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Concurrent Validity of the Strengths and Difficulties Questionnaire in an Indigenous Pre-School Population

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Abstract

The strengths and difficulties questionnaire (SDQ) is a frequently used tool for universal screening of pre-schoolers’ behavioural and emotional problems. However, evidence for its concurrent validity is equivocal and has not been tested in a Māori population. We aimed to evaluate the concurrent validity of the strengths and difficulties questionnaire (SDQ) in Māori pre-schoolers (tamariki), aged 4 and 5. We carried out a prospective study of 225 tamariki (46% female) for whom a recent SDQ was available from the New Zealand Ministry of Health’s Before School Check database. A trained nurse carried out a standardised wellbeing and behavioural assessment for these children. Sensitivity, specificity, positive predictive and negative predictive values were calculated, using optimal total difficulty scale threshold values published for the SDQ (parent version SDQ-P; teacher version SDQ-T). Primary outcome: an assessment-based child referral to Child and Adolescent Mental Health Services or to a Paediatric outpatient service. Secondary outcomes: assessment-based parental referral to a parenting programme and combined referral. The optimal thresholds for child referral were low for the SDQ-P (13) and SDQ-T (7). Child referral SDQ-P: sensitivity 62%, specificity 83%, positive predictive value 0.35, negative predictive value 0.94. Child referral SDQ-T: sensitivity 77%, specificity 78%, positive predictive value 0.31, negative predictive value 0.96. The findings demonstrate optimal threshold values for referral for Māori on the SDQ-P and SDQ-T are much lower when compared to published thresholds (17 vs. 16). Sensitivity values were also low. A surveillance approach for the assessment of psychosocial problems is recommended for pre-schoolers.

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Acknowledgements

We thank the tamariki, families and whānau in this study for their participation.

Funding

This study was supported by the Ministry of Health of New Zealand (grant number 341088). The views and opinions expressed in this article are those of the authors and do not necessarily reflect the official policy or position of the funder.

Author Contributions

PK: designed and executed the study, assisted with the data analyses, and wrote the paper. AV: analysed the data and wrote part of the results. HE: collaborated with the design and writing of the paper, and assisted with the nurse training and support. RT: assisted with recruitment and organising clinical visits. KM: collaborated with the design and writing of the paper and assisted with the nurse training and support.

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Correspondence to Paula Kersten.

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The authors declare that they have no conflict of interest.

Ethical Approval

The study was carried out in accordance with the 1964 Declaration of Helsinki and its later amendments. Ethics approval was gained from the Health and Disability Ethics Committee (ref: NTY/12/04/028) and University’s Ethics Committee (ref: 12/63). All study participants provided informed consent.

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Kersten, P., Vandal, A.C., Elder, H. et al. Concurrent Validity of the Strengths and Difficulties Questionnaire in an Indigenous Pre-School Population. J Child Fam Stud 26, 2126–2135 (2017). https://doi.org/10.1007/s10826-017-0725-5

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