• 검색 결과가 없습니다.

Evidence of emotional and behavioural difficulties: Strengths and Difficulties Questionnaire

The Strengths and Difficulties Questionnaire (SDQ) (Goodman, 1997) is a behavioural screening measure that can be administered by parents or carers of children between the ages of four to 16. It covers common areas of emotional and behavioural difficulties and asks parents or carers to respond to a total of 25 statements in relation to their child. The scale covers five domains. Four of these capture difficulties in the child’s behaviour and relationships, emotional symptoms or difficulties, conduct problems, hyperactivity and peer problems. The fifth domain captures the positive attributes and strengths of the child: the pro-social score. The four difficulties scores are added together to make a total score with a maximum of 40. The pro-social score has a maximum of ten and is reported separately from the difficulties score. The SDQ also explores whether the informant thinks that the child has a problem in these areas, and if so, whether the child

experiences any resultant distress and social impairment. This impact score is graded out of a total of ten. In addition to the parent or carer reported SDQ , there is a teacher report version and a version for children and young people, between the ages of 11 to 16, to complete about themselves (Green et al., 2005).

The British Office of National Statistics carried out two extensive surveys of child and adolescent mental health in 1999 and 2004 (see Meltzer et al., 2000; and Green et al., 2005). One of the primary measures of psychopathology for these surveys was the SDQ.

Both of these surveys obtained SDQ information from a normative sample of nearly 6000

78

children aged between 5 to ten years old, as well as similarly comprehensive data for older children and young people. These datasets allow for comparison of the prevalence of emotional and behavioural difficulties amongst the normative population of children in Britain compared with the prevalence of difficulties amongst the children in the current study.

The SDQ was completed by primary carers of sample children during the course of in-depth interviews, which have been carried out at around the time of the children’s fourth, fifth, sixth, seventh and in some cases eight birthdays. Because of the floating nature of this sample (see Chapter One for further discussion), SDQ information is not available for all children at every time point. Therefore primary carer completed SDQ data have been analysed in the following way:

• Age five SDQ: the most recent SDQ completed for each child up to their fifth birthday (i.e. an age four SDQ or an age five SDQ; where both were available the age five SDQ was used).

• Age eight SDQ: the most recent SDQ completed for each child up to their eighth birthday (i.e. an age six, seven or eight SDQ, where more than one SDQ was available then the most recent was used).

An SDQ carried out between the ages of six and eight years was available for 31 of the 36 cohort children; and for 23 of the same children an age four or five SDQ was also available. It was not always possible or appropriate to ask the parents or carers to complete an SDQ during the in-depth interviews.

A four-fold classification for SDQ scores has been developed based on cut off points in the 2004 British community sample (Green et al., 2005). These groups include; ‘close to average’, ‘slightly raised’, ‘high’ and ‘very high’. For SDQs completed by parents or carers, total difficulties scores of up to 13 out of 40 are considered within the ‘close to average’ band; scores of between 14 and 16 are considered within the ‘slightly raised’

category; scores between 17 and 19 are considered ‘high’; and scores of 20 or more are categorised as ‘very high’. About 80% of children in the general population are expected to score within the ‘close to average’ category; 10% within the ‘slightly raised’ group; 5%

are expected to be classified as ‘high’; and 5% classified as ‘very high’. The table below shows the SDQ total difficulties scores for sample children compared with the scores of those from the 2004 British survey.

79

Table 8: Strengths and Difficulties Questionnaire scores for sample children compared with a representative community sample

Total difficulties Age 4 or 5 years Age 6, 7 or 8

The SDQs completed for sample children between the ages of six and eight years show that 10 (32%) of them fell within the ‘close to average’ range; five (16%) within the

‘slightly raised’ range; four (13%) within the ‘high’ range; and 12 (39%) within the ‘very high’ range. It is important to note that this sample is not representative of all children for whom a core assessment or Section 47 enquiry is completed before the age of one year (see Chapter One). Nevertheless, the finding that, by the age of eight years, 7.8 times as many of these children scored within the ‘very high’ range as would be expected from a normative population is extremely concerning. The SDQ can be a reliable screening instrument for mental disorder in children. When the SDQ is compared with clinical assessments it has been found to be over 90% effective in detecting children with a disorder (Goodman et al., 2009). Higher scores predict much greater rates of mental disorder than lower scores (Goodman and Goodman, 2011). It is therefore likely that many of the 16 children who scored within the ‘very high’ and ‘high’ ranges have or will develop a mental disorder that will require clinical intervention.

Ford and colleagues (2007) examined psychiatric disorder among British looked-after children (n=1453) compared with children living in private households (n=10428). They found that 41.1% of 5-10 year old looked-after children were categorised as having a psychiatric diagnosis according to ICD-10 definitions, compared to 7.6% of children of the same age living in private households. They concluded:

Our study suggests that British children who are looked after by the local authority have higher prevalence of both psychosocial adversity and psychiatric disorder than the most socio-economically disadvantaged children living in private

households, and that care-related variables are strongly related to mental health (Ford et al., 2007 p.323).

The SDQ scores for sample children indicate that both the prevalence and severity of the children’s emotional and behavioural difficulties had increased from when they were four

80

or five years old. SDQ scores were available at ages four or five for 23 of the 31 children who also had an SDQ between the ages of six and eight years. Of these 23 children:

• At age four or five, 10 (43%) fell within the ‘close to average’ range. By the age of eight, four remained within the ‘close to average’ range, however emotional and behavioural difficulties had emerged for six of them: two of these children now scored within the ‘slightly raised’ range, two within the ‘high’ range and two within the ‘very high’ range.

• At age four or five, four (17%) of the 23 children scored within the ‘slightly raised’

range. One of these children remained ‘slightly raised’ at age eight, and emotional and behavioural difficulties increased for the other three: one now scored ‘high’

and two scored ‘very high’.

• Four (17%) children fell within the ‘high’ range on their SDQ at ages four or five.

By the age of eight, two of these children’s emotional and behavioural

development had improved, and they now fell within the ‘slightly raised’ range.

However the other two children’s difficulties increased, and they now scored within the ‘very high’ range.

• At the age of four or five, five (22%) children scored within the ‘very high’ range, indicating a substantial risk of clinically significant problems. Four of these children remained in this category at age eight, and one child made slight improvements, and now fell within the ‘high’ range.

Of the 23 children, for whom an SDQ was available at ages four or five as well as at between six and eight, 19 were displaying emotional and behavioural difficulties at the later time point. For 13 children these had been present from before they were five years old. For all but three of these children, their difficulties increased between the ages of five and eight. Although three children moved in a positive direction, there are no examples of any children being able to overcome emotional and behavioural difficulties that were present at age five, moving from the ‘slightly raised’, ‘high’ or ‘very high’ categories to within the ‘close to average’ range by the age of eight years.

The following sections explore these findings further in relation to the children’s experiences and circumstances.