Strengths And Difficulties Questionnaire Total Score Research Articles

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

Abstract 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 (χ² = 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.

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.

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.

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.

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).

Greenlandic norms for the parent-report and self-report versions of the Strengths and Difficulties Questionnaire (SDQ)

ABSTRACT The Strengths and Difficulties Questionnaire (SDQ) is a brief screening questionnaire of child behaviour, used to evaluate mental health. It is applicable for children 2–17 years, available to both parents and professionals, and exists in a self-report version available from the age of 11 years. This paper aims to generate Greenlandic norms on the self-report and parent-report versions of the SDQ. In 2023, the self-report version was translated, and a representative sample of children and adolescents completed the SDQ (N = 641). In 2008, the parent-report version was translated into Greenlandic and used in a study of children’s well-being (N = 939). Data from both samples were analysed, generating normative scores. Results show significant differences between genders (effect sizes of .006-.145), and discrepancies between parent and self-report. Parents report higher total problems for boys, while self-reporting indicate higher total problems for girls. Cut-off values are higher for self-report norms than parent-report norms. Mean scores on the SDQ total score and subscales differ across age, area of living, caregiver constellation and caregiver’s educational level (effect sizes of .011–.064). With the availability of Greenlandic norms, we anticipate further use of the SDQ in clinical practice and research settings, strengthening screening and assessment of children and adolescents.

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.

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.

Multifamily therapy for adolescent eating disorders: a study of the change in eating disorder symptoms from start of treatment to follow-up

BackgroundThis study aimed to evaluate multifamily therapy (MFT) for adolescents with eating disorders (EDs) in a clinical setting, by presenting the outcome of families participating in this treatment at a specialist ED service. MFT was an adjunct to treatment at local mental health services. In particular, the study aimed to present the change in eating disorder symptoms and psychological distress from before to after treatment and at a 6 months follow-up.MethodsParticipants were 207 adolescents receiving outpatient MFT (10 or 5 months) at Oslo University Hospital in Norway between 2009 and 2022. Adolescents had heterogeneous ED presentations, with a preponderance of anorexia nervosa (AN) and atypical AN. All participants completed pre- and post-treatment questionnaires [The eating disorder examination questionnaire (EDE-Q) and the strengths and difficulties questionnaire (SDQ)]. 142 adolescents additionally completed the same questionnaires at 6 months follow-up. Weight and height were measured at all time points.ResultsLinear mixed model analyses showed that from start of treatment to follow-up, there was a significant increase in BMI percentile (p < 0.001) and a significant decrease in EDE-Q global score (p < 0.001) and SDQ total score (p < 0.001).ConclusionsThe study shows that adolescents with an eating disorder who received adjunct outpatient MFT in a real world clinical setting, experienced reductions in ED symptoms comparable to that found in a randomized controlled trial.Trial registration: The data used in this study was collected as part of routine clinical procedures for quality assurance and trial registration is therefore not required.

Characterization of Premigration and Postmigration Multidomain Factors and Psychosocial Health Among Refugee Children and Adolescents After Resettlement in Australia

A better understanding of the psychosocial health of resettled child and adolescent refugees and associated premigration and postmigration factors may help this population integrate effectively. To estimate the associations of premigration and postmigration multidomain factors with psychosocial health after resettlement among young refugees of different ages. This cross-sectional study used wave 3 data from the Building a New Life in Australia (BNLA) cohort study, as they represented the first time a BNLA study included a child module targeting children and adolescents in the migrating unit as a nested component of the broader study. The study population consisted of children aged 5 to 10 years and adolescents aged 11 to 17 years. The caregivers of the children, the adolescents themselves, and the adolescents' caregivers were invited to complete the child module. Wave 3 data were collected from October 1, 2015, to February 29, 2016. Statistical analysis was performed from May 10 to September 21, 2022. Premigration and postmigration multidomain factors, including individual (child and caregiver), family, school, and community levels, were measured. Social and emotional adjustment and posttraumatic stress disorder (PTSD) were the dependent variables measured by the Strengths and Difficulties Questionnaire (SDQ) and an 8-item PTSD scale. Weighted multilevel linear or logistic regression models were used. Of the 220 children aged 5 to 10 years (mean [SD] age, 7.4 [2.0] years), 117 (53.2%) were boys; of the 412 adolescents aged 11 to 17 years (mean [SD] age, 14.1 [2.0] years), 215 (52.2%) were boys. Among the children, compared with no exposure, exposure to premigration traumatic events (β = 2.68 [95% CI, 0.51-4.85]) and having family conflicts after resettlement (β = 6.30 [95% CI, 2.97-9.64]) were positively associated with SDQ total difficulties score; school achievement was negatively associated with SDQ total difficulties score (β = -5.02 [95% CI, -9.17 to -0.87]). Among the adolescents, being treated unfairly (β = 3.32 [95% CI, 1.41-5.22]) and parenting harshness after resettlement (β = 0.25 [95% CI, 0.11-0.40]) were positively associated with SDQ total difficulties score; engagement in extracurricular activities (β = -3.67 [95% CI, -6.83 to -0.50]) was negatively associated with SDQ total difficulties score. Exposure to premigration traumatic events (adjusted odds ratio [aOR], 2.49 [95% CI, 1.10-5.63]), being treated unfairly (aOR, 3.77 [95% CI, 1.60-8.91]), and facing English language barriers (aOR, 6.41 [95% CI, 1.98-20.79]) after resettlement were positively associated with the presence of PTSD. In this study of refugee children and adolescents, apart from premigration traumatic experiences, several postmigration family- and school-related factors and social integration factors were associated with psychosocial health after resettlement. The findings suggest that family- and school-centered psychosocial care and social integration programs targeting related stressors merit increased attention for improving the psychosocial health of refugee children and adolescents after resettlement.

Parental Recreational Screen Media Practices and Behavioral Difficulties Among Danish 7-Year-Old Children.

This study aimed to investigate the association of parental recreational screen media practices, including time use and level of smartphone addiction, with behavioral difficulties in 7-year-old children. The study was based on cross-sectional data from the Odense Child Cohort, a community-based birth-cohort study. A total of 1152 parent-child dyads with complete data were included based on data from the 7-year examination conducted in 2018-21. Parental recreational screen use was self-reported as hours/day using the SCREENS-questionnaire, and their smartphone addiction was self-reported using the Smartphone Addiction Scale Short Version. Child behavioral difficulties were assessed by the parent-reported version of the Strengths and Difficulties Questionnaire (SDQ). Parental recreational screen time was not consistently associated with behavioral difficulty SDQ subscales and total difficulty scores when adjusted for other determinants of child mental well-being such as sociodemographic factors, parental well-being, and number of siblings. Children had higher total behavioral difficulty scores (adjusted mean difference 2.12 (95% CI, 1.19-3.05)) when comparing fourth quartile versus first quartile of maternal smartphone addiction score. Also, higher maternal smartphone addiction scores were associated with more externalizing and internalizing behavioral problems of their child (adjusted mean difference 1.61 points (95% CI, 0.95-2.27), and 0.81 points (95% CI, 0.19-1.43)) for fourth quartile versus first quartile, respectively. No cross-sectional association was found between total parental recreational screen use and behavioral difficulties in their 7-year-old children, but an association between maternal obsessive smartphone use and behavioral difficulties of their children was found.

Patterns of parent screen use, child screen time, and child socio-emotional problems at 5 years.

Digital media screens have become an essential part of our family life. However, we have insufficient knowledge about parental screen use patterns and how these affect children's socio-emotional development. In total, 867 Canadian parents of 5-year-old children from the TARGet Kids! Cohort (73.1% mothers, mean ± SD age=38.88 ± 4.45 years) participated in this study from 2014 to the end of 2019. Parents reported parental and child time on television (TV) and handheld devices and completed the Strengths and Difficulties Questionnaire (SDQ). Latent profile analysis identified six latent profiles of parent screen use: low handheld users (P1, reference; n=323), more TV than handheld (P2; n=261), equal TV and handheld (P3; n=177), more handheld than TV (P4; n=57), high TV and handheld (P5; n=38), and extremely high TV and handheld (P6; n=11). Parents that were more likely to belong to P6 were also more likely to be living in single-parent households compared to P1 (estimate=-1.49 ± 0.70), p=.03). High membership probability for P2 (estimate=-0.67 ± 0.32, p=.04) and P4 (estimate=-1.42 ± 0.40, p < 0.001) was associated with lower household income compared to P1. Children of parents with higher P4 (χ2 =12.32, p < 0.001) or P5 (χ2 =9.54, p=.002) membership probability had higher total screen time compared to P1. Finally, a higher likelihood to belong to P6 (χ2 =6.82, p=.009) was associated with a higher SDQ Total Difficulties Score compared to P1. Thus, patterns of parent screen use were associated with child screen use and child socio-emotional problems. The emerging link between parental screen use profiles and child behaviors suggests the need for more research on parent screen time.

Emotional and behavioural outcomes at 8 years of age in preterm-born children: A longitudinal study.

To evaluate the predictive value of perinatal factors and neurodevelopmental evaluation in the emotional and behavioural outcomes in preterm-born children at 7-9 years of age. We evaluated the Strengths and Difficulties Questionnaire (SDQ) extended score at 8.2± 0.2 years, among 70 preterm-born children (32 early and 38 moderately preterms) with a previous Bayley-III neurodevelopmental evaluation. Early compared to moderately preterms had a higher total SDQ (12 compared to 8, p= 0.031), and emotional symptoms score (4 compared to 3, p= 0.022); no significant differences were recorded in abnormal/borderline-scored children between the two groups. The total SDQ and emotional symptoms scores were significantly correlated with gestational age, birth weight, perinatal factors and the cognitive and motor Bayley-III scores. Early prematurity was associated with the total SDQ score (beta 2.09, 95% CI 1.32, 3.87), and the score of emotional symptoms (beta 1.70, 95% CI 1.38, 2.19), after adjusting for sex, neonatal sepsis and the existence of an older sibling. Prematurity, birth weight, perinatal factors and the cognitive and motor Bayley-III scores were significantly associated with the total SDQ and the emotional symptoms score, in preterm-born children.