Open Access Research article

A comparison of four scoring methods based on the parent-rated Strengths and Difficulties Questionnaire as used in the Dutch preventive child health care system

Mathilde R Crone1*, Anton GC Vogels1, Femke Hoekstra2, Philip DA Treffers3 and Sijmen A Reijneveld14

Author Affiliations

1 TNO Quality of Life, Leiden, The Netherlands

2 Health Service Amsterdam, Amsterdam, The Netherlands

3 Department of Child and Adolescent Psychiatry, Curium, Leiden University Medical Center, Oegstgeest, The Netherlands

4 Department of Health Sciences/NCH, University Medical Center Groningen, Groningen, The Netherlands

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BMC Public Health 2008, 8:106  doi:10.1186/1471-2458-8-106

Published: 4 April 2008



Validated questionnaires can support the identification of psychosocial problems by the Preventive Child Health Care (PCH) system. This study assesses the validity and added value of four scoring methods used with the Strengths and Difficulties Questionnaire (SDQ) for the identification of psychosocial problems among children aged 7–12 by the PCH.


We included 711 (of 814) children (response: 87%) aged 7–12 undergoing routine health assessments in nine PCH services across the Netherlands. Child health professionals interviewed and examined children and parents. Prior to the interview, parents completed the SDQ and the Child Behaviour Checklist (CBCL), which were not shown to the professionals. The CBCL and data about the child's current treatment status were used as criteria for the validity of the SDQ. We used four SDQ scoring approaches: an elevated SDQ Total Difficulties Score (TDS), parent-defined difficulties, an elevated score for emotional symptoms, conduct problems or hyperactivity in combination with a high impairment score, and a combined score: an elevated score for any of these three methods.


The Cohen's Kappa ranged from 0.33 to 0.64 for the four scoring methods with the CBCL scores and treatment status, generally indicating a moderate to good agreement. All four methods added significantly to the identification of problems by the PCH. Classification based on the TDS yielded results similar to more complicated methods.


The SDQ is a valid tool for the identification of psychosocial problems by PCH. As a first step, the use of a simple classification based on the SDQ TDS is recommended.