Validity of the SDQ as Preventive Child Health Care instrument to identify psychosocial problems in 4,5 and 6 year old children as compared to the LSPPK

Psychosocial problems in young children are highly prevalent. A good and early
detection increases the change of an effective treatment and the child's
healthy development. Research has shown that current identification of
psychosocial problems is not adequately done in the Dutch Preventive Health
Care system. Professional health care workers in the Netherlands do not use any
standard instruments for the detection of problems, or they use the so-called
LSPPK (a Dutch questionnaire to detect psychosocial problems in toddlers and
children). The current version of this questionnaire is however, not validated.
Moreover, the sensitivity and specificity of the first version of LSPPK is far
from perfect.

Recently, the SDQ was chosen as standard instrument for children in the age
between 7 to 12 years. The SDQ was found to be reliable, valid, and
practically usefull for these age groups. Replacing the LSSPK with the SDQ
offers some advantages: using the SDQ professional Health Care workers can
assess and compare the child's development of emotional and behavioral problems
at different ages; the SDQ can broadly be used in different informants such as
parents and teachers, and the implementation of this instrument in the Dutch
Preventive Health Care will be facilitated. However, the SDQ has not yet been
validated for this age group. In this study we examine whether the SDQ is a
reliable and valid instrument in 4, 5 and 6 year old children in comparison to
the current LSPPK version.

This project aims at evaluating the reliability, validity, and the added value
of the SDQ (Parent Format ) compared to LSPPK (a Dutch questionnaire to detect
psychosocial problems in toddlers and children).

The study findings may support the Dutch policy for the use of standard
instruments for the identification of psychosocial problems at early age.
Furthermore, in this study we examine whether the Teacher Format of the SDQ,
the additional impact questions in the SDQ, and the subscales can improve the
detection of psychosocial problems in 4, 5, and 6 year old children.

The study design has three phases:
1) PREPARATION
In this phase we want to include professional Health Care Organisations (GGD)
in the Netherlands in the study. In addition, the questionnaires can be
developed in this phase and will be sent to all participating organisations.
Finally, each organisation will participate in a training session about the
study procedures.

The following questionnaires will be developed:
- Parent questionnaires to determine background information, as well as the
SDQ, LSPPK, and the CBCL.
- Non response questionnaire for the professional.
- Questionnaire for the professional to assess his or her personal evaluation
of the psychosocial problems in a individual child, as well as some background
information on the child's family.
- Teacher version of the SDQ
- a multilingual version of the parent questionnaire (either the SDQ or LSPPK)
to be used orally by those parents who can not read the Dutch language.

2) DATA COLLECTION
The PCH professionals send parents a letter asking them to cooperate in the
study, together with a regular health check invitation. When parents are
willing to participate, they fill in the SDQ Parent Form and the LSPPK
questionnaire. The parents take their completed questionnaire to the regular
consultation. Teachers will be asked whether he or she perceives the child as
having problems, and if so, they answer the SDQ Teacher Form for that child.
This will only be done when parents agree.

3) ANALYIS AND REPORTING
Using Structural Equation Modeling we want to test the scale structure of the
SDQ and the LSPPK.

Area under curve, sensitivity and the specificity of the SDQ and the LSPPK will
be assessed using the CBCL total problem score as a criterium. Prevalence of
elevated scores in the normal population will be compared to scores in a (poli)
clinical sample. We will assess whether the subscales and the impact questions
enhance the prediction of a clinical CBCL score.

Finally, using logistic regresion analyses we want to determine wheter the
Teacher Format of the SDQ, the additional impact questions in the SDQ, and the
subscales can improve the detection of problems in 4 -, 5 and 6 year old
children.

The study findings will be presented in a symposium for Preventive Child Health
Care professionals. Additionally, the study findings will be described in a
report, as well as a peer reviewed scientific publication.

The study takes place in the context of the regular health examination at the
ages of 4, 5 and 6 years. For the purpose of this study, parents are asked to
fill in a written questionnaire. This will take about up to 30 minutes of their
time and implies no risk.