based disparities in children's observed emotional and behavioral difficulties during the COVID-19 lockdown. Methods Participants in this study were parents of children aged 6-17 years. An observational cross-sectional study was conducted through verbal administration of a validated semi-structured questionnaire, the Parent Report Measure, from June 2021 to August 2021 at a nearby community health center. The questionnaire collected socio-demographic details and utilized the Strengths and Difficulties Questionnaire (SDQ), a screening tool to assess children's emotional and behavioral aspects during the six-month lockdown period. The responses were then analyzed using appropriate statistical tools like SPSS statistics, and cumulative SDQ scores were used to categorize participants. Results Out of the total 280 responses analyzed, the prosocial subscale exhibited the highest number of abnormal responses, 73 (26.1%), followed by conduct (42; 15%), hyperactivity (41; 14.6%), and peer (41; 14.6%) subscales. These results indicated that children displayed decreased empathy towards others, restlessness, fidgetiness, reduced attention span, frequent tantrums, and a preference for solitary activities. Furthermore, there was a significant association between abnormal subscale scores and the sex of children. Females showed a considerably higher prevalence of emotional problems (172; 61.5%) than males. Among the behavioral responses, a more significant proportion of females displayed abnormal scores in the conduct subscale (170; 60.7%), while abnormal hyperactivity scores were more frequently observed among males (178; 63.4%). Regarding the peer problems subscale, the proportion of females was slightly higher than males (150; 53.7%) and nearly equal in the prosocial domain. A more significant proportion of females displayed abnormal scores for overall difficulties 144 (51.5%), indicating a notable sex-based disparity. Conclusion Our findings highlight the pandemic's significant impact on many children's psychological well-being. The results emphasize the need for targeted interventions to address the mental health concerns that arose in this population. The observed disparity in emotional and behavioral difficulties among female children is particularly concerning, highlighting the need for gender-sensitive support and care. Various strategies can be helpful, such as virtual support groups, indoor recreational activities, reduced screen time and excessive news consumption, and effective communication with parents. Furthermore, our study also indicates the need to dive deep into such areas of pediatric research to understand and plan timely interventions.

Mental health in the COVID-19 pandemic: A longitudinal analysis of the CLoCk cohort study.

Little is known about the long-term mental health consequences of the pandemic in children and young people (CYP), despite extremely high levels of exposure to the Severe Acute Respiratory Syndrome Coronavirus 2 (SARS-CoV-2) virus and the disruption to schooling and leisure activities due to the resultant restrictions. There are mixed findings from systematic reviews of how the pandemic affected CYP's mental health, which may be due to heterogeneous methods and poor quality studies. Most, but not all, suggest deterioration in mental health but population level studies may obscure the differing experiences of subgroups. The study questions are: (i) are there subgroups of CYP with distinct mental health profiles over the course of the second year of the Coronavirus Disease 2019 (COVID-19) pandemic (between April 2021 and May 2022); and (ii) do vulnerability factors influence CYP's mental health trajectories. A matched longitudinal cohort study of non-hospitalised test-positive and test-negative 11- to 17-year-old CYP in England were recruited from the UK Health Security Agency having undergone PCR testing for COVID-19. They completed the Strengths and Difficulties Questionnaire (SDQ) at least twice over a 12-month follow-up period. Overall, 8,518 of 17,918 (47.5%) CYP who returned their first SDQ at 3 or 6 months post-testing were included in the analytical sample. Associations between age, sex, ethnicity, socioeconomic status (SES), and an educational health and care plan (EHCP, indicating special educational needs) on SDQ score trajectories were examined separately, after adjusting for PCR test result. Findings from multilevel mixed-effects linear regression model showed that on average mental health symptoms as measured by the total SDQ score increased over time (B = 0.11 (per month), 95% CI = 0.09 to 0.12, p < 0.001) although this increase was small and not clinically significant. However, associations with time varied by age, such that older participants reported greater deterioration in mental health over time (B = 0.12 (per month), 95% CI = 0.10 to 0.14 for 15 to 17y; 0.08 (95% CI = 0.06 to 0.10) for 11 to 14y; pinteraction = 0.002) and by sex, with greater deterioration in girls. Children with an EHCP experienced less deterioration in their mental health compared to those without an EHCP. There was no evidence of differences in rate of change in total SDQ by ethnicity, SES, or physical health. Those with worse prior mental health did not appear to be disproportionately negatively affected over time. There are several limitations of the methodology including relatively low response rates in CLoCk and potential for recall bias. Overall, there was a statistically but not clinically significant decline in mental health during the pandemic. Sex, age, and EHCP status were important vulnerability factors that were associated with the rate of mental health decline, whereas ethnicity, SES, and prior poor physical health were not. The research highlights individual factors that could identify groups of CYP vulnerable to worsening mental health.

How do schools influence the emotional and behavioural health of their pupils? A multi-level analysis of 135 schools in the Born in Bradford inner city multi-ethnic birth cohort.

To estimate variation in emotional and behavioural problems between primary schools in Bradford, an ethnically diverse and relatively deprived city in the UK. We did a cross-sectional analysis of data collected from 2017 to 2021 as part of the 'Born In Bradford' birth cohort study. We used multilevel linear regression in which the dependent variable was the Strengths and Difficulties Questionnaire (SDQ) total score, with a random intercept for schools. We adjusted for pupil-level characteristics including age, ethnicity, socioeconomic status, and parental mental health. The study included 5,036 participants from 135 schools. Participants were aged 7-11 years and 56% were of Pakistani heritage. The mean SDQ score was 8.84 out of a maximum 40. We estimated that the standard deviation in school-level scores was 1.41 (95% CI 1.11-1.74) and 5.49% (95% CI 3.19-9.37%) of variation was explained at school level. After adjusting for pupil characteristics, the standard deviation of school-level scores was 1.04 (95% CI 0.76-1.32) and 3.51% (95% CI 1.75-6.18%) of variation was explained at school level. Simulation suggested that a primary school with 396 pupils at the middle of the distribution has 63 pupils (95% CI 49-78) with a 'raised' SDQ score of 15 + /40; and shifting a school from the lower to the upper quartile would prevent 26 cases (95% CI 5-46). The prevalence of emotional and behavioural problems varies between schools. This is partially explained by pupil characteristics; though residual variation in adjusted scores may suggest that schools have a differential impact on mental wellbeing.

Associations between sleep problems and emotional/behavioural difficulties in healthy children and adolescents

ObjectiveThis study aimed to (1) characterise sleep disturbances and emotional/behavioural difficulties among healthy German children and adolescents aged 3 to 13 years, (2) examine the association between parent-reported sleep problems and emotional/behavioural difficulties, (3) point out possible relations between specific kinds of sleep disturbances and different behavioural difficulties.MethodsData were collected between 2011 and 2015 within the LIFE Child study in Germany. The sample included 1101 3- to 13-year-old children and adolescents. Information on sleep disturbances—assessed via the Children’s Sleep Habits Questionnaire (CSHQ), emotional/behavioural difficulties—assessed via the Strengths and Difficulties Questionnaire (SDQ), and socioeconomic status was provided by participants’ parents. Multiple regressions were applied to analyse the associations between general and specific sleep disturbances (independent variables) and emotional/behavioural difficulties (dependent variables).ResultsThe total CSHQ score was positively associated with the total SDQ score and all SDQ subscales (emotional problems, conduct problems, hyperactivity/inattention, peer relationship problems). Most of the CSHQ subscales were related to SDQ subscale scores, except for a few non-significant relations with hyperactivity/inattention and conduct problems. The CSHQ total score, daytime sleepiness, sleep duration and parasomnias showed the strongest associations with the SDQ total score.ConclusionThis study confirms an association between children’s and adolescents’ sleep habits and psychological health. We were able to demonstrate the association between sleep problems and emotional/behavioural difficulties in a large sample of healthy participants. In particular, we observed a significant relation between parasomnias and hyperactive/inattentive behaviour as well as a significant association between emotional problems and sleep problems, especially daytime sleepiness, sleep anxiety and parasomnias.

The Relationship between Online Learning, Associated Factors and Emotional/Behavioral Problems in Primary School 1st Grade Students

Aim: The use of online learning, which has spread rapidly worldwide in recent years, has increased considerably with the COVID-19 pandemic. The study aimed to evaluate the online learning experience of children attending primary school 1st grade and the relationship between online learning, related factors, and Emotional/Behavioral problems. Materials and Methods: This study was carried out with 378 mothers who have a child attending primary school 1st grade. Demographic data were assessed with the Sociodemographic Data Form, which included information about the online learning process and school, and the parent-rated Strengths and Difficulties Questionnaire (SDQ) to assess emotional/behavioral problems. Results: 50.5% of the mothers reported that their children experienced emotional/behavioral problems, while 45.3% reported that online learning exacerbated their children's emotional/behavioral problems. SDQ Emotional problems score was significantly higher in girls, while SDQ Conduct problems and Hyperactivity/inattention subscores, and SDQ total scores were significantly higher in boys. The SDQ peer problems subscore and SDQ total scores of illiterates were significantly higher than those of literates. There was a significant negative correlation between the extracurricular screen time and all SDQ scores except the prosocial behavior subscore. The SDQ conduct problems and peer problems subscores and SDQ total scores of children with regular activities/hobbies were significantly lower than the others, while the SDQ prosocial behavior score was significantly higher. Conclusion: Our study findings showed that online learning negatively affected almost half of the children in terms of emotional/behavioral problems for different reasons, gender can lead to differences in emotional/behavioral problems in early childhood, illiterate children and children with increased extracurricular screen time may be more at risk in terms of emotional/behavioral problems and regular activities/hobbies may contribute positively to the process.

Effect of Quality Improvement Interventional Tool on Emotional, Behavioural and Self-perception Profile of Children with Type 1 Diabetes Mellitus: A Pretest, Post-test Quasi-experimental Study

Introduction: Psychological stress associated with Type 1 Diabetes Mellitus (T1DM) in children is relatively higher in developing countries due to limited health resources. However, no data are available regarding the impact of a Quality Improvement (QI) intervention on emotional, behavioural, and self-perception in paediatric patients with T1DM. Aim: To study the impact of a QI interventional tool on the emotional, behavioural, and self-perception profile in children with T1DM. Materials and Methods: This pretest, post-test quasiexperimental study was conducted at PGIMS, Rohtak, Haryana, India from August 2021 to July 2022. A total of 50 children, aged between 6-14 years with T1DM, were enrolled from the paediatric outpatient department and paediatric ward for the study. Initially, baseline data were collected, and patients were followed-up for six months during which required interventions were given, including one-on-one counseling with mother and child, demonstration of insulin injection, providing them with a booklet for recording blood glucose at home, etc. After six months, data were collected again for comparison. The Strengths and Difficulties Questionnaire (SDQ) and Self-perception Profile for Children (SPPC) questionnaires were used for the study. Data were statistically analysed using a paired t-test. Results: In the present study, there were 27 (54%) males and 23 (46%) females with an average age of 9.64±2.3 years. Positive outcomes were noted in the emotional, behavioural, and selfperception profiles of children following the intervention. HbA1C values (pre: 13.12±1.02%, post: 10.63±1.07%), hypoglycaemic episodes (pre: 2.54±0.88, post: 1.24±0.43), and Diabetic Ketoacidosis (DKA) episodes (pre: 2.76±0.52, post: 1.08±0.27) significantly reduced following the intervention. The SDQ score was significantly lower (pre: 16.97±1.48, post: 7.76±2.14), and the SPPC score was significantly higher (pre: 76.52±0.61, post: 94.34±1.06) after the intervention. Conclusion: In the present study, it was found that psychological and behavioural interventions have a beneficial effect on children with diabetes in terms of better compliance with therapy, glycaemic control, as well as better relationships with family and peers, and improved coping capability.

Impact of the COVID-19 Pandemic on Children with Autism and Their Caregivers: Findings from an Online Survey

Abstract Background: The coronavirus pandemic has had an unparalleled impact on the social, economic, physical, and subjective well-being of individuals in general, and children with special needs and their families in particular. Objectives: The objective is to examine the emotional and behavioral impact of the COVID-19 pandemic on children with autism and their families. Methodology: The study utilized an online Google Form and elicited information on sociodemographic background, types of therapies utilized before the pandemic, services available during the pandemic, utilization of services, satisfaction, challenges faced in management, perceived stress, and behavioral and emotional functioning of children during the ongoing COVID-19 pandemic. Parenting stress was measured using the Perceived Stress Scale (PPS) and the Strengths and Difficulties Questionnaire (SDQ) measured the emotional and behavioral functioning of autism spectrum disorders children. Results: A total of 62 caregivers responded to the survey. The COVID-19 restrictions were found to have significantly limited access to face-to-face educational and therapeutic services for the majority of the patients and only 17.7% reported receiving health-care services. Among the families that utilized the online intervention services, only 36.4% were satisfied and the satisfaction among families utilizing virtual educational services (43.5%) was even lower (14.5%). The stepwise multivariate regression analysis indicated that 16.1% of the variance in the total SDQ score of the child was accounted for by the PPS score (F = 11.47, P = 0.001). Conclusions: The worsening of challenging behaviors during COVID-19 underscores the need to intervene early and to expand the outreach of empirically supported telehealth interventions, especially among the underserved communities.

Family UNited: piloting of a new universal UNODC family skills programme to improve child mental health, resilience and parenting skills in Indonesia and Bangladesh

BackgroundFamily is one of the most influential social institutions and caregivers act as the main protective factors for children’s mental health and resilience skills. Family skills programmes support caregivers to be better parents and strengthen positive age-specific and age-appropriate family functioning and interactions. We developed a universal, brief and light programme for implementation in low-resource settings, the Family UNited (FU) programme, and conducted a pilot study to show feasibility of implementation, replicability and effectiveness in improving family functioning, child behaviour and resilience.MethodsWe recruited caregivers with children aged 8–14 years through schools in East Java, Indonesia and Dhaka, Bangladesh to the FU programme. Demographic data, emotional and behavioural difficulties of children, child resilience and parental skills and family adjustment measures were collected from children and caregivers before, 2 and 6 weeks after the intervention. Outcome was assessed through the SDQ (Strengths and Difficulties Questionnaire), PAFAS (Parenting and Family Adjustment Scales) and CYRM-R (Child and Youth Resilience Measure).ResultsWe enrolled 29 families in Bangladesh and allocated 37 families to the intervention and 33 to the control group in Indonesia. Overall, there was no effect over time in the control group on any of the PAFAS subscales, whereas significant reductions in scores were found on six of the seven subscales in either country in the intervention group, most prominently in caregivers with higher scores at baseline. We found highly significant reductions in total SDQ scores in the intervention group in both countries, whereas there was no effect over time in the control group in Indonesia. Boys in the intervention group in Indonesia and in Bangladesh seemed to have benefitted significantly on the SDQ as well as the total resilience scale. Overall, on the CYRM-R, particularly children below the 33rd percentile at pre-test benefitted substantially from the programme.ConclusionsThe implementation of a brief family skills programme was seemingly effective and feasible in resource-limited settings and positively improved child mental health, resilience and parenting practices and family adjustment skills. These results suggest the value of such a programme and call for further validation through other methods of impact assessment and outcome evaluation.Trial registration: Clinical Trial Registration: ISRCTN99645405, retrospectively registered, 22 September, 2022.

Is it time to revise the SDQ? The psychometric evaluation of the Strengths and Difficulties Questionnaire.

Despite the wide use of the Strengths and Difficulties Questionnaire (SDQ) to assess adolescent mental health, its psychometric functionality is still under debate. This study investigated the structural validity and reliability of the SDQ scores, and the resemblance of the SDQ sum scores and factor scores. Factor one-dimensionality and competing multifactor structures were tested against data. With the best acceptable models, measurement invariance was tested between genders and over time. Subscale reliability and correspondence between subscale sum scores and factor scores were estimated. The nationally representative self-report data from 23,980 Finnish early (12-13 years) and mid- (15-16 years) adolescents (50.4% girls) were collected from two cohorts in 2008 and 2013. The results showed that among early adolescents, the revised SDQ with a controlled method effect had an excellent fit. In contrast, none of the tested models had an acceptable fit among the mid-adolescents. Among early adolescents, strong measurement invariance was achieved between genders and over time. Three of the five subscales were one-dimensional, and all subscales had low reliability. The resemblance between the subscale sum scores and factor scores was alarmingly low. Researchers should be cautious when using the SDQ Total Difficulties sum score or the subscale scores as they may be substantially biased, and practitioners should desist from using the SDQ as a screening tool in its current form. This study strongly supports the revision of the SDQ. In line with the previous findings, we suggest rewording the worst functioning items and revising the reverse-worded difficulties items. (PsycInfo Database Record (c) 2023 APA, all rights reserved).