Strengths And Difficulties Questionnaire Total Difficulties Research Articles

Characteristics of children with a psychiatric disorder in 1999, 2004 and 2017: an analysis of the national child mental health surveys of England.

While research has described the profile of children with poor mental health, little is known about whether this profile and their needs have changed over time. Our aim was to investigate whether levels of difficulties and functional impact faced by children with a psychiatric disorder have changed over time, and whether sociodemographic and family correlates have changed. Samples were three national probability surveys undertaken in England in 1999, 2004 and 2017 including children aged 5-15 years. Psychiatric disorders were assessed using the Development and Well-Being Assessment (DAWBA), a standardised multi-informant diagnostic tool based on the tenth International Classification of Diseases (ICD-10). The impact and difficulties of having a disorder (emotional, behavioural or hyperkinetic) were compared over time using total difficulty and impact scores from the Strengths and Difficulties Questionnaire (SDQ). Analyses explored the impact of having any disorder, as well as for each disorder separately. Regression analyses compared associations between disorders and sociodemographic factors over time. Parent- and adolescent-reported total SDQ difficulty and impact scores increased between 1999 and 2017 for children and adolescents with disorders. No differences were noted when using teacher ratings. No differences in total SDQ difficulty score were found for children without a disorder. Comparison of sociodemographic correlates across the surveys over time revealed that ethnic minority status, living in rented accommodation and being in the lowest income quintile had a weaker association with disorder in 2017 compared to 1999. Our study reveals a concerning trend; children with a disorder in 2017 experienced more severe difficulties and greater impact on functioning at school, home and in their daily lives, compared to children with a disorder in earlier decades. Research is needed to identify and understand factors that may explain the changing nature and level of need among children with a disorder.

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.

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.

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.

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.

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.

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.

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).

Responses to the Strengths and Difficulties Questionnaire predict HbA1c trajectories in children and adolescents with type 1 diabetes: a population-based study

IntroductionWe aimed to determine whether caregiver responses to the Strengths and Difficulties Questionnaire (SDQ) are predictive of HbA1c trajectory membership in children and adolescents with type 1 diabetes, when adjusting...

Behavior Problems in Low-Income Young Children Screened in Pediatric Primary Care

Screening of behavior problems in young children in pediatric primary care is essential to timely intervention and optimizing trajectories for social-emotional development. Identifying differential behavior problem trajectories provides guidance for tailoring prevention and treatment. To identify trajectories of behavior problems in children 2 to 6 years of age screened in pediatric primary care. This retrospective cohort study identified trajectories of behavior problems and demographic and clinical correlates. Data were collected as part of routine care in 3 pediatric primary care offices and 3 school-based health centers in Ohio serving a primarily low-income population. In total, 15 218 children aged 2 to 6 years with well-child visits between July 13, 2016, and January 31, 2022, were included. Caregivers completed the Strengths and Difficulties Questionnaire (SDQ) at annual well-child visits. Trajectory groups were identified using latent growth mixture modeling of SDQ total difficulties scores, and relative risk ratio (RRR) of various demographic (eg, race) and clinical (eg, depression in caregiver) variables were assessed by multinomial logistic regression analysis. Of 15 281 children (51.3% males), 10 410 (68.1%) were African American or Black, 299 (2.0%) were Asian, 13 (0.1%) were American Indian or Alaska Native, 876 (5.7%) were multiracial, 26 (0.2%) were Native Hawaiian and Other Pacific Islander, 2829 (18.5%) were White, and 39 (0.02%) were categorized as other. In addition, 944 (6.2%) identified as Hispanic and 14 246 (93.2%) as non-Hispanic. Four behavior problem trajectory groups reflecting severity were identified: low-stable (LS; 10 096 [66.1%]), moderate-decreasing (MD; 16.6%), low-increasing (LI; 13.1%), and high-increasing (HI; 4.3%). Relative to the LS group, patients in each elevated group were more likely to be male (HI RRR, 1.87 [95% CI, 1.55-2.26]; MD RRR, 1.55 [95% CI, 1.41-1.71]; and LI RRR, 1.94 [95% CI, 1.70-2.21]), White (HI RRR, 2.27 [95% CI, 1.83-2.81]; MD RRR, 1.28 [95% CI, 1.13-1.45]; and LI RRR, 1.54, [95% CI, 1.32-1.81]), publicly insured (HI RRR, 0.49 [95% CI, 0.28-0.84]; MD RRR, 0.56 [95% CI, 0.43-0.73]; and LI RRR, 0.50 [95% CI, 0.35-0.73]), have a social need (HI RRR, 3.07 [95% CI, 2.53-3.73]; MD RRR, 2.02 [95% CI, 1.82-2.25]; and LI RRR, 2.12 [95% CI, 1.84-2.44]), and have a caregiver with depression (HI RRR, 1.66 [95% CI, 1.38-2.00]; MD RRR, 1.44 [95% CI, 1.31-1.58]; and LI RRR, 1.39 [95% CI, 1.23-1.58]). Relative to the LI group, patients in the MD group were less likely to be male (RRR, 0.80; 95% CI, 0.68-0.93). The substantial portion of young children with increased behavior problems observed in this cohort study underscores the need for screening in pediatric primary care. Caregivers with depression and family social needs warrant prioritization in early prevention and treatment to alter elevated trajectories.

Effects of the COVID-19 Pandemic on the Risk of Developing Psychopathology in Children in Portugal: A Cross-Section Study

Introduction: This study is based on preliminary data from a 2021 survey of parents of children aged 3-13 years atthe time of SARS-CoV-2 infection. The aim is to understand the consequences of SARS-CoV-2 infection on children's mental health. Methods: Using the Strengths and Difficulties Questionnaire (SDQ) and survey data, we specified multiple linear regression models to explain the variation in the total SDQ and the variation in its five components ‐ emotional symptoms, conduct problems, hyperactivity, peer relationship problems, and prosocial behaviour. We used explanatory variables selected according to current literature and other empirical studies, such as age, gender, household changes, confinement, hospitalization time, previous mental health care and long‐COVID symptoms (headache, sleep problems, concentration problems, fatigue). Results: The results showed that age was not statistically significant in any of the estimated models. The gender variable proved to be significant in three models (total SDQ, conduct problems, hyperactivity) and the results show that girls have fewer problems when compared to boys.Conclusion: Results suggest that intensive care hospitalisation and long-COVID symptoms increase the risk of psychopathology.

A prospective analysis of physical activity and mental health in children: the GECKO Drenthe cohort

BackgroundMental health problems in young people have become a global health burden. The positive effects of physical activity on mental health in adults are well known but still not clear in children. The aim of this study was to investigate to what extent physical activity in early childhood would affect mental health in middle childhood.MethodsFrom the Dutch GECKO Drenthe birth cohort, 850 children (51.5% boys) were enrolled in this analysis. Physical activity and sedentary time were measured at age 5–6 using ActiGraph GT3X. Mental health was assessed using the Strengths and Difficulties Questionnaire (SDQ) at age 5–6 and age 10–11. Multiple linear regression models were used to estimate the associations between physical activity, sedentary time and SDQ subscales, stratified by gender, adjusting for age, BMI, maternal education level, family size, accelerometer wear time and season, and additionally adjusting for SDQ scores at age 5–6 to take tracking of mental health over time into account.ResultsGreater physical activity volume at age 5–6 was associated with lower peer problems scores at age 10–11 in boys and girls. An increase in MVPA was associated with lower peer problems scores in boys (b = -0.445, -0.713 to -0.176) and girls (b = -0.354, -0.601 to -0.107), however, increased sedentary time was linked to higher peer problems scores in boys (b = 1.18, 0.455 to 1.906) and girls (b = 0.870, 0.191 to 1.550). For hyperactivity, higher levels of physical activity volume and MVPA were associated with higher hyperactivity scores in boys. Increased sedentary time was related to lower hyperactivity scores in boys. Further adjustment for SDQ scores at age 5–6 attenuated associations between physical activity and hyperactivity in boys but hardly changed the relationships with peer problems. No significant associations between physical activity and other SDQ subscales or total difficulties scores were observed, neither in boys nor in girls.ConclusionsChildren who are more physically active at age 5–6 have fewer peer problems at age 10–11, and for boys, greater activity levels at age 5–6 could be an indicator of hyperactivity at age 10–11.

51 Mental Health Trajectories of Children and Caregivers who Accessed School-based Health Centres during the COVID-19 Pandemic

Abstract Background School-based health centres (SBHCs) improve health care access for students with mental health concerns, especially for disadvantaged communities who face access barriers. During the pandemic, health care access was restricted; however our SBHCs remained accessible. How SBHCs supported children’s and parents’/caregivers’ mental health during the pandemic is unclear. Objectives The primary objective of this study was to compare the trajectory of mental health symptoms in children who used SBHCs during the pandemic compared to those who did not. Design/Methods This was a prospective longitudinal cohort study of children who used SBHCs serving disadvantaged children with developmental and mental health conditions. A mental health survey which included the Strengths and Difficulties Questionnaire (SDQ) and the Generalized Anxiety Disorder-7 (GAD-7) was used at three time points during the pandemic for children registered with SBHCs. The primary analysis compared the trajectory of SDQ scores over time between children who accessed the SBHCs during the pandemic and those that did not. The secondary analysis was the same, using the GAD-7 scores for parents/caregivers. Results There were 435 children included in the study. The mean age was 10.7 years (SD=3.2). Two hundred and ninety-five children (67.8%) identified as male. One hundred and twenty-eight (29.4%) children had an annual family income of less than $30,000.00. After adjusting for age, gender, and diagnoses, children who attended SBHCs had higher SDQ scores over time relative to children who did not (0.15, 95% CI 0.03 to 0.28, p=0.02). Specifically, the total SDQ score increased by 0.14 (95% CI: 0.02, 0.27; p = 0.03) per month in those who accessed SBHCs during the pandemic, while the change in total SDQ score per month was -0.01 (95% CI: -0.06, 0.03; p = 0.55) in those who did not. Parents of children who attended SBHCs also had higher GAD-7 scores over time (0.16, 95% CI = 0.06 to 0.27, p = 0.002) compared with those whose children did not visit the SBHCs. Conclusion Mental health symptoms and anxiety symptoms worsened among children and parents/caregivers who attended a SBHC at least once during the pandemic. SBHCs may have decreased access barriers for children and parents/caregivers with socioeconomic risk factors who experienced mental health symptoms during the pandemic, when other healthcare options were limited. Longitudinal studies with longer follow up would help determine the role of SBHCs in supporting at-risk children and parents/caregivers with mental health needs during the pandemic.

Validating existing clinical cut-points for the parent-reported Strengths and Difficulties Questionnaire in a large sample of Canadian children and youth.

The Strengths and Difficulties Questionnaire (SDQ), for assessing behavioural and emotional difficulties, has been used internationally as a screening measure for mental health problems. Our objective was to validate the existing (British) SDQ cut-points in a sample of Canadian children and youth, and develop new Canadian SDQ cut-points if needed. This study includes data from children and youth aged 6 to 17 years from the Canadian Health Measures Survey (n = 3435) and outpatient records from the Children's Hospital of Eastern Ontario (n = 1075). The parent-reported SDQ data were collected. We adjusted the existing SDQ cut-points using a distributional and receiver-operating characteristic (ROC) curve approach. We subsequently calculated the sensitivity, specificity and diagnostic odds ratio of the existing and new SDQ clinical cut-points to determine whether the new cut-points had better clinical utility, using both analytic approaches. Our data show differences in the screening effectiveness between the existing British and the Canadian-specific clinical cut-points. Specificity is maximized using the Canadian distributional cut-points, improving the likelihood of identifying true negative results. The total SDQ score met the threshold for clinical utility (diagnostic odds ratio > 20) using both the existing and new cut-points; however, the individual scales did not reach clinical utility threshold using either cut-points. Future Canadian SDQ research should consider the new cut-points derived from our study population and the existing British cut-points to allow for historical and international comparisons.

Comparing behavioural outcomes in children born extremely preterm between 2006 and 1995: the EPICure studies.

Children born extremely preterm (EP) are at increased risk of neurocognitive and behavioural morbidity. Here, we investigate whether behavioural outcomes have changed over time concomitant with increasing survival following EP birth. Comparison of outcomes at 11years of age for two prospective national cohorts of children born EP in 1995 (EPICure) and 2006 (EPICure2), assessed alongside term-born children. Behavioural outcomes were assessed using the parent-completed Strengths and Difficulties Questionnaire (SDQ), DuPaul Attention-Deficit/Hyperactivity Disorder Rating Scale (ADHD-RS), and Social Communication Questionnaire (SCQ). In EPICure, 176 EP and 153 term-born children were assessed (mean age: 10.9years); in EPICure2, 112 EP and 143 term-born children were assessed (mean age: 11.8years). In both cohorts, EP children had higher mean scores and more clinically significant difficulties than term-born children on almost all measures. Comparing outcomes for EP children in the two cohorts, there were no significant differences in mean scores or in the proportion of children with clinically significant difficulties after adjustment for confounders. Using term-born children as reference, EP children in EPICure2 had significantly higher SDQ total difficulties and ADHD-RS hyperactivity impulsivity z-scores than EP children in EPICure. Behavioural outcomes have not improved for EP children born in 2006 compared with those born in 1995. Relative to term-born peers, EP children born in 2006 had worse outcomes than those born in 1995. There is an ongoing need for long-term clinical follow-up and psychological support for children born EP.

Mediterranean Dietary Pattern and Psychosocial Health Problems in Spanish Adolescents: The EHDLA Study.

The aims of the present study were twofold: to determine the association between adherence to the Mediterranean diet (MedDiet) and psychological problems and to assess the relationship between different food groups of the MedDiet and different patterns of psychosocial health problems in a sample of Spanish adolescents from the Valle de Ricote (Region of Murcia, Spain). This cross-sectional study included a representative sample of 700 adolescents (57% girls) between 12 and 17 years of age. Adherence to the MedDiet was assessed by the Mediterranean Diet Quality Index for Children and Teenagers (KIDMED). Psychosocial health problems were measured by the 25-item self-report version of the Strengths and Difficulties Questionnaire (SDQ). ANCOVA models were used to test the mean differences in psychosocial health problems (SDQ subscales) by adherence to MedDiet categories (low, medium, and high). Multiple linear regression was used to determine the association between different food groups of the MedDiet and psychosocial health problems. Adolescents with low adherence to the MedDiet had significantly higher scores in SDQ total difficulties, conduct problems, and hyperactivity problems and lower scores in pro-social behavior (p < 0.05) than their peers with medium and high adherence to the MedDiet. In relation to specific MedDiet food groups, fruit, nut, and legume intake were associated with higher psychosocial health. However, sweets, skipping breakfast, or high consumption of pasta or rice (≥5 weeks) were associated to higher psychosocial health problems. Our results show that adolescents with higher adherence to the MedDiet could benefit from greater psychosocial health. Individually, some patterns of MedDiet, such as fruit, nut, and legume intake, may reduce psychosocial health problems. These cross-sectional results should be confirmed in longitudinal and intervention studies.

Gaming among female adolescents: profiling and psychopathological characteristics in the Indian context.

Gaming is a predominant leisure time activity among adolescents, and the literature suggests that unrestrained gaming behavior might lead to gaming disorder. ICD-11 and DSM-5 have recognized gaming disorder as a psychiatric condition and grouped it under the behavioral addiction category. Research on gaming behavior and addiction is largely based on data from the male population, and problematic gaming has largely been understood from the male perspective. In this study, we are attempting to bridge the existing lacuna in the literature by exploring gaming behavior, gaming disorder, and its related psychopathological characteristics among female adolescents in India. The study was conducted on a sample of 707 female adolescent participants who were contacted through schools and academic institutes in a city in Southern India. The study adopted a cross-sectional survey design, and data were administered using the mixed modality of online and offline data collection. The participants filled out the following set of questionnaires: socio-demographic sheet, Internet Gaming Disorder Scale-Short-Form (IGDS9-SF), Strength and Difficulties Questionnaire (SDQ), Rosenberg self-esteem scale, and Brief sensation-seeking scale (BSSS-8). The data gathered from the participants were then statistically analyzed using SPSS software version 26. The descriptive statistics revealed that 0.8% of the sample (i.e., five participants out of 707) obtained scores meeting gaming addiction criteria. Correlation analysis demonstrated a significant relationship between all the psychological variables with total IGD scale scores (p < 0.05). Total SDQ, total BSSS-8, and domain scores of SDQ, such as emotional symptoms, conduct, hyperactivity, and peer problems, were positively correlated, whereas total Rosenberg scores and domain scores of prosocial behaviors of SDQ were negatively correlated. The Mann-Whitney U-test was employed to compare "with gaming disorder" and "without gaming disorder" categories of female participants. Comparing these two groups revealed significant differences in emotional symptoms, conduct, hyperactivity/inattention, peer problem, and self-esteem scale scores. Furthermore, quantile regression was computed, showing that conduct, peer problem, and self-esteem displayed trend-level prediction for gaming disorder. Female adolescents prone to gaming addiction can be identified through psychopathological characteristics of conduct, peer problem, and low self-esteem. This understanding can be useful in developing a theoretical model focusing on early screening and preventive strategies for at-risk female adolescents.

Mental Wellbeing among Children with Cancer during COVID-19 Pandemic in Indonesia: A Cross-sectional Study

Abstract Introduction Coronavirus disease 2019 (COVID-19) has affected both physical and mental aspect of people worldwide, especially the high-risk group such as pediatric cancer patients. Children with cancer were considered both clinically and mentally vulnerable during this pandemic. They were also affected by the self-isolation, quarantine, and social distancing policy taken as a respond to public threat. Objectives To evaluate the impact of social distancing and health protocol during COVID-19 on the mental health profile of children with cancer in Indonesia. Methods A cross-sectional study evaluating the mental health of children with cancer during COVID-19 pandemic was conducted in Cipto Mangunkusumo Hospital, Jakarta, Indonesia from June to September 2020. An online questionnaire was used to collect demographics of parents and children, children's Strength and Difficulties Questionnaire (SDQ) score, and parents' Self-Reporting Questionnaire (SRQ). SDQ score consists of five subscales, including the emotional symptoms, conduct problems, hyperactivity, peer relationships problems and prosocial behavior. Cancer types were grouped into retinoblastoma, nonretinoblastoma (other solid tumors), and leukemia. Results There were 156 valid responses, consisting of 42 patients with retinoblastoma, 34 patients with nonretinoblastoma (other solid tumors), and 80 patients with leukemia. Pandemic-related lifestyle changes did not significantly impact emotional or behavioral problems. Children with normal total SDQ (odds ratio [OR]: 473, p = 0.001) and emotional scores (OR: 3.19, p = 0.07) had parents with normal SRQ scores (&lt;6). Leukemia patients with shorter diagnosis period had worse hyperactivity score (p = 0.01). On the contrary, leukemia inpatients had better prosocial scores than outpatients (p = 0.03). More bilateral retinoblastoma patients (p = 0.04) with longer duration of cancer diagnosis (p = 0.03) faced peer problems. Conclusions Our study revealed that lifestyle changes during early COVID-19 pandemic were not major factors impacting emotional and behavioral problems in children with cancer. However, disease-related factors pose great challenges; thus, a holistic mental health support system should be available to both children and parents.