Strengths & Difficulties Questionnaire – what does it mean?

One of the most common screening questionnaires for children’s mental health is the Strengths and Difficulties Questionnaire (SDQ). It’s used in research studies, clinical assessments, as well as schools to help inform Personal Education Plans. The SDQ has five subscales: emotional symptoms, conduct problems, hyperactivity/inattention, peer relationships and prosocial behaviour. There is also an impact score and the total score. But what do the scores actually mean and how can people use them?

Well firstly, a high total score, or a high score on any subscale, points to the likelihood of a significant disorder – the subscales suggest what type of disorder it might be. That said a high scores doesn’t guarantee there is a disorder and similarly, a low score doesn’t guarantee a lack of problems.  The SDQ is more used to highlight where any potential problems might lie.

Total Score

This is the overall level of difficulties, so higher scores represent greater problems experienced.  As the score increases, the risk of developing (or having) a mental health disorder increases. This can show an average, raised, high or very high risk of disorder. (Note it’s risk for rather than definitely having a disorder).

Impact

This measures how severe the child feels the problem is, the higher the scores the more distressing the child is likely to find it. Specifically this scale measures the duration and the impact of the problem on the child and others.

Emotional Symptoms

This scale is linked to disorders like depression and anxiety, so children who score on high on this subscale are likely to have low mood and/or be fearful.  These children may seem to be ok so it can be harder to know there is a problem because disorders like anxiety tend to affect how children feel rather than how they behave (i.e. they may not be disruptive or act out). However, they may not enjoy activities and be apathetic, become withdrawn and lack confidence, be irritable or grumpy, not be able to concentrate, be indecisive or be unable to relax. Physically, they may complain of feeling tired or have various aches and pains like headaches/stomach aches.

Conduct Problems

This scale is linked to problems like conduct disorder. These children are likely to be disruptive in class, they may be cheeky, aggressive or disobedient and break rather than conform to rules.  They may even get into fights, steal, lie and truant.  They can find it hard to make friends and often have difficulties in social situations.  On the inside they may feel worthless.

Hyperactivity

This scale is linked to Attention Deficit Hyperactive Disorder (ADHD). High scores suggest there may be problems with attention and concentration and the child may be restless. Their problems could be linked to attention in which case they could be easily bored or distracted, lose things and struggle to follow instructions and learn new information or it may be they have more problems with hyperactivity and they struggle to sit still and find it hard to work quietly wanting to talk and move about.  They may also be impulsive, interrupt, acting without thinking and be easily frustrated.

Peer Problems

This scale measures trouble with relationships. These children may be picked on or bullied by others and may not be widely liked as they have problems relating to their peers.  This can make them isolated and lonely.

Prosocial Score

This scale doesn’t assess problems but rather a child’s prosocial behaviours – high scores suggest they have social skills and competencies which are adaptive. Children who score high are more likely to be considerate, helpful and kind and are less likely to display aggressive and delinquent behaviours.

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