This document appears to be a student's final year project examining the inter-rater reliability of the Strengths and Difficulties Questionnaire (SDQ) when used to rate the psychological wellbeing of adolescents. The student had adolescents, their parents, and teachers complete the SDQ and analyzed agreement levels between the three groups. Fair agreement was found between adolescents and parents, and adolescents and teachers, while parents and teachers showed good agreement. The conclusions suggest further research with larger samples is needed to understand the role of teacher reporting when using the SDQ to rate adolescent mental health.
A scoping review of qualitative studies on the voice of the child in child cu...
PY4097 11133546
1.
Conor
Barry
11133546
BSc
(Physiotherapy)
2016
2. 2
Examining
the
inter-‐rater
reliability
of
the
Strengths
and
Difficulties
Questionnaire:
Do
the
adolescent,
parent
and
teacher
rate
the
adolescent’s
psychological
wellbeing
similarly?
Conor
Barry
11133546
Supervisor:
Dr.
Amanda
Connell
PY4097
and
PY4008
Final
Year
Project
Word
Count:
4992
3. 3
I,
the
undersigned
declare
that
this
project
which
I
am
submitting
is
all
my
own
work
and
that
the
data
presented
is
authentic.
______________________________________
(Printed
Name)
______________________________________
(Signature)
Date
/
/
4. 4
Acknowledgements
This
project
would
not
have
been
possible
without
the
help
and
guidance
of
many
people.
First
and
foremost,
my
utmost
gratitude
goes
to
Dr.
Amanda
Connell.
Thank
you
for
all
your
assistance,
knowledge
and
guidance
throughout
this
project.
Thank
you
for
helping
me
develop
the
idea
for
this
project
from
the
very
first
day
that
I
mentioned
my
interest
in
exploring
the
mental
health
field.
To
4th
Year
Head,
Dr.
Susan
Coote,
thank
you
for
your
help
in
completing
this
project
and
with
everything
else
over
the
course
of
the
four
years.
To
my
close
friends,
no
names
are
needed,
thank
you
for
all
being
generally
sound
lads.
To
my
classmates,
it’s
been
a
great
four
years
and
thank
to
you
all.
Shout
out
to
Brian,
PJ
and
Timmy
in
particular
for
showing
me
the
college
way.
Who
knows
what
next…
To
the
clinical
educators
who
have
given
me
the
confidence
to
succeed
and
enjoy
life
as
a
Physiotherapist,
thank
you.
To
my
guitar
and
golf
clubs,
thank
you
for
being
the
outlet
I
need
when
it’s
time
to
take
a
break.
To
any
artists’
music
that
gets
me
through
the
day.
Thank
you.
Last
but
most
certainly
not
least,
thank
you
to
my
family,
Brendan,
Yvonne
and
Eve.
Thank
you
all
for
the
relentless
support
and
encouragement,
no
matter
what
it
is
I
do.
5. 5
Abstract
Background:
Mental
health
and
psychiatric
disorders
have
become
the
leading
cause
of
disability
in
young
people
worldwide.
The
SDQ
is
a
new
popular
screening
tool
used
to
assess
children’s
mental
health.
Gathering
reports
from
multiple
informants
is
considered
best
practice
in
evaluating
the
child’s
mental
health.
Little
research
has
examined
agreements
across
these
three
raters
using
the
SDQ
in
an
adolescent
population.
Objectives:
To
determine
the
level
of
agreement
between
three
informant
pair
groups
when
using
the
SDQ
to
rate
the
adolescent’s
psychological
wellbeing
(i)
adolescent
and
parent
(ii)
adolescent
and
teacher
(iii)
parent
and
teacher.
Methods:
Fourteen
male
adolescent
students
each
completed
a
self-‐report
version
of
the
SDQ.
A
parent
and
a
teacher
of
each
student
also
completed
the
proxy-‐
version
of
the
SDQ.
Total
difficulties
scores
and
subscales
were
analysed
for
correlations
across
all
three
informants.
Results:
Adolescents
and
parents
showed
fair
levels
of
agreement
(r=0.44),
as
did
adolescents
and
the
teacher
(r=0.41).
Parents
and
teachers
showed
good
levels
of
agreement
(r=0.70),
which
were
statistically
significant
(p=0.015).
Correlations
on
the
problem
subscales
ranged
from
0.07
to
0.69
between
the
three
group
pairings.
Conclusions:
The
fair
levels
of
agreement
between
the
parent
and
child
found
in
this
study,
are
consistent
with
those
of
previous
studies
which
have
used
the
SDQ.
Parents
and
teachers
of
adolescents
may
show
stronger
correlations
than
those
of
younger
children.
Further
research
involving
a
larger
sample
is
needed
to
determine
the
role
of
teacher
reporting
in
rating
the
adolescents’
psychological
wellbeing.
Keywords:
Mental
health,
strengths
and
difficulties
questionnaire
(SDQ),
adolescents,
inter-‐rater
agreements
7. 7
1.
Introduction
Mental
health
and
psychiatric
disorders
have
become
the
leading
cause
of
disability
in
young
people
worldwide
(WHO,
2013).
Mental
illness
refers
to
a
wide
range
of
mental
health
disorders
such
as
depression,
anxiety,
eating
disorders
and
addictive
behaviour,
any
of
which
can
have
a
negative
effect
on
someone’s
mood,
thinking
and
behaviour
(Mayo
Clinic,
2015).
In
Ireland,
as
in
the
rest
of
the
world,
increasing
numbers
of
children
and
adolescents
are
presenting
with
a
wide
range
of
mental
health
issues,
as
outlined
in
a
recent
study
by
the
Royal
College
of
Surgeons
in
Ireland
(Cannon
et
al.,
2013).
The
study
found
that
31%
of
11
to
13
year
olds
and
56%
of
19
to
24
year
olds
had
experienced
some
form
of
mental
disorder
over
the
course
of
their
lives.
Despite
the
fact
that
these
problems
can
create
much
distress
for
those
suffering
from
them,
many
people
with
psychiatric
disorders
go
undetected
and
receive
no
professional
help
(Arman
et
al.,
2013).
Early
detection
of
psychological
disturbances,
much
like
with
physical
conditions
such
as
cancer,
is
essential
in
allowing
the
patient
to
receive
appropriate
treatment
and
improving
overall
prognosis
(Genrich
and
McGuire,
2009).
A
multi-‐informant
approach
to
the
evaluation
of
a
child’s
psychological
wellbeing
is
regarded
as
the
preferred,
best-‐practice
approach
(Jensen
et
al.,
1999;
Becker
et
al.,
2004).
This
usually
involves
a
combination
of
interviews
with
the
child,
his/her
family
members
and
in
some
cases
with
his/her
teacher,
or
with
other
health
care
workers
who
may
be
familiar
with
the
child.
A
child
may
display
mental
health
difficulties
within
some
contexts
but
not
in
others;
therefore
gathering
insight
from
various
reporters
may
assist
mental
health
professionals
in
identifying
problems
and
tailoring
treatment
to
the
child’s
needs
(De
Los
Reyes
et
al.,
2015).
The
regular
use
of
rating
scales
and
screening
tools
in
conjunction
with
clinical
interviews
is
recommended
as
a
means
of
further
evaluating
and
quantifying
the
extent
of
the
child’s
psychological
distress
(NICE,
2005).
One
such
screening
tool
8. 8
that
is
gaining
popularity
among
clinicians
worldwide
is
the
Strengths
and
Difficulties
Questionnaire
(SDQ)
(Goodman,
1997).
The
SDQ
is
a
brief
behavioural
screening
instrument
that
is
used
to
rate
the
psychological
wellbeing
of
children
and
adolescents.
The
proxy
version
of
the
SDQ
can
be
completed
by
the
parents
and
teachers
of
4
to
17
year
old
children,
while
a
similar
version
phrased
in
the
first
person
can
be
self-‐completed
by
children
aged
11
to
17.
The
SDQ
has
been
found
to
be
a
valid
and
reliable
screening
tool
in
detecting
psychiatric
issues
in
line
with
clinical
diagnoses
(Goodman,
2000;
Kovacs
and
Sharp,
2014).
However,
despite
the
importance
of
utilising
a
multi-‐informant,
multi-‐method
approach
to
assessing
psychological
wellbeing,
research
has
found
there
to
be
some
discrepancies
and
lack
of
concordance
between
raters
when
rating
a
child’s
mental
wellbeing
(Achenbach
et
al.,
1987).
Recent
studies
utilising
the
SDQ
to
examine
inter-‐rater
agreement
appear
to
also
follow
this
trend
of
‘low
to
moderate’
agreement
(Wille
et
al.,
2008;
Van
Roy
et
al.,
2010).
However,
these
studies
have
looked
solely
at
the
agreements
between
two
raters;
predominantly
parent-‐child
and
parent-‐teacher
reports.
There
is
scarce
research
evaluating
the
reliability
of
the
SDQ
across
three
informants,
particularly
in
the
adolescent
population.
As
there
appear
to
be
some
discrepancies
in
two-‐rater
reports,
gaining
insight
from
a
third
informant,
such
as
a
teacher,
could
be
valuable
in
more
accurately
and
more
speedily
identifying
adolescents
who
are
experiencing
mental
health
problems.
Parents
are
familiar
with
their
child’s
behaviour
in
a
variety
of
situations
over
a
long
period
of
time,
while
teachers
have
a
base
of
children
similarly
aged
to
compare
the
child
with
(Van
Slyke,
2007).
Young
Irish
males
rank
amongst
the
highest
in
Europe
in
presenting
with
psychiatric
disorders,
with
suicide
being
the
leading
cause
of
death
of
males
ages
15
to
36
in
Ireland
(McMahon
et
al.,
2014).
Examining
the
reliability
of
the
clinically
popular
SDQ
across
three
informants
(i.e.
adolescent
males,
their
parents
and
their
teachers),
9. 9
could
offer
valuable
insight
into
the
difficulties
that
young
males
are
experiencing
and
its
usefulness
as
a
screening
tool.
2.
Aims
(1) To
determine
the
level
of
inter-‐rater
agreement
between
three
informant
group
pairs
when
using
the
SDQ
to
rate
the
adolescent’s
psychological
wellbeing:
(i)
Adolescent
students
and
their
parents
(ii)
Adolescent
students
and
their
teachers
(iii)
The
parents
and
teachers
of
adolescent
students
3.
Methodology
3.1
Ethics
Ethical
approval
was
obtained
from
the
University
of
Limerick
Research
Ethics
Committee.
The
University
of
Limerick
Child
Protection
Guidelines
(2006)
were
adhered
to
at
all
times.
10. 10
3.2
Study
Design
The
study
took
the
form
of
a
quantitative
cross-‐sectional
analysis.
This
was
deemed
most
appropriate
in
evaluating
the
levels
of
agreement
between
the
three
raters
when
using
the
questionnaire.
3.3
Sample
Recruitment
Sample
recruitment
was
sought
from
an
all-‐boys
suburban
secondary
school.
Initial
contact
was
made
with
the
principal
of
the
school
via
letter
and
a
meeting
was
arranged
to
discuss
the
project
further.
Upon
securing
the
secondary
school
as
a
recruitment
centre,
Transition
Year
students
(n=55)
were
approached
to
partake
in
the
study.
Transition
Year
students
were
selected
because
of
the
convenience
of
their
exam-‐free
schedule
and
also
because
of
the
generally
held
view
that
‘Transition
Year’
is
a
year
of
personal
and
social
development
(Dempsey,
2001).
Information
sheets
and
consent
forms
were
distributed
to
each
of
the
55
students
via
the
school
administration
office,
to
be
read
and
signed
by
their
parents/guardian.
Of
the
55
distributed,
14
signed
consent
forms
were
returned
(25.5%
response
rate).
These
14
student-‐parent
pairs
were
included
in
the
study.
Teachers
from
the
school
were
approached
by
a
recruitment
e-‐mail
that
was
forwarded
onto
the
staff
mail
listing
by
the
principal
of
the
school.
Two
teachers
expressed
interest
in
partaking
in
the
study.
One
of
the
teachers,
who
did
not
teach
Transition
Year,
was
deemed
unsuitable
to
rate
the
sample
accurately,
as
he
was
insufficiently
familiar
with
the
students.
11. 11
3.4
Data
Collection
Each
of
the
14
students
recruited
was
assigned
a
unique
code
(SDQ001
to
SDQ014)
to
ensure
participant
confidentiality,
while
also
allowing
data
sets
to
be
compared
across
the
three
informants.
A
suitable
date
and
time
for
data
collection
was
arranged
with
the
principal.
The
14
students
were
gathered
in
a
classroom
with
the
researcher.
Information
sheets
were
distributed
to
the
students
along
with
consent
forms,
which
they
subsequently
signed.
Each
student
was
provided
with
his
own
individually
coded
SDQ.
The
researcher
facilitated
the
session
and
asked
the
students
to
take
their
time
in
answering
their
SDQ
as
truthfully
as
possible.
The
session
lasted
20
minutes
in
total.
The
students
were
then
given
coded
envelopes
containing
the
parent
version
of
the
SDQ
to
bring
home
to
their
parent/guardian,
to
be
completed,
sealed
and
returned
in
the
following
days.
The
participating
teacher
was
provided
with
an
information
sheet
and
a
consent
form,
which
was
subsequently
signed.
The
teacher
was
then
given
14
coded
teacher
versions
of
the
SDQ
as
well
as
a
list
of
the
participating
student
names
alongside
their
respective
codes,
and
asked
to
complete
them
as
truthfully
as
possible.
The
SDQs
were
completed
in
the
teacher’s
free
time
at
school
and
collected
by
the
researcher
at
the
end
of
the
school
day.
3.5
Outcome
Measure
The
outcome
measure
used
was
the
SDQ
(Goodman,
1997),
both
the
self-‐rater
11
to
17
year
old
child
version
and
the
proxy-‐rater
parent/teacher
version.
When
completing
the
SDQ,
the
rater
is
asked
to
declare
how
‘true’
they
find
each
of
25
statements
in
relation
to
the
child’s
wellbeing.
The
SDQ
consists
of
25
statements,
each
of
which
the
informant
can
select
as
being
‘certainly
true’,
‘somewhat
true’
or
12. 12
‘not
true’.
The
25
statements
are
divided
into
5
subscales,
each
containing
5
statements.
Four
of
these
subscales
(emotional
symptoms,
conduct
problems,
hyperactivity-‐inattention
and
peer
problems)
contribute
to
the
total
difficulties
score,
while
the
‘prosocial
behaviour’
subscale
is
scored
separately.
10
statements
are
worded
to
reflect
strengths
of
the
child,
with
5
being
reverse-‐scored
as
difficulties.
14
statements
probe
potential
difficulties
of
the
child,
and
one
is
neutral
but
scored
as
a
difficulty
on
the
peer
problems
scale.
The
‘total
difficulties’
score
of
a
completed
SDQ
can
then
be
used
to
categorise
the
child’s
mental
health
as
being
normal,
borderline
or
abnormal.
The
cutoffs
for
total
difficulties
scores,
which
are
based
on
the
80th
and
90th
percentile,
as
well
as
each
of
the
individual
subscales,
are
presented
in
Table
1.
Normal Borderline Abnormal
Self-completed SDQ
Total difficulties score
Emotional problems score
Conduct problems score
Hyperactivity score
Peer problems score
Prosocial score
Parent completed SDQ
Total difficulties score
Emotional problems score
Conduct problems score
Hyperactivity score
Peer problems score
Prosocial score
Teacher completed SDQ
Total difficulties score
Emotional problems score
Conduct problems score
Hyperactivity score
Peer problems score
Prosocial score
0-15
0-5
0-3
0-5
0-3
6-10
0-13
0-3
0-2
0-5
0-2
6-10
0-11
0-4
0-2
0-5
0-3
6-10
14-16
6
4
6
4-5
5
14-16
4
3
6
3
5
12-15
5
3
6
4
5
17-40
7-10
5-10
7-10
6-10
0-4
17-40
5-10
4-10
7-10
4-10
0-4
16-40
6-10
4-10
7-10
5-10
0-4
Table
1:
The
original
three-‐band
categorisation
scores
of
SDQ
total
difficulties
scores
and
subscales
for
self-‐,
parent-‐
and
teacher-‐reports
13. 13
3.6
Data
Analysis
The
completed
SDQs
were
analysed
using
the
SDQ
scoring
criteria
in
order
to
determine
total
difficulties
scores,
subscale
scores
and
categorisation
for
each
student,
as
rated
by
each
informant
group.
Data
analysis
was
conducted
using
the
Statistical
Programme
for
the
Social
Sciences
(SPSS)
version
21.
All
data
was
found
to
be
normally
distributed
(Kolmorgorov-‐Smirnov
p
>
0.05).
Differences
in
mean
total
difficulties
scores
between
raters
were
analysed
using
paired
sample
t-‐tests.
Significant
level
was
set
at
p
<0.05.
In
line
with
other
studies
assessing
inter-‐rater
agreement
using
the
SDQ
(Van
Roy
et
al.,
2010;
Stone
et
al.,
2010),
correlations
between
raters’
total
difficulties
scores
were
analysed.
The
inter-‐rater
agreement
between
parent-‐,
teacher-‐
and
self-‐
reports
of
the
SDQ
total
difficulties
scores
were
analysed
with
Pearson’s
correlation
coefficient.
For
Pearson
coefficients
(r
values),
less
than
0.25
show
poor
agreement,
between
0.25
and
0.50
indicate
fair
agreement,
between
0.50
and
0.75
show
‘moderate
to
good’
agreement
and
greater
than
0.75
indicate
‘good
to
excellent’
agreement
(Portney
and
Watkins,1993,
cited
in
Reiman
and
Manske,
2009).
Correlations
of
the
five
individual
subscales
were
also
analysed
to
gain
further
insight
into
areas
of
poor
and
strong
agreement
between
raters,
as
recommended
by
Goodman
et
al.
(2000).
3.7
Follow
Up
Letter
In
compliance
with
the
ethical
application
of
this
project,
in
the
incidence
of
any
student
participating
in
the
study
whose
self-‐completed
SDQ
total
difficulties
score
was
in
the
‘abnormal’
range,
a
letter
was
sent
home,
notifying
the
parent/guardian.
14. 14
4.
Results
4.1
Descriptive
Statistics
The
mean
age
of
the
all-‐male
student
sample
(n=14)
was
15.86
years.
Figure
1
represents
the
mean
scores
and
standard
deviation
as
per
each
rater.
Students’
mean
total
difficulties
scores
were
the
highest
of
the
three
raters
(11.50,
sd=5.69).
Parents’
mean
total
difficulties
scores
were
10.64
(sd=5.69),
and
the
teachers’
mean
total
difficulties
scores
were
the
lowest
(8.43,
sd=4.70).
While
there
was
some
variance
in
mean
scores
between
raters,
these
differences
were
not
statistically
significant
(Student-‐Parent:
p=0.674,
Student-‐Teacher:
p=0.06,
Parent-‐Teacher:
p=0.174).
Figure
1:
Mean
total
difficulties
scores
for
students
(11.50),
parents
(10.63)
and
teachers
(8.43)
(n=14).
15. 15
Table
3
shows
the
frequency
distributions
for
the
three
categories
of
psychological
wellbeing
-‐
normal,
borderline
and
abnormal
-‐
as
per
each
rater.
Two
students
(14.3%)
rated
themselves
in
the
abnormal
range.
Two
students
(14.3%)
were
rated
in
the
abnormal
range
by
their
parent,
while
the
teacher
rated
one
student
(7.1%)
in
the
abnormal
range.
Overall,
four
students
(28.6%)
were
rated
in
the
abnormal
range
by
at
least
one
rater.
One
student’s
(7.1%)
self-‐report
scored
in
the
borderline
range,
while
two
students
(14.3%)
were
scored
as
borderline
by
their
parents.
The
teacher
rated
two
students
(14.3%)
in
the
borderline
range.
In
total,
six
students
(42.8%)
of
the
sample
were
categorised
as
either
borderline
or
abnormal
by
at
least
one
rater.
Student
Frequency
Student
%
Parent
Frequency
Parent
%
Teacher
Frequency
Teacher
%
Normal
Borderline
Abnormal
Total
11
1
2
14
78.6
7.1
14.3
100.0
10
2
2
14
71.4
14.3
14.3
100.0
11
2
1
14
78.6
14.3
7.1
100.0
Table
2:
Categorisation
frequencies
based
on
total
difficulties
scores
from
student-‐,
parent-‐
and
teacher-‐reports.
4.2
Student-‐Parent
Agreement
Inter-‐rater
agreement
between
student,
parent
and
teacher
total
difficulties
scores
was
analysed
using
Pearson’s
correlation
coefficient
(r).
The
correlation
between
student
and
parent
total
difficulties
scores
was
0.44
(Figure
2,
Table
3).
This
correlation
was
not
statistically
significant
(p=0.11),
and
as
per
Portney
and
Watkins
(1993),
r=0.44
indicates
a
‘fair’
level
of
agreement
between
students
and
their
parents
in
rating
the
students’
psychological
wellbeing.
16. 16
Table
3
shows
the
correlations
on
the
individual
subscales
between
raters.
The
strongest
correlations
between
students
and
parents
were
on
the
emotional
problems
(r=0.69)
and
peer
problems
subscales
(r=0.63).
Conduct
problems
presented
the
weakest
correlations
(r=0.07).
Student - Parent Student - Teacher Parent - Teacher
Total Difficulties 0.44 0.41 0.70
Emotional 0.69 0.35 0.48
Conduct 0.07 0.21 0.45
Peer 0.63 0.51 0.62
Hyperactivity 0.22 0.08 0.60
Prosocial 0.37 -0.57 -0.17
Table 3: Pearson’s correlation coefficient values for agreement between
informants on total difficulties scores and individual subscales.
Figure
2:
Correlations
between
adolescent
students
and
parents
total
difficulties
scores
(r=0.44).
17. 17
4.3
Student-‐Teacher
Agreement
The
correlation
between
student
and
teacher
total
difficulties
scores
was
0.41,
thus
indicating
a
‘fair’
level
of
agreement
(Figure
2).
This
correlation
was
not
statistically
significant
(p=0.151)
and
was
the
weakest
between
the
three
sets
of
rater
pairings.
The
peer
problems
subscale
showed
the
strongest
correlations
(r=0.54),
while
the
hyperactivity-‐inattention
subscale
showed
the
weakest
correlations
(r=0.08)
(Table
3).
The
prosocial
subscale
also
showed
very
poor
agreement
between
the
teacher
and
student
(r=-‐0.57).
Figure
2:
Correlations
between
adolescent
student
and
teachers
total
difficulties
scores
(r=0.41).
total
difficulties
scores
(r=0.41).
18. 18
4.4
Parent-‐Teacher
Agreement
Parent-‐teacher
total
difficulties
scores
presented
as
the
strongest
correlation
between
the
three
informant
pairings
(r=0.70)
(Figure
3).
The
correlations
were
found
to
be
statistically
significant
(p=0.015)
and
would
indicate
‘moderate
to
good’
agreement,
using
the
Portney
and
Watkins
(1993)
cutoff
points.
The
problem
subscales
ranged
from
0.45
to
0.62,
with
the
peer
problems
(r=0.62)
and
hyperactivity-‐inattention
(0.60)
subscales
showing
particularly
strong
correlations
(Table
3).
The
prosocial
subscale
showed
poor
correlations
between
parents
and
teachers
(r=-‐0.17).
Figure
3:
Correlations
between
parent
and
teacher
total
difficulties
scores
(r=0.70).
19. 19
5.
Discussion
This
study
aimed
to
examine
the
level
of
agreement
between
adolescents,
parents
and
teachers
in
rating
the
adolescent
students’
psychological
wellbeing
when
using
the
SDQ.
Fourteen
adolescents,
their
parents
and
teacher
each
completed
their
respective
versions
of
the
SDQ
and
the
total
difficulties
scores
were
analysed
across
the
three
informants
for
correlations.
The
individual
subscales
of
the
SDQ
were
also
analysed
for
correlations
to
gain
further
insight
into
areas
of
agreement/disagreement.
This
study
found
there
to
be
‘fair’
levels
of
agreement
between
the
adolescents
and
their
parents
(r=0.44),
as
well
as
‘fair’
levels
of
agreement
between
adolescents
and
their
teacher
(r=0.41).
Parent
and
teacher
reports
exhibited
‘good’
correlations,
when
rating
the
adolescent
sample
(r=0.70).
5.1
Student-‐Parent
Agreement
Discrepancies
between
raters
came
to
the
forefront
of
research
in
the
adolescent
psychological
wellbeing
field
following
a
ground-‐breaking
meta-‐analysis
published
by
Achenbach
et
al.
in
1987.
The
paper
highlighted
the
poor
correlations
between
the
three
informant
pairs
-‐
parents
and
children,
children
and
teachers
and
teachers
and
parents.
Since
then,
a
large
of
number
of
studies
have
focused
on
examining
agreement
levels
between
raters,
particularly
since
the
development
of
the
widely-‐used
SDQ
screening
tool
by
Goodman
(1997).
Parents
are
recognised
as
being
the
strongest
influence
in
getting
adolescents
to
receive
professional
help
for
their
psychological
difficulties
(Wahlin
et
al.,
2012).
Therefore,
it
is
important
that
there
is
a
level
of
agreement
between
adolescents
and
their
parents
when
rating
the
adolescents’
mental
health.
The
present
study
found
there
to
be
a
‘fair’
level
of
agreement
between
the
adolescent
students
and
their
parents
when
rating
the
adolescents
psychological
wellbeing
using
the
SDQ
(r=0.44).
Several
studies
with
large
sample
sizes
have
20. 20
looked
at
parent-‐child
agreements
using
the
SDQ,
and
similarities
can
be
drawn
between
these
and
the
present
study.
Van
Roy
et
al.,
(2010)
(n=8154)
found
correlations
of
0.38
between
pre-‐adolescent
males
(mean
age
11.5)
and
their
parents.
In
a
mixed
gender
study,
Muris
et
al.,
(2003)
(n=562)
reported
‘reasonable’
correlations
of
0.46
between
children
(mean
age
12.3)
and
their
parents.
Van
Widenfelt
et
al.
(2003)
(n=479)
assessed
an
age
group
(mean
age
14.1)
closer
to
that
of
the
present
study
and
found
similar
results
to
those
mentioned
previously
(r=0.47).
Overall,
this
would
suggest
that
the
parent-‐child
correlations
found
in
the
present
study,
despite
its
small
sample
size,
follow
the
same
trend
as
previous
studies,
i.e.
a
‘fair’
level
of
agreement
between
parent
and
child
SDQ
total
difficulties
scores
(Portney
and
Watkins,
1993).
In
analysing
the
individual
problem
subscales,
the
poorest
level
of
agreement
was
seen
on
the
conduct/behavioural
problems
subscale
(r=0.07).
Interestingly,
this
was
also
the
case
in
a
study
by
Muris
et
al.
(2003),
who
found
conduct
problems
to
show
the
weakest
correlations
of
all
the
subscales
(r=0.38).
Differences
between
parents’
and
children’s
perceptions
of
the
child’s
behaviour
and
conduct
are
common
and
can
be
due
to
various
reasons.
Children
can
often
be
unaware
of
their
behaviour
and
impact
of
their
actions,
while
parents
witness
and
judge
their
child’s
conduct
on
a
daily
basis
(Halpenny
et
al.,
2010).
This
theory
may
be
evident
in
case
SDQ007
(Table
4),
where
the
parent
reports
abnormal
conduct/behavioural
problems,
while
the
child
reports
almost
no
conduct
related
issues.
Contrastingly,
the
adolescent
may
also
report
behavioural
problems
that
the
parent
is
unaware
of,
as
appears
to
be
the
case
in
SDQ012
(Table
5),
where
the
child
has
reported
conduct
problems,
but
the
parent
has
identified
almost
no
issues.
Emotional Conduct Hyper. Peer Total Difficulties Prosocial
Student
Parent
Teacher
2
*4
2
1
**7
1
4
**8
3
*4
**10
**5
13
**29
11
9
9
*5
Table
4
(SDQ007):
Students’
total
difficulties
rated
in
normal
range
by
self-‐report
and
teacher-‐report.
Parent-‐report
rated
in
abnormal
range.
*
=
Borderline
score
**
=
Abnormal
score
21. 21
Emotional Conduct Hyper. Peer Total Difficulties Prosocial
Student
Parent
Teacher
**8
**7
2
**7
1
0
*6
1
3
*4
*3
3
**25
12
8
7
8
*5
Table
5
(SDQ012):
Students’
total
difficulties
rated
in
abnormal
range
by
self-‐report.
Parent-‐report
and
teacher-‐report
rated
in
normal
range.
*
=
Borderline
score
**
=
Abnormal
score
5.2
Student-‐Teacher
Agreement
After
parents,
teachers
are
considered
the
second
most
valuable
adult
informants
in
assessing
the
psychological
wellbeing
of
children
(Van
Slyke
et
al.,
2007).
Teachers
offer
a
different
perspective
to
the
parent
as
they
observe
the
child
in
a
setting
outside
of
the
home
environment.
Teachers
also
have
a
familiarity
with
a
large
base
of
similarly
aged
children,
thus
allowing
them
to
compare
and
contrast
the
child
with
what
they
consider
the
norms
for
childhood
behaviour
(Van
Slyke
et
al.,
2007).
In
the
current
study,
the
correlations
between
students
and
teacher
were
found
to
be
weakest
of
the
three
informant
pair
groups
(r=0.41).
However,
as
with
the
parent-‐child
correlations
(r=0.44),
they
also
met
the
cutoff
points
for
a
‘fair’
level
of
agreement.
There
appears
to
be
scarce
research
assessing
adolescent-‐teacher
agreements
using
the
SDQ.
However,
one
study
by
Becker
et
al.
(2004)
examined
the
correlations
between
SDQ
self-‐reports
and
separate
adult
informants
(parent
and
teacher)
in
a
German
clinical
setting.
The
study
involved
a
sample
of
124
adolescents
(83
males)
with
a
mean
age
of
13.8.
Correlations
between
the
male
adolescents
and
teachers
were
found
to
be
much
poorer
than
that
of
the
present
study
for
total
difficulties
scores
(r=0.21).
Similarly
to
the
present
study,
Becker
et
al.
(2004)
found
the
correlations
between
the
adolescent
males
and
their
parents
(r=0.29)
to
be
stronger
than
those
between
the
adolescents
and
the
teachers.
As
the
study
by
Becker
et
al.
(2004)
included
children
with
“at
least
one
clinically
diagnosed
psychiatric
disorder”,
some
differences
would
be
expected
when
22. 22
comparing
the
results
with
that
of
a
study
involving
a
community-‐based
sample.
The
results
of
the
current
study,
in
line
with
those
of
Becker
et
al.
(2004),
may
indicate
that
parents
are
more
reliable
in
rating
the
child’s
psychological
wellbeing
than
the
teacher.
However,
further
and
more
comprehensive
research
is
needed
to
identify
more
accurately
the
degree
of
correlation
between
adolescents
and
their
teachers
using
the
SDQ,
and
to
fully
determine
the
usefulness
of
teacher
reporting
in
a
community-‐based
adolescent
sample.
Analysis
of
the
present
study’s
teacher-‐adolescent
subscale
correlations
found
that
the
results
were
similar
to
that
of
the
parent-‐adolescent
reports,
with
hyperactivity
(0.08)
and
conduct
(0.21)
problems
showing
the
weakest
correlations.
A
similar
rationale
to
that
discussed
regarding
the
discrepancies
in
behavioural
problems
between
parent-‐adolescent
reports
may
apply
(Table
4,
Table
5).
The
strongest
correlations
in
teacher-‐student
reports
appeared
on
the
peer
problems
subscale
(r=0.51).
This
is
exhibited
in
case
SDQ006
(Table
6),
where
both
student
and
teacher
have
identified
the
peer
problems
subscale
to
be
in
abnormal
range.
Similarly,
good
peer
correlations
are
seen
in
Table
4.
These
cases
alongside
the
stronger
overall
correlations
suggest
teachers
may
be
reliable
informants
in
reporting
on
the
relationships
between
the
adolescent
and
their
peers.
Emotional Conduct Hyper. Peer Total Difficulties Prosocial
Student
Parent
Teacher
**8
**6
4
2
2
3
4
4
5
**6
*4
**6
**20
*16
**18
10
10
6
Table
6
(SDQ006):
Students’
total
difficulties
rated
in
abnormal
range
by
self-‐report
and
teacher-‐report.
*
=
Borderline
score
**
=
Abnormal
score
In
previous
studies,
the
use
of
teachers
in
the
evaluation
of
the
child’s
mental
health
has
been
predominantly
sought
out
in
studies
involving
younger
children.
This
may
be
due
to
the
fact
that
in
primary
schools,
children
tend
to
have
just
one
teacher
for
the
entire
school
day.
In
secondary
schools,
adolescent
students
can
have
a
large
number
of
teachers,
each
of
whom
may
only
see
the
child
for
23. 23
approximately
40
minutes
a
day.
This
suggests
that
secondary
school
teachers
would
be
less
familiar
with
the
child
and
deemed
less
suitable
in
rating
the
child’s
mental
health
by
past
researchers.
It
may
also
be
that
teachers
decline
to
partake
in
such
studies.
This
was
the
case
in
a
study
by
Koskelainen
et
al.,
(2000),
where
the
group
of
secondary
school
teachers
that
were
approached,
declined
to
partake
in
the
study
as
they
felt
they
were
not
well
enough
informed
to
rate
the
mental
health
of
the
adolescent
samples.
The
current
study
aimed
to
ensure
that
any
teacher
who
responded
to
the
recruitment
e-‐mail
was
both
comfortable
in
rating
an
adolescent
sample
and
familiar
with
the
students
included
in
the
study.
5.3
Parent-‐Teacher
Agreement
Interestingly,
the
present
study
found
that
parents
and
teachers
showed
the
strongest
correlations
of
the
three
informant
pairs
(r=0.70).
These
correlations
were
statistically
significant
(p=0.015)
and
range
within
the
‘good’
cutoff
limits
for
levels
of
agreement.
Compared
with
other
studies
that
have
assessed
parent-‐
teacher
correlations
using
the
SDQ,
the
findings
of
the
current
study
appear
to
differ
somewhat.
A
review
by
Stone
et
al.
(2010)
examined
the
psychometric
properties
of
the
parent
and
teacher
versions
of
the
SDQ.
The
review
included
eight
studies
that
assessed
parent-‐teacher
agreements
and
found
the
mean
correlation
of
studies
to
be
0.44
(ranging
from
0.37
to
0.62).
However,
the
review
did
not
include
any
studies
with
an
adolescent
sample,
as
it
focused
solely
on
studies
of
children
aged
between
4
and
12
years.
More
recently,
in
a
large
Japanese
sample
(n=7977)
parents
and
teachers
of
7
to
15
year
old
children
were
assessed
for
agreements
using
the
SDQ
(Moriwaki
et
al.,
2014).
This
study
yielded
similar
results
to
that
of
Stone
et
al.,
showing
parents
and
teachers
‘moderately’
agreeing
(r=0.40)
on
the
children’s
mental
health.
Another
recent
study
by
Borg
et
al.,
(2012),
which
looked
at
parent-‐teacher
agreements
in
a
younger
sample
(mean
age
6.1),
showed
slightly
higher
correlations
of
0.48
for
the
male
part
of
its
sample
(n=2217).
24. 24
The
correlation
values
of
the
previous
studies
for
parent-‐teacher
agreement
all
appear
to
be
significantly
lower
than
that
of
the
current
study.
The
generalisability
of
the
results
may
be
somewhat
hampered
by
the
small
sample
size
of
the
current
study.
However,
as
there
is
little
research
involving
purely
adolescent
samples,
some
new
perspectives
may
be
gained
by
discussing
the
findings
of
the
current
study.
The
results
indicate
that
teachers
and
parents
may
offer
similar
values
in
rating
the
adolescents’
mental
health.
Analysing
the
problem
subscales,
strong
correlations
were
seen
across
the
board,
ranging
from
0.48
to
0.62.
Particularly
strong
correlations
were
found
in
the
peer
problems
(0.62)
and
hyperactivity-‐
inattention
scales
(0.60).
This
suggests
parents
and
teachers
may
have
similar
insights
into
the
adolescents’
friendships
or
lack
thereof,
as
well
as
their
ability
to
pay
attention.
Parent-‐teacher
agreements
could
also
offer
valuable
insights,
that
otherwise
could
be
missed,
as
shown
in
case
SDQ009
(Table
7).
In
this
case,
the
student
has
rated
himself
in
normal
range,
while
the
parent
and
teacher
have
rated
him
in
abnormal
and
borderline
range
respectively.
This
suggests
the
child
could
be
having
some
problems
and
indicate
a
need
for
further
assessment.
However,
SDQ
self-‐reports
are
generally
considered
the
most
reliable
in
the
clinical
setting,
particularly
in
older
children
(Muris
et
al.,
2004).
Therefore
strong
parent-‐teacher
correlations
must
be
interpreted
with
some
caution,
as
while
they
may
agree
with
one
another,
they
could
both
be
significantly
different
from
the
self-‐report.
An
interesting
example
of
this
can
be
seen
in
case
SDQ012
(Table
5),
where
the
parent
and
teacher
both
“agree”
by
rating
the
child
in
normal
range,
while
the
child
has
rated
himself
with
a
strikingly
high
total
difficulties
score.
Emotional Conduct Hyper. Peer Total Difficulties Prosocial
Student
Parent
Teacher
1
**5
2
2
**4
*3
5
**8
4
1
*3
**5
9
**20
*14
8
6
*5
Table
7
(SDQ009):
Students’
total
difficulties
rated
in
normal
range
by
self-‐report.
Parent-‐report
rated
in
abnormal
range.
Teacher-‐report
rated
in
borderline
range.
*
=
Borderline
score
**
=
Abnormal
score
25. 25
Both
parents
and
teacher
only
showed
‘fair’
levels
of
agreement
with
the
adolescents’
reports,
with
the
parents
presenting
with
the
slightly
higher
correlations
of
the
two.
This
may
suggest
that
in
an
adolescent
population,
parent
reports
may
suffice,
especially
if
a
teacher
is
unavailable
or
unwilling
to
report
on
the
child’s
mental
health,
which
can
often
be
the
case
(Koskelainen
et
al.,
2000).
The
strong
correlations
between
parent
and
teacher
reports
may
also
relate
to
the
theory
that
as
children
age,
the
range
of
what
adults
deem
as
“acceptable”
behaviour
narrows
(Halpenny
et
al.,
2010).
This
may
be
the
cause
of
the
higher
parent-‐teacher
correlations
seen
in
this
adolescent
population,
versus
the
studies
with
younger
samples.
Ultimately,
further
research
is
needed,
involving
a
large
adolescent
sample,
to
fully
determine
the
relationship
between
parent
and
teacher
reports
and
their
use.
5.4
Prevalence
of
Abnormal
Cases
As
outlined
by
a
recent
report
from
the
Royal
College
of
Surgeons
in
Ireland
(RCSI)
(Cannon
et
al.,
2013),
there
is
increasing
concern
about
the
psychological
wellbeing
of
the
young
people
of
Ireland.
The
report
laments
the
lack
of
previous
research
surrounding
the
prevalence
rates
of
mental
health
disorders
in
Ireland.
The
present
study
found
14.3%
of
its
adolescent
male
sample
to
be
self-‐rated
in
the
SDQ’s
abnormal
range,
with
a
further
14.3%
in
borderline
range.
Although
the
sample
size
of
this
study
was
small
(n=14),
some
similarities
can
be
drawn
with
recent
studies,
which
have
looked
at
prevalence
rates
of
mental
health
disorders
in
Ireland.
One
follow-‐up
study
included
in
the
RCSI
report
(Lynch
et
al.,
2006,
cited
in
Cannon
et
al.,
2013)
found
that
in
a
large
community-‐based
sample
(n=723),
almost
‘one
in
five’
(19.5%)
young
adults
were
found
to
be
‘at
risk’
of
suffering
from
a
mental
health
disorder.
Lynch
et
al.
(2006)
used
the
SDQ
self-‐report
scores
alongside
the
Children’s
Depression
Inventory
in
screening
for
possible
disorders.
Another
study
examining
prevalence
rates
in
an
Irish
adolescent
community
26. 26
sample
(n=346)
using
the
SDQ
(Greally
et
al.,
2009)
found
8.9%
of
its
sample
was
self-‐rated
in
abnormal
range
and
a
further
15.3%
rated
in
borderline
range.
While
the
SDQ
is
not
a
stand-‐alone
diagnostic
tool,
its
sensitivity
in
identifying
psychiatric
disorders
has
been
found
to
be
quite
strong,
ranging
from
70-‐90%
for
behavioural,
inattentive
and
depressive
disorders
(Goodman,
2000).
Therefore,
the
findings
of
the
current
study,
in
line
with
those
of
Lynch
et
al.
(2006)
and
Greally
et
al.
(2009),
suggest
that
mental
health
disorders
are
certainly
prevalent
in
a
considerable
proportion
of
the
Irish
adolescent
community,
with
between
19.5
and
28.6%
identifying
themselves
as
being
‘at
risk’.
Unlike
the
US
and
the
UK,
there
is
no
standardized
screening
strategy
for
youth
mental
health
in
place
in
Ireland
(Greally
et
al.,
2009).
With
an
increasing
volume
of
evidence
outlining
the
prevalence
of
disorders
in
Ireland,
and
with
rates
of
serious
consequential
behaviours
such
as
self-‐harm
and
suicide
amongst
the
highest
in
Europe,
it
would
appear
some
form
of
regular
screening
is
needed.
The
distribution
of
a
brief,
reliable
screening
tool
such
as
the
SDQ
in
a
school
setting,
every
term
or
school
year,
could
help
prevent
many
undetected
disorders
from
going
untreated.
Further
research
is
needed
surrounding
the
prevalence
of
mental
health
disorders
in
Ireland
across
a
wider
population
of
young
people.
This
would
allow
normative
data
to
be
established
and
ultimately
allow
a
regular
screening
strategy
to
be
put
in
place.
5.5
Limitations
The
main
limitation
of
this
study
was
its
small
sample
size.
Consent
was
obtained
from
the
parents
of
14
of
the
55
students
who
were
provided
with
information
sheets
and
consent
forms
by
the
school’s
administration.
The
researchers
had
expected
a
greater
response
rate
than
25.5%.
There
are
likely
to
be
various
reasons
that
led
to
the
poor
response
rate
that
was
obtained.
Recruiting
children
and
adolescents
for
research
projects
in
all
research
fields
can
prove
to
be
challenging
for
a
variety
of
reasons,
with
a
common
issue
being
the
forgetfulness
of
potential
participants
during
the
recruitment
process
(Foss
et
al.,
2010).
This
may
27. 27
have
been
the
case
in
the
present
study,
where
some
information
sheets
and
consent
forms,
may
have
been
mislaid
or
forgotten
about.
However,
there
is
also
the
possibility
that
the
subject
matter
of
the
study
may
have
been
perceived
as
being
too
sensitive
to
disclose
in
this
manner
by
some
of
the
parents
or
adolescents.
The
topic
of
‘mental
health’
has
been
shown
to
carry
elements
of
stigma
within
the
general
public
throughout
the
world
(Corrigan,
2004).
The
stigma
surrounding
mental
illness
in
Ireland
is
recognised
as
a
primary
barrier
to
young
people
receiving
the
help
and
support
they
require
(Buckley
et
al.,
2011).
Parents
of
adolescents
with
psychosocial
concerns
have
been
found
to
display
reluctance
towards
seeking
help
for
their
child
due
to
social
stigmas
(Hoyt
et
al.,
1999).
More
recent
studies
suggest
these
levels
of
stigma
may
be
reducing,
as
there
appears
to
be
a
deliberate
movement
to
reduce
the
stigmas
associated
with
mental
illness
in
the
general
public
(Polaha
et
al.,
2014).
However
it
is
possible
that
a
percentage
of
the
parents
who
upon
reading
the
present
study’s
information
sheets,
may
have
simply
chosen
to
avoid
participation
based
as
it
may
have
probed
‘sensitive
issues’.
This
was
anticipated
by
the
researchers
somewhat,
with
the
information
sheets
provided
to
the
parents
stating
that:
while
the
SDQ
does
explore
psychological
wellbeing
of
adolescents,
its
questioning
is
relatively
benign
in
nature.
However,
the
poor
response
rate
suggests
the
researchers
could
have
stressed
this
more
in
the
recruitment
process.
Another
limitation
of
the
study
was
that
it
involved
a
male
only
sample.
Differences
in
how
male
and
female
adolescents
report
their
mental
health
are
well
documented
(Cannon
et
al.,
2013).
Therefore
any
significance
of
this
study’s
results
can
only
be
applied
to
the
male
adolescent
population.
A
male
only
sample
was
recruited
for
this
study
for
convenience
reasons.
However,
given
the
worrying
statistics
surrounding
the
self-‐harming
behaviours
of
young
Irish
males,
male
specific
research
in
the
mental
health
field
is
warranted.
Further
research
assessing
a
large
mixed-‐gender
adolescent
sample
would
offer
valuable
gender-‐
specific
insights
into
the
areas
in
which
Irish
adolescents
are
experiencing
28. 28
difficulties.
This
would
also
allow
gender
effects
to
be
analysed
for
correlations
between
the
adolescent,
their
parents
and
teachers.
6.
Conclusion
This
study
aimed
to
examine
inter-‐rater
agreements
between
adolescents,
parents
and
teachers
when
rating
the
adolescents’
psychological
wellbeing
using
the
SDQ.
Results
showed
‘fair’
levels
of
agreement
between
adolescents
and
their
parents,
which
was
consistent
with
that
of
other
studies
in
the
field.
Adolescents
and
their
teacher
showed
slightly
lower
levels
of
agreement,
but
were
also
considered
as
‘fair’.
Parents
and
teacher
showed
‘good’
levels
of
agreement
when
rating
the
child’s
mental
health,
which
was
stronger
in
comparison
with
previous
studies
that
have
assessed
parent-‐teacher
agreements
with
younger
children.
Future
studies
involving
a
large
sample,
assessing
correlations
between
adolescents
of
both
genders,
their
parents
and
teachers
is
warranted.
The
study
was
limited
by
its
small
sample
size
and
all-‐male
nature.
However,
even
in
a
small
sample,
the
prevalence
of
adolescents
who
may
be
at
risk
of
a
psychological
disorder
found
in
this
study
appears
consistent
with
that
of
other
recent
studies
carried
out
in
community-‐based
populations
in
Ireland.
Further
research
is
needed
to
gain
a
clearer
view
on
the
scale
of
mental
health
problems
amongst
young
people
of
Ireland.
29. 29
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