Abstract
Background
Scientifically sound and valid information concerning course and prediction of mental health problems in children and adolescents in the general population is scarce, although needed for public mental health issues and daily clinical practice.
Objectives
The psychopathological profiles of children and adolescents were analysed using the parent version of the Strengths and Difficulties Questionnaire (SDQ-P) in a longitudinal setting, also investigating the predictive value of the SDQ-scores.
Methods
SDQ’s total psychopathological difficulties, emotional symptoms and hyperactivity-inattention scores of n = 630 children and adolescents (age 6–18;11 years) were examined along four assessment measurement points (T0–T3) over 6 years, using data from the BELLA study. According to the English normative data, the participants were categorized as “normal”, “borderline” or “abnormal” based on their SDQ-scores. Groups remaining within categories were descriptively determined by means of frequency analysis, a subsequent graphical evaluation displayed the transitions from T0 to T3 concerning the different categorical classifications. Finally, ordered probit regression was used to examine whether age, gender, socio-economic status (SES) and baseline impact-score (IS) correspond to the SDQ-predicted classification.
Results
As expected, low SES and high SDQ-IS were associated with significantly increased scores on all examined SDQ-scales. Regarding the long-term aspect of SDQ-scores it could be shown that most children and adolescents remained “normal” over a measurement period of 6 years, while only a small number of children and adolescents steadily remained “abnormal” or newly developed mental health problems, respectively. For example, on the “hyperactivity-inattention”-scale, only 1 % of the children and adolescents changed from “normal” to “abnormal” (T0–T3), whereas on the “emotional symptoms”-scale, 7 % changed from “normal” to “abnormal” (T0–T3). In general, the SDQ-category “borderline” and specifically the subscale “emotional symptoms” change in both directions. Abnormal SDQ-scores at baseline, SES, gender and IS were related to the prediction of the SDQ-sores at T3.
Conclusion
An SDQ-screening of children and adolescents may help for early detection, prediction and treatment planning. Also, these results may contribute to a better understanding of the course of mental health problems in childhood and concurrently may allow a better psychoeducation and prevention.




Similar content being viewed by others
Notes
Note that since we use ordered probit regression the standard interpretations of the parameters as log-odds cannot be applied.
It must be noted that these probabilities are constructed on point estimators of which some have sizeable standard errors. Consequently, the precision of the results obtained should be treated with the appropriate caution.
References
Achenbach TM, Edelbrock CS (1983) Manual for the child behavior checklist and revised child behavior profile. Quee City Printers Inc, Burlington
Achenbach T, Becker A, Döpfner M, Heiverang E, Roessner V, Steinhausen HC, Rothenberger A (2008) Multicultural assessment of child and adolescent psychopathology with ASEBA and SDQ instruments: research findings, applications and future directions. J Child Psychol Psychiatry 49:251–275
Anda RF, Brown DW, Dube SR, Bremner JD, Felitti VJ, Giles WH (2008) Adverse childhood experiences and chronic obstructive pulmonary disease in adults. Am J Prev Med 34:396–403
Barkmann C, Schulte-Markwort M (2012) Prevalence of emotional and behavioural disorders in German children and adolescents: a meta-analysis. J Epidemiol Community Health 66(3):194–203. doi:10.1136/jech.2009.102467
Becker A, Woerner W, Hasselhorn M, Banaschewski T, Rothenberger A (2004) Validation of the parent and teacher SDQ in a clinical sample. Eur Child Adolesc Psychiatry 13(2):11–16
Becker A, Steinhausen HC, Baldursson G, Dalsgaard S, Lorenzo MJ, Ralston SJ, Döpfner M, Rothenberger A (2006) Psychopathological screening of children with ADHD: Strengths and Difficulties Questionnaire in a pan-European study. Eur Child Adolesc Psychiatry 15(1):i56–i62
Bird HR (1996) Epidemiology of childhood disorders in a cross-cultural context. J Child Psychol Psychiatry 37(1):35–49
Costello EJ, Egger HL, Angold A (2005) 10-Year research update review: the epidemiology of child and adolescent psychiatric disorders: I. methods and public health burden. J Am Acad Child Adolesc Psychiatry 44:972–986
Dickey WC, Blumberg SJ (2004) Revisiting the factor structure of the Strengths and Difficulties Questionnaire: United States, 2001. J Am Acad Child Adolesc Psychiatry 43:1159–1167
Dube SR, Fairweather D, Pearson WS, Felitti VJ, Anda RF, Croft JB (2009) Cumulative childhood stress and autoimmune disease in adults. Psychosom Med 71:243–250
Efron B (1979) Bootstrap methods: another look at the Jackknife. Annal Stat 7(1):1–26
Felitti VJ (2002) The relation between adverse childhood experiences and adult health: turning gold into lead. Permanente J 6(1):44–47
Georgiou SN, Stavrinides P (2008) Bullies, victims and bully -victims: psychosocial profiles and attribution styles. School Psychol Int 29(5):574–589
Gómez-Beneyto M, Nolasco A, Moncho J, Pereyra-Zamora P, Tamayo-Fonseca N, Munarriz M, Salazar J, Tabarés-Seisdedos R, Girón M (2013) Psychometric behaviour of the strengths and difficulties questionnaire (SDQ) in the Spanish national health survey 2006. BMC Psychiatry 13(95):1–10
Goodman R (1997) The Strengths and Difficulties Questionnaire: a research note. J Child Psychol Psychiatry 38:581–586
Goodman R (2001) The psychometric properties of the Strengths and Difficulties Questionnaire. J Am Acad Child Adolesc Psychiatry 40:1337–1345
Goodman A, Lamping DL, Ploubidis GB (2010) When to use broader internalising and externalising subscales instead of the hypothesised five subscales on the Strengths and Difficulties Questionnaire (SDQ): data from British parents, teachers and children. J Abnorm Child Psychol 38(8):1179–1191
Harrington R, Rutter M, Fombonne E (1996) Developmental pathways in depression: multiple meanings, antecedents, and endpoints. Dev Psychopathol 8:601–616
Hölling H, Erhart M, Ravens-Sieberer U, Schlack R (2007) Verhaltensauffälligkeiten bei Kindern und Jugendlichen. Erste Ergebnisse aus dem Kinder- und Jugendgesundheitssurvey (KiGGS). Bundesgesundheitsblatt—Gesundheitsforschung—Gesundheitsschutz·50:84–793
Ihle W, Esser G (2002) Epidemiologie psychischer Störungen im Kindes- und Jugendalter: Prävalenz, Verlauf, Komorbidität und Geschlechtsunterschiede. Psychologische Rundschau 53(4):159–169 doi:10.1026//0033-3042.53.4.159
Ihle W, Frenzel T, Esser G (2006) Epidemiologie und Verlauf psychischer Störungen im Kindes- und Jugendalter. In: F. Mattejat (Hrsg) Lehrbuch der Psychotherapie. Band 4: Verhaltenstherapie mit Kindern, Jugendlichen und Familien S CIP Medien, München, 85–96
In-Albon T (2012) Aktueller stand internalisierender störungen im kindes- und jugendalter: sind sie aus den kinderschuhen ausgewachsen? Verhaltenstherapie 22:246–257
Klasen H, Woerner W, Rothenberger A, Goodman R (2003) Die deutsche Fassung des Strengths and Difficulties Questionnaire (SDQ-Deu)—Übersicht und Bewertung erster Validierungs- und Normierungsbefunde. Praxis der Kinderpsychologie und Kinderpsychiatrie 52:491–502
Koglin U, Barquero B, Mayer H, Scheithauer H, Petermann F (2007) Deutsche version des Strengths and Difficulties Questionnaire (SDQ-Deu): psychometrische Qualität der Lehrer-/Erzieherversion für Kindergartenkinder. Diagnostica 53(4):175–183
Lampert T, Bock M, Naber D, Löwe B, Schulte-Markwort M, Schäfer I, Gumz A (2013) Die psychische Gesundheit von Kindern, Jugendlichen und jungen Erwachsenen—Teil 1: Häufigkeit, Störungspersitenz, Belastungsfaktoren, Service-Inanspruchnahme und Behandlungsverzögerung mit Konsequenzen. Fortschritt in der Neurologischen Psychiatrie 81(11):614–627. doi:10.1055/s-0033-1355843
Laucht M, Esser G, Schmidt MH (2000) Externalisierende und internalisierende Störungen in der Kindheit: Untersuchungen zur Entwicklungspsychopathologie. Zeitschrift für Klinische Psychologie und Psychotherapie 29(4):284–292
Merikangas KR, Nakamura EF, Kessler RC (2009) Epidemiology of mental disorders in children. Dialogues in Clinical Neuroscience 11(1):7–20
Niclasen J, Teasdale TW, Andersen A-MN, Skovgaard AM, Elberling H et al (2012) Psychometric properties of the Danish Strength and Difficulties Questionnaire: the SDQ Assessed for more than 70.000 raters in four different cohorts. PLoS ONE 7(2):e32025. doi:10.1371/journal.pone.0032025
Ogburn KM, Sanches M, Williamson DE, Caetano SC, Olvera RL, Pliszka S, Hatch JP, Soares JC (2010) Family environment and pediatric major depressive disorder. Psychopathology 43(5):312–318
R Core Team, R: A Language and Environment for Statistical Computing, Version 2.15.2, 2013, Vienna www.R-project.org
Ravens-Sieberer U, Kurth B-M, the KiGGS study group and BELLA study group (2008) The mental health module (BELLA study) within the German Health Interview and Examination Survey of Children and Adolescents (KiGGS): study design and methods. Eur Child Adolesc Psychiatry 17(1):10–21
Ravens-Sieberer U, Otto C, Kriston L, Rothenberger A, Döpfner M, Herpertz-Dahlmann B, Barkmann C, Schön G, Hölling H, Schulte-Markwort M, Klasen F, the BELLA study group (2014) The longitudinal BELLA study: design, methods and course of mental health problems. Eur Child Adolesc Psychiatry. doi:10.1007/s00787-014-0638-4
Ravens-Sieberer U, Wille N, Bettge E & Erhart M (2007) Psychische Gesundheit von Kindern und Jugendlichen in Deutschland. Bundesgesundheitsblatt—Gesundheitsforschung—Gesundheitsschutz 50:871–878
Rothenberger A, Becker A, Erhart M, Wille N, Ravens-Sieberer U, the BELLA Study Group (2008) Psychometric properties of the parent strengths and difficulties questionnaire in the general population of German children and adolescents: results from the BELLA study. Eur Child Adoles Psychiatry [Suppl 1] 17:99–105
Schlack R, Hölling H, Kurth B-M, Huss M (2007) Die Prävalenz der Aufmerksamkeitsdefizit-/Hyperaktivitätsstörung (ADHS) bei Kindern und Jugendlichen in Deutschland. Erste Ergebnisse aus dem Kinder- und Jugendgesundheitssurvey (KiGGS). Bundesgesundheitsblatt—Gesundheitsforschung—Gesundheitsschutz 50:827-835
Stone LL, Otten R, Engels RCME, Vermulst AA, Janssens JMAM (2010) Psychometric properties of the parent and teacher versions of the Strengths and Difficulties Questionnaire for 4- to 12-year-olds: a review. Clin Child Fam Psychol Rev 13:254–274
Wichstrøm L, Berg-Nielsen TS, Angold A, Egger HL, Solheim E, Sveen TH (2012) Prevalence of psychiatric disorders in preschoolers. J Child Psychol Psychiatry 53:695–705
Winkler J, Stolzenberg H (1999) Der Sozialschichtindex im Bundes-Gesundheitssurvey. Gesundheitswesen 61 2:178–183
Woerner W, Becker A, Friedrich C, Rothenberger A, Klasen H, Goodman R (2002) Normierung und Evaluation der deutschen Elternversion des Strengths and Difficulties Questionnaire (SDQ): Ergebnisse einer repräsentativen Felderhebung. Zeitschrift für Kinder- und Jugendpsychiatrie und Psychotherapie 30(2):105–112
Woerner W, Becker A, Rothenberger A (2004) Normative data and scale properties of the German parent SDQ. Eur Child Adoles Psychiatry 13(Suppl 2):3–10
Disclosure
Aribert Rothenberger: Advisory Board and Speakers Bureau: Lilly, Shire, Medice, Novartis; Research Support: Shire, German Research Society, Schwaabe; Travel Support: Shire; Educational Grant: Shire; Consultant: UCB/Shire; Lilly. Andreas Becker, Alexander Sohn: None.
Conflict of interest
None.
Author information
Authors and Affiliations
Consortia
Corresponding author
Additional information
Andreas Becker and Aribert Rothenberger have contributed equally.
Members of the BELLA study group are: Ulrike Ravens-Sieberer and Fionna Klasen, Hamburg (Principal Investigators), Claus Barkmann, Hamburg; Monika Bullinger, Hamburg; Manfred Döpfner, Köln; Beate Herpertz-Dahlmann, Aachen; Heike Hölling, Berlin; Franz Resch, Heidelberg; Aribert Rothenberger, Göttingen; Sylvia Schneider, Bochum; Michael Schulte-Markwort, Hamburg; Robert Schlack, Berlin; Frank Verhulst, Rotterdam; Hans-Ulrich Wittchen, Dresden.
Electronic supplementary material
Below is the link to the electronic supplementary material.
Rights and permissions
About this article
Cite this article
Becker, A., Rothenberger, A., Sohn, A. et al. Six years ahead: a longitudinal analysis regarding course and predictive value of the Strengths and Difficulties Questionnaire (SDQ) in children and adolescents. Eur Child Adolesc Psychiatry 24, 715–725 (2015). https://doi.org/10.1007/s00787-014-0640-x
Received:
Accepted:
Published:
Issue Date:
DOI: https://doi.org/10.1007/s00787-014-0640-x