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Validating Screening Tool in Malayalam for Mental Disorders

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Valid screening tools are needed to identify Indian children and adolescents with mental health problems, both for clinical or research purposes. The present study validated the Strengths and Difficulties Questionnaire (SDQ) in Malayalam across different informants and sub-scales.


A sample of 150 children and adolescents seen in a psychiatric clinic for children in Kerala, India was compared to a community sample of 1984 children from six surrounding urban and rural districts. Children in clinic and community samples were screened with the parent-report SDQ; those over 11 y completed the self-report SDQ. The community sample was also screened with the teacher-report SDQ and the clinical sample received formal diagnoses from a child psychiatrist blind to SDQ scores. The discriminative validity of the SDQ was investigated using Receiver Operator Characteristic (ROC) curves and by assessing Area Under the Curve (AUC).


The SDQ discriminated reliably between clinical and community samples for the SDQ total score and its subscales. Within the clinic sample, 49 % of patients qualified for more than one broad diagnostic grouping. The SDQ discriminated between diagnostic categories in the clinic sample, but did so most effectively for conduct disorders. Based on the cut-offs that generated the highest combined value of sensitivity and specificity, the estimated rate of psychiatric disorder in the community sample was 13.6 % (parent-report) and 7.3 % (self-report).


The SDQ is a useful screening tool for child and adolescent mental disorders for Malayalam speakers in Kerala, India.

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  1. Bird HR, Canino G, Rubio-Stipec M, et al. Estimates of the prevalence of childhood maladjustment in a community survey in Puerto Rico. The use of combined measures. Arch Gen Psychiatry. 1988;45:1120–6.

    Article  CAS  PubMed  Google Scholar 

  2. Canino G, Shrout PE, Rubio-Stipec M, et al. The DSM-IV rates of child and adolescent disorders in Puerto Rico: prevalence, correlates, service use, and the effects of impairment. Arch Gen Psychiatry. 2004;61:85–93.

    Article  PubMed  Google Scholar 

  3. Fleitlich-Bilyk B, Goodman R. Prevalence of child and adolescent psychiatric disorders in southeast Brazil. J Am Acad Child Adolesc Psychiatry. 2004;43:727–34.

    Article  PubMed  Google Scholar 

  4. Hackett R, Hackett L. Child psychiatry across cultures. Int Rev Psychiatry. 1999;11:225–35.

    Article  Google Scholar 

  5. Hackett R, Hackett L, Bhakta P, Gowers S. The prevalence and associations of psychiatric disorder in children in Kerala, South India. J Child Psychol Psychiatry. 1999;40:801–7.

    Article  CAS  PubMed  Google Scholar 

  6. Pillai A, Patel V, Cardozo P, Goodman R, Weiss HA, Andrew G. Non-traditional lifestyles and prevalence of mental disorders in adolescents in Goa, India. Br J Psychiatry. 2008;192:45–51.

    Article  PubMed  Google Scholar 

  7. Belfer ML. Child and adolescent mental disorders: the magnitude of the problem across the globe. J Child Psychol Psychiatry. 2008;49:226–36.

    Article  PubMed  Google Scholar 

  8. Timimi S, Taylor E. ADHD is best understood as a cultural construct. Br J Psychiatry. 2004;184:8–9.

    Article  PubMed  Google Scholar 

  9. Leung PW, Luk SL, Ho TP, Taylor E, Mak FL, Bacon-Shone J. The diagnosis and prevalence of hyperactivity in Chinese schoolboys. Br J Psychiatry. 1996;168:486–96.

    Article  CAS  PubMed  Google Scholar 

  10. Polanczyk G, de Lima MS, Horta BL, Biedermann J, Rohde LA. The worldwide prevalence of ADHD: a systematic review and metaregression analysis. Am J Psychiatry. 2007;164:942–8.

    Article  PubMed  Google Scholar 

  11. Cortina MA, Sodha A, Fazel M, Ramchandani PG. Prevalence of child mental health problems in sub-Saharan Africa: a systematic review. Arch Pediatr Adolesc Med. 2012;166:276–81.

    Article  PubMed  Google Scholar 

  12. Rutter M, Graham P. The reliability and validity of psychiatric assessment of child: I. Interview with the child. Br J Psychiatry. 1968;114:563–79.

    Article  CAS  PubMed  Google Scholar 

  13. Graham P, Rutter M. The reliability and validity of psychiatric assessment of child: II. Interview with the parent. Br J Psychiatry. 1968;114:581–92.

    Article  CAS  PubMed  Google Scholar 

  14. Goodman R. The strengths and difficulties questionnaire: a research note. J Child Psychol Psychiatry. 1997;38:581–6.

    Article  CAS  PubMed  Google Scholar 

  15. Goodman R, Meltzer H, Bailey V. The strengths and difficulties questionnaire: a pilot study on the validity of the self-report version. Eur Child Adolesc Psychiatry. 1998;7:125–30.

    Article  CAS  PubMed  Google Scholar 

  16. Goodman R. The extended version of the strengths and difficulties questionnaire as a guide to child psychiatric caseness and consequent burden. J Child Psychol Psychiatry. 1999;40:791–9.

    Article  CAS  PubMed  Google Scholar 

  17. Goodman R, Scott S. Comparing the strengths and difficulties questionnaire and the child behavior checklist: is small beautiful? J Abnorm Child Psychol. 1999;27:17–24.

    Article  CAS  PubMed  Google Scholar 

  18. WHO, ICD-10, Vol. 3. International statistical classification of diseases and related health problems: Alphabetical index, 10th ed. Geneva, Switzerland: WHO{a}; 1994. p. iii + 750.

  19. Goodman A, Patel V, Leon DA. Why do British Indian children have an apparent mental health advantage? J Child Psychol Psychiatry. 2010;51:1171–83.

    Article  PubMed Central  PubMed  Google Scholar 

  20. Ho TP, Leung PWL, Luk ES, Taylor E, Bacon-Shone J, Mak FL. Establishing the constructs of childhood behavioral disturbances in a Chinese population: a questionnaire study. J Abnorm Child Psychol. 1996;24:417–31.

    Article  CAS  PubMed  Google Scholar 

  21. Sen A. Mortality as an indicator of economic success and failure. Econ J. 1998;108:1–25.

    Article  Google Scholar 

  22. Goodman R. Psychometric properties of the strengths and difficulties questionnaire. J Am Acad Child Adolesc Psychiatry. 2001;40:1337–45.

    Article  CAS  PubMed  Google Scholar 

  23. Achenbach TM, McConaughy SH, Howell CT. Child/adolescent behavioral and emotional problems: implications of cross-informant correlations for situational specificity. Psychol Bull. 1987;101:213–32.

    Article  CAS  PubMed  Google Scholar 

  24. Alyahri A, Goodman R. Harsh corporal punishment of Yemeni children: occurrence, type and associations. Child Abuse Negl. 2008;32:766–73.

    Article  PubMed  Google Scholar 

  25. Mullick MS, Goodman R. The prevalence of psychiatric disorders among 5–10 year olds in rural, urban and slum areas in Bangladesh: an exploratory study. Soc Psychiatry Psychiatr Epidemiol. 2005;40:663–71.

    Article  PubMed  Google Scholar 

  26. Woerner W, Becker A, Rothenberger A. Normative data and scale properties of the German parent SDQ. Eur Child Adolesc Psychiatry. 2004;13:II3–10.

    PubMed  Google Scholar 

  27. Beecham J. Annual research review: child and adolescent mental health interventions: a review of progress in economic studies across different disorders. J Child Psychol Psychiatry. 2014;55:714–32.

    Article  PubMed  Google Scholar 

  28. Snell T, Knapp M, Healey A, et al. Economic impact of childhood psychiatric disorder on public sector services in Britain: estimates from national survey data. J Child Psychol Psychiatry. 2013;54:977–85.

    Article  PubMed  Google Scholar 

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The authors wish to acknowledge the support and help of Mr. M.S.S Mohan, Miss Roshin Sudesh, and Dr. Sudeshni Mirza, Hopes and Dreams foundation, Kerala, India for their input into data collection, data entry and other logistic support.


JPO and RG analysed the data and produced the manuscript. KAHM and RG designed the protocol, gained ethical approval, translated the SDQ and supervised data collection. KAHM reviewed the manuscript. RG will act as guarantor for this paper.

Conflict of Interest

RG is the owner of Youthinmind Ltd that produces no-cost and low-cost websites relating to the Strengths and Difficulties Questionnaire.

Source of Funding

Departmental funds.

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Correspondence to Robert Goodman.

Additional information

Jacqueline A. Phillips Owen and K. A. H. Mirza are joint first authors

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Phillips Owen, J.A., Mirza, K.A.H. & Goodman, R. Validating Screening Tool in Malayalam for Mental Disorders. Indian J Pediatr 82, 595–600 (2015).

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