A Systematic Review of Some Reliability and Validity Issues regarding the Strengths and Difficulties Questionnaire Focusing on Its Use in Out-of-Home Care

Figures & data

Table 1. Definitions of the psychometric properties of the SDQ

Reliability
Inter-rater reliability	The extent to which scores for people are the same across repeated measurements by different raters of the same type, e.g., two teachers rating the same pupil.
Cross-informant consistency	The extent to which scores for people are the same across repeated measurement by different types of raters, e.g., a teacher in a school context and a parent in a home environment.
Test-retest reliability and temporal stability ^a	The degree to which repeated measurements using the same instrument provide similar scores. Interim period between two measurement points under 31 days = test-retest reliability; interim period of at least 31 days = temporal stability.
Criterion validity (capacity to discriminate)
Sensitivity and specificity	Ability of a tool to discriminate between two extreme groups (e.g. “normal” and “abnormal”). Sensitivity: The proportion of children who are correctly identified by the SDQ as being in the “abnormal” range. Specificity: The proportion of children who are correctly identified by the SDQ as being in the “normal” range.
Positive Predictive Value (PPV) and Negative Predictive Value (NPV)	PPV: The probability that following a positive SDQ result (i.e. scoring above the clinical cutting score or being in the “abnormal” range), a child will have a psychiatric diagnosis. NPV: The probability that following a negative SDQ result (i.e. scoring below the clinical cutting score or being in the “normal” range), a child will not have a psychiatric diagnosis.

^aEvers et al. (2013).

Figure 1. Literature review flowchart (modified PRISMA 2009 version, Moher et al., 2009)

Table 2. Summary of articles included in the review

								Reliabilty				Discriminate validity
No	Article	Total sample	Age (years)	Infor-mant	Source population	Country	General study aim	Test-retest	Inter	Cross	Se	Sp	PPV	NPV	Source of diagnosis	Quality 0–21
1	Aebi et al. (2017)	252/95	13–17	P,S	CO/CL	Germany	Ability of the SDQ to predict disorders			X					DAWBA	15
2	Aitken et al. (2015)	501	6–9	P,T	CO	Canada	Psychometric properties			X						15
3	Almaqrami and Shuwail (2004)	657	12–17	S	CO/CL	Yemen	Validity				X	X			Clinically diagnosed	11
4	Becker et al. (2004)	214	11–17	P,T,S	CL	Germany	Reliability and validity			X					Clinically diagnosed	11
5	Bekker et al. (2016)	244	5–13	P	CL	Australia	Validity						X	X	Clinically diagnosed	12
6	Boman et al. (2016)	512	7–8	P,T	CO	Sweden	Reliability and validity			X						12
7	A.-M. Borg et al. (2012), A. M. Borg et al. (2014)	2,682	4–9	P,T	CO/CL	Finland	Reliability, validity, and norms	X ^a	X ^a	X ^a	X	X			DAWBA	12
8	Brøndbo et al. (2011)	286	5–18	P,T,S	CL	Norway	Validity				X	X	X	X	DAWBA	12
9	Capron et al. (2007)	1400	11–13	T,S	CO	France	Psychometric properties	X		X ^a						18
10	Cornes and Brown (2012)	26–31	11–18	P,T,S	CO	Australia	Validity of Auslan ^b SDQ			X						14
11	Davé et al. (2008)	248	4–6	P	CO	United Kingdom	Reliability		X							12
12	Doi et al. (2014)	393	4–6	P	CO	Japan	Reliability	X								15
13	Downs et al. (2012)	179/298	3–6	P,T	CO	Germany/USA	Reliability, validity and cultural influences	X	X ^c	X ^c						12
14	Du et al. (2008)	1965	3–17	P,T,S	CO	China	Reliability, validity and norms	X		X ^d						16
15	Emerson (2005)	4,449/93	11–15	P,T,S	CO/CL	United Kingdom	Reliability and validity			X ^a						13
16	Ezpeleta et al. (2013)	1,341	3	P,T	CO/CL	Spain	Psychometric properties				X	X			DICA-PPYC	12
17	R. Goodman (1997)	403	4–16	P,T	CO/CL	United Kingdom	Reliability and validity			X					Attendees at child and adolescent mental health clinic	12
18	R. Goodman (1999)	699	5–15	P,T,S	CO/CL	United Kingdom	Validity	X^c							Attendees at child and adolescent mental health clinic	12
19	R. Goodman (2001), R. Goodman et al. (2003), R. Goodman et al. (2004)	9,998	5–15	P,T,S	CO	United Kingdom	Psychometric properties	X		X ^a	X	X	X	X	DAWBA	12
20	R. Goodman et al. (1998)	83/116	11–16	P,T,S	CO/CL	United Kingdom	Reliability and validity			X					Attendees at child and adolescent mental health clinic	12
21	R. Goodman et al. (2004)	7,984/ 1,029	5–17	P,T,S	CO/CL	United Kingdom	Validity				X				DAWBA	12
22	Gustafsson et al. (2016)	690	1–6	T	CO/CL	Sweden	Psychometric properties	X ^a							Attendees at child and adolescent mental health clinic	11
23	Hawes and Dadds (2004)	1,359	4–9	P	CO	Australia	Psychometric properties	X								12
24	He et al. (2013)	6,483	13–18	P	CO	USA	Psychometric properties				X	X	X	X	Computerized DSM-IV criteria algorithm	12
25	Hysing et al. (2007), Posserud et al., 2014)	9,430	7–9	P,T	CO	Norway	Validity				X	X	X	X	DAWBA/K-SADS	12
26	Indredavik et al. (2005)	199^e	14	P,T,S	CO	Norway	Validity				X	X			K-SADS	12
27	Janssens and Deboutte (2009)	116	3–18	P,S	CL	Belgium	Ability to use the SDQ as screener			X					Attendees at child welfare institutions	16
28	Jee, Szilagyi, et al. (2011)	50	11–17	P,S	CL	USA	Reliability and validity				X	X	X	X	ChIPS	11
29	Johnson et al. (2014)	219^e	11	P,T	CO	United Kingdom and Ireland	Validity				X	X	X	X	DAWBA	12
30	Kim et al. (2015)	3,199	11–16	S	CO/CL	Korea	Psychometric properties	X							Attendees at adolescent mental health clinic	12
31	Klasen et al. (2000)	110	12–13	P, S	CO	Germany	Comparing the SDQ and CBCL			X						15
32	Koskelainen et al. 2000	735	7–15	P,T,S	CO	Finland	Reliability, validity and help-seeking behavior			X						12
33	Kovacs & Sharp, 2014	159	12–17	P, S	CL	USA	Validity				X	X	X	X	CDISC	12
34	Lai et al., 2010, Lai et al., 2014	3722/494	6–12	P, T	CO/CL	Hong Kong, China	Reliability and validity	Xc		X	X	X	X	X	Attendees at child and adolescent mental health clinic	18
35	Lappalainen et al., 2014	588	11–12	P,T,S	CO	Finland	Reliability and validity	X		X						12
36	Lehmann et al. (2014)	279	6–12	P,T	CL	Norway	Validity				X	X	X	X	DAWBA	13
37	Li et al. (2017)	422	12–17	P, S	CO	Italy	Psychometric properties and norms		X	X						12
38	Liu et al. (2013)	3,534/211	6–15	P,T,S	CO/CL	Taiwan	Psychometric properties and norms	X ^c		X					K-SADS-E	12
39	Lukumar et al. (2008)	125	11–16	S	CO/CL	Sri Lanka	Reliability and validity				X	X	X	X	Attendees at child and adolescent mental health clinic	12
40	Malmberg et al. (2003)	493	5–14	P	CO/CL	Sweden	Validity				X	X	X		Attendees at child and adolescent mental health clinic	12
41	Mathai et al. (2002), Mathai et al. (2004)	130	4–14	P,T,S	CL	Australia				X	X				Clinically diagnosed	12
42	Mellor (2004)	917	7–17	P,T,S	CO	Australia	Reliability	X		X						13
43	Mellor et al. (2011)	700	6–11	P	CO	China	Reliability and validity		X							12
44	Mellor et al. (2016)	443	12–18	P,S	CL	China	Psychometric properties			X	X	X			Clinically diagnosed	18
45	C. Mieloo et al. (2012), C. L. Mieloo et al. (2014)	9,355	5–6	P,T	CO	The Netherlands	Reliability and validity			X						12
46	Moriwaki and Kamio (2014)	24519	7–15	P,T	CO	Japan	Psychometric properties and norms	X		X ^a						18
47	Muris et al. (2003)	562	9–15	P,S	CO	The Netherlands	Reliability and validity	X		X						12
48	Muris et al. (2004)	1111	8–13	S,T	CO	The Netherlands	Psychometric properties			X						12
49	Niclasen et al. (2012)	63,615 ^f	5–12	P,T	CO	Denmark	Psychometric properties and norms			X						12
50	Rimvall et al. (2014)	2,315	5–7	P,T	CO	Denmark	Validity				X	X	X	X	DAWBA	12
51	Ruchkin et al. (2012)	538	13–18	T,S	CO	Russia	Psychometric properties			X						12
52	Salayev et al. (2016)	614	4–16	P	CO/CL	Azerbaijan	Validity				X	X			Clinically diagnosed	15
53	Samad et al. (2005)	212	4–16	P	CO/CL	Pakistan	Validity				X	X			Clinically diagnosed	11
54	Sharp et al. (2014)	466	7–11	P,T,S	CO	South Africa	Reliability and Validity			X	X	X			CDISC	12
55	Silva et al. (2015)	120	6–12	P	CO	Brazil	Validity				X	X			DAWBA	12
56	Stringaris and Goodman (2013)	4,479	5–16	P,T,S	CO	United Kingdom	Psychometric properties over time	X		X						12
57	Sveen et al. (2013), Sveen et al. (2016)	1,038	4 & 6	P,T	CO/CL	Norway	Validity				X	X	X	X	PAPA	12
58	Van den Heuvel et al. (2017)	394	4–10	P,T	CO	The Netherlands	Reliability and validity			X						18
59	Van Widenfelt et al. (2003)	970	11–16	P,T,S	CO	The Netherlands	Reliability, validity and norms			X						15
60	Yao et al. (2009)	1,135	11–18	S	CO	China	Reliability and validity	X								12

References using the same sample have been grouped. CO = community sample; CL = clinical sample; Inter = Inter-rater reliability; Cross = Cross-informant consistency, Se = Sensitivity; PPV = Positive Predictive Value; NPV = Negative Predictive Value; P = parent, T = teacher; S = self-report; DAWBA = Development and Well-Being Assessment; Auslan = Australian sign language; DICA-PPYC = Diagnostic Interview for Children and Adolescents for Parents of Preschool and Young Children; ChIPS = Children´s Interview for Psychiatric Syndromes; K-SADS-E = Schedule for Affective Disorders and Schizophrenia for School-Age Children – Epidemiologic Version; CDISC = Computerized Diagnostic Interview Schedule for Children; PAPA = Preschool Age Psychiatric Assessment.

^aSpearman´s rho. ^b Deaf children used the written form. ^c Intraclass correlation. ^d Both Pearson and Spearman’s rho. ^e Population(s) defined as community sample here. ^f Equals the number of included parents.

Table 3. Summary of inter-rater correlations (Pearson’s, Spearman’s, and ICC Coefficients)

Informants	SDQ scale	No. of articles	No. of samples	Total sample size	Weighted mean correlation	95% C.I.
Community samples
Mother vs.	TDS	5	6	3,355	.62	[.60,.64]
Father	Emotional symptoms	5	6	3,355	.52	[.50,.54]
	Conduct problems	4	4	2,655	.59	[.57,.61]
	Hyper. – Inattention	4	4	2,655	.64	[.62,.66]
	Peer relationship prob.	4	4	2,655	.51	[.48,.54]
	Prosocial behavior	5	6	3,355	.51	[.48,.54]

No. of articles refers to the number of unique references. No. of samples refers to unique sub-samples of the total sample in an article which were used in calculating different psychometric indicators.

Table 4. Summary of cross-informant consistency (Pearson’s, Spearman’s, and ICC coefficients)

	Informants	SDQ scale	No. of articles	No. of samples	Total sample size	Weighted mean correlation	95% C.I.
Community samples
	Parent and Self-report	TDS	14	15	12,792	.46^c	[.45,.47]
		Emotional symptoms	16	17	13,556	.36^c	[.35,.38]
		Conduct problems	17	18	15,997	.37^b	[.36,.38]
		Hyper. – Inattention	17	18	15,997	.38^a	[.37,.39]
		Peer relationship prob.	13	14	12,396	.36^a	[.35,.38]
		Prosocial behavior	13	14	14,727	.30^a	[.29,.32]
		Impact scale	3	3	9,114	.36^b	[.34,.38]
	Parent and Teacher	TDS	18	22	31,356	.44^c	[.43,.45]
		Emotional symptoms	19	23	31,485	.29^b	[.28,.30]
		Conduct problems	19	23	31,485	.33^a	[.32,.34]
		Hyper. – Inattention	19	23	31,485	.46^a	[.45,.47]
		Peer relationship prob.	18	22	31,023	.36^b	[.35,.37]
		Prosocial behavior	19	23	34,377	.26^b	[.25,.27]
		Impact scale	4	6	19,667	.42	[.41,.43]
	Teacher and Self-report	TDS	11	11	9,966	.33^b	[.31,.35]
		Emotional symptoms	13	13	10,777	.19^a	[.17,.21]
		Conduct problems	13	13	10,777	.28^a	[.26,.30]
		Hyper. – Inattention	13	13	10,777	.33^b	[.31,.35]
		Peer relationship prob.	12	12	10,315	.26^a	[.24,.28]
		Prosocial behavior	12	12	10,315	.23^b	[.21,.25]
		Impact scale	2	3	6,255	.30	[.28,.32]
Clinical samples
	Parent and Self-report	TDS	5	5	466	.38	[.30,.46]
		Emotional symptoms	5	5	466	.40	[.32,.47]
		Conduct problems	5	5	466	.53	[.46,.59]
		Hyper. – Inattention	5	5	466	.47	[.40,.54]
		Peer relationship prob.	4	4	371	.51	[.43,.58]
		Prosocial behavior	3	3	333	.48	[.39,.56]
		Impact scale	2	2	188	.28	[.14,.41]
	Parent and Teacher	TDS	3	3	270	.30	[.19,.41]
		Emotional symptoms	3	3	270	.34	[.23,.44]
		Conduct problems	3	3	270	.44	[.34,.53]
		Hyper. – Inattention	3	3	270	.57	[.48,.65]
		Peer relationship prob.	3	3	270	.38	[.27,.48]
		Prosocial behavior	2	2	171	.24	[.09,.38]
	Teacher and Self-report	TDS	4	4	321	.34	[.24,.43]
		Emotional symptoms	4	4	321	.35	[.25,.44]
		Conduct problems	4	4	321	.46	[.37,.54]
		Hyper. – Inattention	3	3	295	.42	[.32,.51]
		Peer relationship prob.	4	4	321	.39	[.29,.48]
		Prosocial behavior	3	3	295	.28	[.17,.38]

No. of articles refers to the number of unique references. No. of samples refers to unique sub-samples of the total sample in an article which were used in calculating different psychometric indicators. Fisher’s z-transformation: ^a r for the clinical sample is significantly higher than for the community sample, ^b r is not significantly different between clinical and community samples, and ^c r for the clinical sample is significantly lower.

Table 5. Summary of test-retest reliability and temporal stability (Pearson’s, Spearman’s, ICC coefficients)

	Respondents	SDQ scale	No. of articles	No. of samples	Total sample size	Weighted mean correlation	95% C.I.
Test-retest reliability (interval between measurements: under 31 days)
	Parent	TDS	4	4	827	.84	[.82,.86]
		Emotional symptoms	3	3	799	.80	[.77,.82]
		Conduct problems	4	4	1,023	.69	[.66,.72]
		Hyper. – Inattention	4	4	1,023	.80	[.78,.82]
		Peer relationship prob.	3	3	802	.71	[.67,.74]
		Prosocial behavior	4	4	1,023	.73	[.70,.76]
	Teacher	TDS	4	5	913	.88	[.86,.89]
		Emotional symptoms	4	5	913	.78	[.75,.80]
		Conduct problems	4	5	913	.84	[.82,.86]
		Hyper. – Inattention	4	5	913	.87	[.85,.89]
		Peer relationship prob.	4	5	913	.80	[.78,.82]
		Prosocial behavior	5	6	1146	.82	[.80,.84]
	Self-report	Emotional symptoms	2	2	329	.65	[.58,.71]
		Conduct problems	2	2	329	.56	[.48,.63]
		Hyper. – Inattention	2	2	329	.73	[.68,.78]
		Peer relationship prob.	2	2	329	.63	[.56,.69]
		Prosocial behavior	2	2	329	.60	[.53,.67]
Temporal stability (interval between measurements: At least 31 days)
	Parent	TDS	6	6	3,633	.74	[.73,.75]
		Emotional symptoms	6	6	3,242	.63	[.61,.65]
		Conduct problems	6	6	3,242	.65	[.63,.67]
		Hyper. – Inattention	7	7	3,834	.74	[.73,.75]
		Peer relationship prob.	6	6	3,242	.63	[.61,.65]
		Prosocial behavior	6	6	3,242	.63	[.61,.65]
		Impact scale	3	5	14,756	.44	[.43,.45]
	Teacher	TDS	4	5	1,220	.78	[.76,.80]
		Emotional symptoms	5	6	1,468	.60	[.57,.63]
		Conduct problems	5	6	1,468	.65	[.62,.68]
		Hyper.-Inattention	5	6	1,468	.78	[.76,.80]
		Peer relationship prob.	5	6	1,468	.65	[.62,.68]
		Prosocial behavior	5	6	1,468	.68	[.65,.71]
	Self-report	TDS	5	5	1,314	.69	[.66,.72]
		Emotional symptoms	6	6	1,818	.60	[.57,.63]
		Conduct problems	6	6	1,818	.55	[.52,.58]
		Hyper. – Inattention	6	6	1,818	.62	[.59,.65]
		Peer relationship prob.	6	6	1,818	.59	[.56,.62]
		Prosocial behavior	6	6	1,818	.55	[.52,.58]

No. of articles refers to the number of unique references. No. of samples refers to unique sub-samples of the total sample in an article which were used in calculating different psychometric indicators.

Table 6. Summary of criterion validity: capacity to discriminate

	Informants	SDQ scale	No. of articles	No. of samples	Total sample size	Weighted mean	Range
Sensitivity
	Parent	TDS	16	21	26,356	50.94	29.90 – 83.00
		Emotional symptoms	10	10	19,278	55.57	32.20 – 75.00
		Conduct problems	10	9	19,066	68.65	46.30 – 79.31
		Hyper. - Inattention	11	11	19,562	67.84	45.00 – 75.00
		Peer relationship prob.	8	8	18,494	37.35	29.30 – 93.00
		Prosocial behavior	8	8	18,593	30.78	25.00 – 95.00
		Impact scale	4	4	5,717	75.54	16.20 – 85.00
	Self	TDS	7	9	5,430	34.49	17.00 – 76.42
		Emotional symptoms	3	3	4,607	36.63	29.00 – 82.54
		Conduct problems	3	3	4,607	38.68	29.00 – 75.76
		Hyper. - Inattention	4	4	5,050	44.91	40.00 – 64.29
		Peer relationship prob.	2	2	4,142	38.03	37.00 – 63.75
	Teacher	TDS	8	10	13,533	45.42	17.00 – 86.40
		Emotional symptoms	4	4	8,616	30.28	15.00 – 52.00
		Conduct problems	3	3	8,616	58.43	23.10 – 62.00
		Hyper. - Inattention	3	3	8,616	64.34	34.30 – 71.00
		Peer relationship prob.	3	3	8,154	25.70	25.00 – 33.00
		Prosocial behavior	2	2	7,935	36.74	35.00 – 57.20
		Impact scale	2	2	4,566	53.90	20.80 – 65.30
Specificity
	Parent	TDS	15	20	29,587	90.31	58.00 – 95.80
		Emotional symptoms	10	10	18,772	88.73	61.76 – 91.20
		Conduct problems	9	9	18,907	89.49	67.00 – 92.10
		Hyper. - Inattention	11	11	19,562	89.12	64.89 – 93.00
		Peer relationship prob.	8	8	18,494	87.03	60.00 – 97.00
		Prosocial behavior	8	8	18,434	85.94	20.00 – 91.00
		Impact scale	5	5	5,224	86.66	69.50 – 97.10
	Self	TDS	6	8	4,987	85.63	51.00 – 95.00
		Emotional symptoms	3	3	4,607	87.12	56.00 – 96.00
		Conduct problems	3	3	4,607	86.87	51.00 – 96.00
		Hyper.-Inattention	4	4	4,987	81.55	47.00 – 91.00
		Peer relationship prob.	2	2	4,142	88.22	68.66 – 89.00
	Teacher	TDS	8	10	13,533	89.39	56.00 – 95.00
		Emotional symptoms	4	4	8,616	88.61	53.00 – 93.00
		Conduct problems	4	4	8,616	84.83	52.00 – 95.00
		Hyper. - Inattention	4	4	8,616	89.49	62.00 – 93.00
		Peer relationship prob.	3	3	8,154	94.19	84.00 – 95.00
		Prosocial behavior	2	2	7,935	90.53	85.00 – 91.00
		Impact scale	3	5	6,538	89.88	89.80 – 90.60
PPV
	Parent	TDS	10	10	23,313	47.71	9.50 – 91.77
		Emotional symptoms	8	8	10,418	23.39	21.00 – 85.00
		Conduct problems	8	8	17,772	33.66	13.00 – 81.70
		Hyper. - Inattention	8	8	17,971	28.22	17.00 – 87.00
		Peer relationship prob.	6	6	17,369	29.54	21.00 – 67.60
		Prosocial behavior	5	5	17,253	24.63	22.00 – 80.00
		Impact scale	3	3	772	80.67	74.00 – 85.30
	Self	TDS	3	3	4,268	38.71	35.00 – 91.35
		Emotional symptoms	2	2	4,142	31.88	29.00 – 72.14
		Conduct problems	2	2	4,142	21.25	19.00 – 54.97
		Hyper. - Inattention	2	2	4,142	10.12	9.00 – 38.10
		Peer relationship prob.	2	2	4,142	27.75	26.00 – 71.48
	Teacher	TDS	3	3	11,441	43.83	43.00 – 53.00
		Emotional symptoms	2	2	7,532	14.29	14.00 – 24.00
		Conduct problems	2	2	7,532	37.80	31.00 – 38.00
		Hyper. - Inattention	2	2	7,532	19.58	19.00 – 39.00
		Peer relationship prob.	2	2	7,532	33.48	16.00 – 34.00
NPV
	Parent	TDS	8	8	22,764	93.09	39.89 – 99.60
		Emotional symptoms	7	7	17,279	96.14	24.00 – 96.90
		Conduct problems	7	7	17,279	97.63	77.74 – 98.00
		Hyper.-Inattention	6	6	17,035	97.83	82.00 – 99.00
		Peer relationship prob.	5	5	16,876	91.67	87.70 – 99.00
		Prosocial behavior	4	4	16,760	89.87	55.00 – 92.00
	Self	TDS	3	3	4,268	89.91	48.97 – 92.00
		Emotional symptoms	2	2	4,142	94.43	67.17 – 96.00
		Conduct problems	2	2	4,142	96.49	89.43 – 97.00
		Hyper.-Inattention	2	2	4,142	97.66	89.13 – 98.00
		Peer relationship prob.	2	2	4,142	89.83	60.59 – 91.00
	Teacher	TDS	3	3	11,441	92.75	82.00 – 94.00
		Emotional symptoms	2	2	7,532	96.85	92.00 – 97.00
		Conduct problems	2	2	7,532	97.94	96.00 – 98.00
		Hyper. - Inattention	2	2	7,532	98.91	96.00 – 99.00
		Peer relationship prob.	2	2	7,532	93.00	93.00 – 93.00
Using SDQ multi-informant predictive algorithm combining 2 or more SDQ scales or Impact score
Sensitivity			9	9	12,737	62.52	30.00 – 93.00
Specificity			8	8	12,607	91.89	50.00 – 96.20
PPV			8	8	12,607	50.45	26.70 – 93.00
NPV			8	8	12,607	94.63	60.00 – 98.30

Note. No. of articles refers to the number of unique references. No. of samples refers to the unique sub-samples of the total sample in an article that were used in calculating different psychometric indicators.

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