Detecting psychiatric disorders in preschoolers: screening with the strengths and difficulties questionnaire

Abstract

Objective: To examine screening efficiency for preschool psychopathology by comparing the Strengths and Difficulties Questionnaire findings against diagnostic information, and to determine the added value of impact scores and teacher information.

Method: Using a 2-phase sampling design, a population-based sample of 845 children 4 years of age was recruited from community health check-ups in Trondheim, Norway, screen score stratified and oversampled for high screening scores. Blinded to screen ratings, DSM-IV diagnoses were assigned using the Preschool Age Psychiatric Assessment interview, against which the Strengths and Difficulties Questionnaire scores were compared through receiver operating characteristic analysis.

Results: Emotional and behavioral disorders were identified through parent ratings with a specificity of 88.8% (range, 87.0%-90.6%) and a sensitivity of 65.1% (range, 51.6-78.6%). The negative predictive value was 97.9% (range, 96.8%-98.9%), whereas the positive predictive value was 24.2% (range, 18.0%-30.3%) at a prevalence of 5.2%. Parental ratings identified more behavioral disorders (79.3%) than emotional disorders (59.2%). Screening for any disorder was somewhat less efficient: specificity, 88.9% (range, 87.0%-90.7%); sensitivity, 54.2% (range, 41.8%-66.6%); negative predictive value, 96.4% (range, 95.0%-97.8%); and positive predictive value, 25.9% (range, 19.6%-32.2%) at a prevalence of 6.7%. The area under the curve (AUC) value was 0.83 (range, 0.76-0.90) for emotional and behavioral disorders and 0.76 (range, 0.68-0.83) for any disorder. The prediction accuracy was not improved by impact scores or teacher information.

Conclusions: The results indicate that preschoolers' emotional and behavioral disorders can be screened with the same efficiency as those of older children and adults. Other disorders were identified to a lesser extent. Further research should explore the potential of preschool screening to improve early detection and subsequent intervention.