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Psychometric properties of the teacher version of the strengths and difficulties questionnaire in a diverse U.S. sample

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Title:
Psychometric properties of the teacher version of the strengths and difficulties questionnaire in a diverse U.S. sample
Creator:
Bosik, Sata Wynne
Place of Publication:
Denver, CO
Publisher:
University of Colorado Denver
Publication Date:
Language:
English

Thesis/Dissertation Information

Degree:
Doctorate ( Doctor of psychology)
Degree Grantor:
University of Colorado Denver
Degree Divisions:
School of Education and Human Development, CU Denver
Degree Disciplines:
School psychology
Committee Chair:
Harris, Bryn
Committee Members:
Crepeau-Hobson, Franci
Donovan, Courtney Vidacovich

Notes

Abstract:
This study assesses the utility of the U.S. version of the Strengths and Difficulties Questionnaire (SDQ) teacher form as a screener for mental health and behavior concerns. The SDQ was administered to a community sample of 391 culturally and linguistically diverse students in grades K-6. Internal reliability was assessed using Cronbach’s alpha. Difference by sex and grade were explored through t-tests and one-way analysis of variance (ANOVA), respectively. A confirmatory factor analysis (CFA) was conducted to evaluate factor structure. Results revealed strong internal reliability for the measure as a whole (a = .77). Scale alphas were minimally acceptable to satisfactory (a range = .69 to .91). Analysis showed significant differences across sex and grade. Males experienced significantly more total difficulties than females, and females demonstrated significantly more prosocial behaviors. Students in lower grades displayed less prosocial behavior than those in grades above them, whereas students in higher grades exhibited more emotional symptoms than those in grades below them. CFA found a five-factor model to be the best fit among those tested, however it was barely acceptable even with modifications. Overall, the U.S. version of the SDQ teacher form was determined to be adequate for identifying students experiencing general difficulties but lacking in the psychometric soundness to help evaluators differentiate among the types of problems with which students may struggle.

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University of Colorado Denver
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Auraria Library
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Copyright Sara Wynne Bosik. Permission granted to University of Colorado Denver to digitize and display this item for non-profit research and educational purposes. Any reuse of this item in excess of fair use or other copyright exemptions requires permission of the copyright holder.

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Full Text
PSYCHOMETRIC PROPERTIES OF THE TEACHER VERSION OF THE STRENGTHS
AND DIFFICULTIES QUESTIONNAIRE IN A DIVERSE U S. SAMPLE
by
SARA WYNNE BOSIK B.A., University of Colorado Boulder, 2006
A thesis submitted to the Faculty of the Graduate School of the University of Colorado in partial fulfillment of the requirements of the degree of Doctor of Psychology School Psychology Program
2019


©2019
SARA WYNNE BOSIK
ALL RIGHTS RESERVED


This thesis for the Doctor of Psychology degree by Sara Wynne Bosik has been approved for the School Psychology Program by
Bryn Harris, Chair Franci Crepeau-Hobson Courtney Vidacovich Donovan
Date: May 18, 2019


Bosik, Sara Wynne (PsyD, School Psychology Program)
Psychometric Properties of the Teacher Version of the Strengths and Difficulties Questionnaire in a Diverse U.S. Sample
Thesis directed by Associate Professor Bryn Harris
ABSTRACT
This study assesses the utility of the U.S. version of the Strengths and Difficulties Questionnaire (SDQ) teacher form as a screener for mental health and behavior concerns. The SDQ was administered to a community sample of 391 culturally and linguistically diverse students in grades K-6. Internal reliability was assessed using Cronbach’s alpha. Difference by sex and grade were explored through t-tests and one-way analysis of variance (ANOVA), respectively. A confirmatory factor analysis (CFA) was conducted to evaluate factor structure. Results revealed strong internal reliability for the measure as a whole (a = .77). Scale alphas were minimally acceptable to satisfactory (a range = .69 to .91). Analysis showed significant differences across sex and grade. Males experienced significantly more total difficulties than females, and females demonstrated significantly more prosocial behaviors. Students in lower grades displayed less prosocial behavior than those in grades above them, whereas students in higher grades exhibited more emotional symptoms than those in grades below them. CFA found a five-factor model to be the best fit among those tested, however it was barely acceptable even with modifications. Overall, the U.S. version of the SDQ teacher form was determined to be adequate for identifying students experiencing general difficulties but lacking in the psychometric soundness to help evaluators differentiate among the types of problems with which students may struggle.
The form and content of this abstract are approved. I recommend its publication.
Approved: Bryn Harris
IV


TABLE OF CONTENTS
CHAPTER
I. INTRODUCTION.....................................................1
II. LITERATURE REVIEW...............................................4
Instrument Overview...........................................4
Factor Structure: International Findings......................5
Factor Structure: U.S. Findings...............................7
Cultural Considerations.......................................8
The Current Study............................................11
III. METHODS.......................................................13
Participants.................................................13
Procedures ..................................................14
Measures.....................................................15
Data Analysis................................................16
IV. RESULTS........................................................17
Descriptive Statistics.......................................17
Differences by Sex...........................................20
Differences by Grade Level...................................21
Factor Structure.............................................23
V. DISCUSSION.....................................................29
Implications.................................................33
Limitations and Future Research..............................34
Conclusion...................................................35
REFERENCES.........................................................36
v


CHAPTERI
INTRODUCTION
Many students in the United States experience mental health and behavioral difficulties.
In fact, a national survey indicated that 2.7 million American youths between the ages of 4-17 struggle with problems related to behavior, emotion, concentration, and social interactions (Simpson, Bloom, Cohen, Blumberg, & Bourdon, 2005). Though precise prevalence rates are difficult to ascertain, the large number of children and adolescents who exhibit or are at risk for mental health and behavioral problems has prompted a movement toward early identification and intervention. The intention of this undertaking is to provide timely and appropriate supports to struggling students so that they can achieve positive life outcomes as soon as possible.
The stakes are high for students with untreated mental health and behavioral challenges. Both short- and long-term negative outcomes are well documented. For example, students with emotional and behavioral difficulties experience poorer academic achievement (Reid, Gonzalez, Nordness, Trout, & Epstein, 2004) and are less likely to complete high school (McLeod &
Kaiser, 2004; Wagner, Newman, Cameto, Levine, & Garza, 2006). Post-school outcomes include low employment rates (Wagner & Newman, 2012) and less financially independence (Sanford et al., 2011). Despite these significant and far-reaching consequences, many youths are not getting the help they need. Studies have found that less than half of children with emotional and behavioral difficulties receive mental health services (Kataoka, Zhang, & Wells, 2002; Simpson et al., 2005). Furthermore, the rate of identifying children in need of help is even lower (Levitt, Saka, Romanelli, & Hoagwood, 2007).
Identifying students who are experiencing or are at risk for mental health and behavior problems is the first step to connecting them to services and, ultimately, mitigating adverse outcomes. Schools have been recognized as an optimal setting for identification (Levitt et al.,


2007). In addition to having access to the majority of American children and adolescents, schools employ mental health professionals skilled at assessing problems and providing interventions. In fact, a large proportion of students who receive mental health services access them at school (Farmer, Bums, Phillips, Angold, & Costello, 2003; Merikangas et al., 2011). As schools begin embracing prevention-oriented service delivery models such as Multi-Tiered Systems of Support (MTSS), mental health providers are starting to utilize screening measures to aid in identifying struggling youths and match them with a continuum of supports based on need (Kettler, Glover, Albers, & Feeney-Kettle, 2014). Screener results can facilitate data-based decision making to ensure students receive appropriate services.
As mental health screening procedures in schools become more prevalent, a number of screening instruments are gaining popularity. However, not all screeners are created equal and careful consideration must be taken when selecting screening instruments. Kamphaus, Reynolds, and Dever (2014) emphasize the growing need to critically evaluate the psychometric properties of screeners and verify their utility for informing decisions in a variety of contexts. In light of this counsel, a closer look at the Strengths and Difficulties Questionnaire (SDQ; R. Goodman, 1997) is warranted. The SDQ is widely used internationally and extensive research boasts generally strong psychometrics (R. Goodman, 2001; Stone, Otten, Engels, Vermulst, & Janssens, 2010). However, as use of the SDQ becomes increasingly widespread in schools across the United States to screen large populations of diverse students for mental health and behavioral concerns, very little literature to-date explores the appropriateness of the teacher form as a screener in U.S. schools and no studies exist investigating the form’s use beyond first grade.
With this research gap in mind, this study aims to evaluate the use of the SDQ teacher form to screen students in the United States. Specifically, this research seeks to determine if the
2


SDQ teacher form is a valid screener of mental health and behavioral concerns in American
youth.
3


CHAPTER II
LITERATURE REVIEW
Instrument Overview
Developed in Britain in 1997, the Strengths and Difficulties Questionnaire (SDQ; R. Goodman, 1997) is a 25-item questionnaire designed to screen for mental health and behavioral problems in children and adolescents (www.sdqinfo.com). Parent and teacher forms are available to assess children ages 3-16 and self-report forms are available for adolescents ages 11-16. Each item evaluates either a positive or negative attribute by asking the respondent to rate how well the characteristic or behavior listed describes the individual (not true, somewhat true, or certainly true). Twenty negative-attribute items contribute evenly to four subscales: emotional symptoms, conduct problems, hyperactivity-inattention, and peer relationship problems. These subscales generate a single total difficulties score. Five positive-attribute items contribute to a fifth subscale entitled prosocial behavior.
A number of SDQ features make it appealing for use as a screener. Its short length is desirable for quick administration and completion. Multiple forms allow for measures of functioning across informants and in a variety of settings. The questionnaire is written at a fifth-grade reading level, making it accessible to many parents, teachers, and students (Hill & Hughes, 2007). Furthermore, assessing both positive and negative attributes, rather than focusing solely on deficits, is believed to enhance parent and teacher acceptability of the measure (Hill & Hughes, 2007). The SDQ is available in over 60 languages and downloadable free online. Normative data are offered for many, though not all, of the forms. These qualities have contributed to the SDQ’s rise in popularity throughout the world. Consequently, a large amount of research on the instrument’s psychometric properties has accumulated.
4


The vast majority of studies on the SDQ’s psychometric properties have been conducted internationally. Specifically, a great deal of attention has been placed on the construct validity of the tool. As the SDQ continues to be translated into multiple languages for use in countries around the world, it becomes increasingly important to ensure that the originally purported five-factor structure—emotional, conduct, hyperactivity-inattention, peer, and prosocial (R.
Goodman, 2001)—aligns with the conceptions of mental functioning and behavioral expectations of those using the instrument. In other words, for the SDQ to be considered a valid tool in non-British settings, the constructs it claims to measure must be interpreted by respondents in diverse cultures in a similar manner to those using the screener in populations for which it was originally designed. An overview of international findings precedes an exploration of SDQ findings from the United States. Cultural considerations and justification for the current study follow.
Factor Structure: International Findings
International studies evaluating the construct validity of the SDQ as measured through factor analysis reveal mixed results. Findings differ across populations and the various forms of the questionnaire. Additionally, the method of factor analysis used (principal component analysis, exploratory factor analysis or EFA, confirmatory factor analysis or CFA) may contribute to some of the reported differences.
Using principal component analysis, the creator of the SDQ confirmed the predicted five-factor structure for all three forms (parent, teacher, and self) using a nationwide British sample of 10,438 children ages 5-15 (R. Goodman, 2001). A number of European studies employing principal components analysis also found support for the five-factor structure (Becker et al.,
2006; Smedje, Broman, Hetta, & Von Knorring, 1999; Woerner, Becker, & Rothenberger, 2004). Notably, all three of these studies were conducted using the parent version of the SDQ. Similar
5


results extend beyond Europe. In Japan, Matsuishi et al. (2008) used EFA to analyze the Japanese translation of the parent SDQ and results corresponded to the originally proposed five factors. An Australian study of the SDQ parent form confirmed the five constructs, with most items loading onto anticipated factors (Hawes & Dadds, 2004).
Not all EFAs or principal component analyses conducted internationally on the SDQ aligned with R. Goodman’s (1997) theoretical structure. A study from Sweden confirmed the five factors in the teacher form but not in the parent form (Boman et al., 2016). It is worth mentioning that this study was limited by only sampling children ages 7-8, a relatively small age range compared to the previously discussed studies. An EFA study on the Maltese translation of the parent and teacher forms suggested that a three-factor model comprised of internalizing problems, externalizing problems, and prosocial behavior offered the best fit for the data (Cefai, Camilleri, Cooper, & Said, 2011).
Studies using CFA have become more prevalent as the hypothesized structure of the SDQ becomes more established. CFA studies supporting the five-factor structure have been produced in Spain (Rodriguez-Hernandez et al., 2012), Russia (Ruchkin, Koposov, Vermeiren, & Schwab-Stone, 2012), Italy (Tobia & Marzocchi, 2017), Sweden (Bjornsdotter, Enebrink, & Ghaderi, 2013), the United Kingdom (Croft, Stride, Maughan, & Rowe, 2015), the Netherlands (Stone et al., 2013), Norway (Boe, Hysing, Skogen, & Breivik, 2016; Running, Handegaard, Sourander, & Morch, 2004; Van Roy, Veenstra, & Clench-Aas, 2008), China (Yao et al., 2009), and the Sultanate of Oman (Emam, Abu Hilal, Kazem, & Alkharousi, 2016). Several of these studies reported the use of modified models and professed that, while fit was often acceptable, it was not optimal. Patterns of items loading onto factors in an unpredictable manner were also observed. While not every country validated all three forms, support for the five latent dimensions exists for each form in at least two countries.
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Similar to EFAs and principal component analyses, not all CFAs confirm the five-factor structure. Many support a three-factor structure either exclusively or in addition to the five-factor structure (Di Riso et al., 2010; Ellis, Jones, & Mallett, 2014; Gomez-Beneyto et al., 2013; Haynes, Gilmore, Shochet, Campbell, & Roberts, 2013; Van Leeuwen, Meerschaert, Bosmans, De Medts, & Braet, 2006). Others support two second-order internalizing and externalizing factors across multiple forms of the SDQ (Ezpeleta, Granero, de la Osa, Penelo, & Domenech, 2013; A. Goodman, Lamping, & Ploubidis, 2010; Niclasen, Skovgaard, Andersen, Somhovd, & Ob el, 2013).
Factor Structure: U.S. Findings
Despite the abundance of research on the SDQ’s psychometric properties worldwide, relatively few studies have been undertaken in the United States. However, use of the SDQ is gaining momentum, as is evidenced by its adoption for inclusion in the 2001-2007 National Health Interview Survey to measure emotional and behavioral problems in a large national sample of American children ages 4-17 (Pastor, Reuben, & Duran, 2012). In 2005, U.S.-based norms were established on the parent form (Bourdon, Goodman, Rae, Simpson, & Koretz, 2005). To-date, no U.S. norms exist for the teacher or self-report forms.
Regarding factor analysis, only seven U.S. studies were identified. In a community-based sample of 9,574 youths ages 4-17, Dickey and Blumberg (2004) found that exploratory and confirmatory factor analyses both supported a three-factor model composed of externalizing problems, internalizing problems, and a positive construal factor for the parent form. Ruchkin, Jones, Vermeiren, and Schwab-Stone (2008) also established that a three-factor structure showed better internal consistency than a five-factor model, though the five-factor model did show adequate fit. This study evaluated the self-report form rather than the parent form. Several CFA studies found support for the five-factor structure but had notable limitations that impact
7


generalizability of results. One study of the parent form looked only at adolescents ages 13-18 (He, Burstein, Schmitz, & Merikangas, 2013). Two studies that included evaluation of the teacher form focused solely on preschool populations (Downs, Strand, Heinrichs, & Cerna, 2012; Yu, Sun, & Cheah, 2016) and one restricted respondents to grandparents and used the British English version of the SDQ (Palmieri & Smith, 2007). Hill and Hughes (2007) found minimal support for five-factors in a clinical sample of first graders at risk for academic failure. Their study is the only U.S. study that has sought to evaluate the teacher form in a non-preschool setting.
Cultural Considerations
While the variations in factor analysis procedures (principal component analysis, EFA, and CFA), populations (nationality, language, age range, community versus clinical), and forms assessed (parent, teacher, self) all likely contribute to some of the differences seen in factor analysis results, cultural considerations deserve particular attention. The original SDQ was created in Britain, normed on a British sample, and ultimately reflects British conceptions of mental health and behavior problems. When using SDQ in cultures other than the one it was conceptualized in, it is critical to reassess its validity. In fact, a number of the alternative factor structures have been explained as resulting from cultural incongruities.
In a study of the Arabic translation of the SDQ with children in the Gaza strip, Thabet, Stretch, and Vostanis (2000) observed that several items did not load highly onto hypothesized factors. The authors concluded that some items may have different meanings to respondents in non-western cultures. For example, they noted that what may be perceived as separation anxiety in the west may be considered typical behavior for young children in collectivist cultures that value close, interconnected family and community relationships. Similar comments on the potential misinterpretation of non-western culturally acceptable behaviors are made in the
8


articles by Mieloo et al. (2014) and Emam et al. (2016). Kashala, Eigen, Sommerfelt, and Tylleskar (2005) asserted that some SDQ items did not align with cultural understandings of teachers in Kinshasa, Democratic Republic of Congo.
Cultural variation exists not only across nationalities but within them. When interpreting study results, it is critical to acknowledge the specific attributes of the sample population and consider how they may influence the findings. For instance, the demographic distributions of the samples utilized in U.S. SDQ factor analysis studies reflect the country’s diverse racial, ethnic, linguistic, and socio-economic composition. Downs et al. (2012) used a sample of children from low-income families of whom almost half were Spanish-speaking and nearly two-thirds identified as Latino/a. This is over-representative of the nation’s overall Hispanic or Latino population, which the United States Census Bureau (2018) estimated is about 18.1%. Hills and Hughes (2007) also drew from an economically disadvantaged group of American children with substantial Hispanic and bilingual representation. This is a far contrast from Yu, Sun, and Cheah’s (2016) sample, which was comprised entirely of first generation Asian American preschoolers, and Palmieri & Smith’s (2007) sample, which only included Caucasian and African American informants; the race of the children being evaluated was not reported. Interestingly, despite the diversity of the samples, all aforementioned studies found support for a five-factor structure, suggesting that the constructs of the SDQ are interpreted similarly across varying sub-populations in the United States. This does not hold true for all U.S.-based SDQ factor analysis studies, however. Dickey and Blumberg (2004) used a large, nationally representative sample but failed to find adequate support for five factors. Ruchkin et al. (2008) concluded that a three-factor model was most appropriate based on two very different samples of American children: a predominately African American and Hispanic inner-city sample and a largely Caucasian suburban sample. As all the U.S. studies employed CFA, statistical
9


methodology does not appear to be at the root of these varying results. Additional research based on well-documented sample demographics may help illuminate why the findings of some U.S studies differ from others.
Translation issues may also contribute to cross-cultural discrepancies in SDQ validity study findings. Rodriguez-Hernandez et al. (2012) observed, “In the case of item 10 the translation for fidgeting and squirming was moviendose and revoltoso. In Canary Island culture a child that moves a lot and does not stop is possibly not seen as a child with hyperactivity” (p. 276). Boe et al. (2016) pointed out problems with the Norwegian translation of an item from the conduct scale that may have caused cross-loadings onto the emotion factor. Even the language of the U.S. version of SDQ has been altered from the original British version. For example, the British English item “often has temper tantrums or hot tempers” was altered to “often loses temper” in the American English form. Such changes may have a subtle but significant impact on interpretation of an item. Though the United States and Britain share many common cultural characteristics, they are distinctly different and have unique populations and cultural norms.
The Current Study
A wealth of research supports the SDQ as a promising screener for mental health and behavior problems in children and adolescents. With its growing popularity and use in the United States, it is important to ensure that the tool possesses psychometric and cultural validity. A study of the use of the U.S. version of SDQ teacher form in schools is especially needed, as the existing research in this area is sparse and limited. Of the three U.S.-based studies that have assessed the validity of the U.S. teacher form, two are based on culturally and linguistically diverse clinical samples of very young children from poor socio-economic backgrounds (Downs et al., 2012; Hill & Hughes, 2007) and the other is based on a community sample of Asian American preschool students (Yu et al., 2016). Thus, there is need for exploration of schools’ use
10


of the SDQ teacher form as a screener with community populations that span a wider age range and reflect the broad cultural and linguistic demographics found in the United States.
In addition, while further investigation of all forms (teacher, parent, and self) of the U.S. version of the SDQ are needed, the teacher version warrants particular attention at this time as the quest for a quality screener that can be effectively and efficiently utilized in schools intensifies. In general, young children are unreliable self-assessors of their own mental health and behavior, and adult input is critical for comprehensive assessment (Levitt et al. 2007). Teachers can be valid informants, particularly for students in elementary and middle school (Kamphaus et al., 2014). Indeed, studies have shown that teachers rate both externalizing and internalizing symptoms at least as well as parents (Aitken, Martinussen, & Tannock, 2017; Mattison, Carlson, Cantwell, & Asarnow, 2007). While a multi-informant approach to assessment is best practice for obtaining a well-rounded understanding of a student’s functioning (Whitcomb & Merrell, 2013), it is important that the tools used by each informant are well vetted.
With these considerations in mind, this study seeks to extend existing research by conducting a confirmatory factor analysis of the teacher form of the SDQ to assess its validity as a screener in a community sample of diverse elementary school students in grades K-6.
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CHAPTER III
METHODS
Participants
A data set was provided by an urban elementary school in the western United States. Twenty teachers completed the U.S. version of the SDQ teacher form for a total 391 students in kindergarten through sixth grade. The data set included the following information for each student: classroom, grade, sex, and SDQ scores at the item and domain levels.
Student enrollment for the 2017-18 school year was 80.1% Hispanic, 12.3% Caucasian, 2.7% African American, 3.2% two or more races, and 1.0% American Indian or Alaska Native, and 0.7% Asian. Ninety-three percent of students received free or reduced-price lunch. The school received Title 1 funding to help support its low-income student body. Roughly 43% of students were English language learners and 13% had disabilities and were on Individual Education Plans (IEPs). A breakdown of basic demographic information of the sample is provided in Table 1. While the sample is not nationally representative, it reflects a demographic profile common to many urban areas in the United States. It is similar in make-up to the samples used in two of the three existing studies of the U.S. version of the SDQ teacher form (see Downs et al., 2012; Hill & Hughes, 2007) and thus provides a useful comparison when considering the validity of the SDQ’s use with this particular sub-set of culturally and linguistically diverse American students.
Table 1. Demographic Characteristics of Sample by Grade______________________________
K 1 2 3 4 5 6
Sex n % n % n % n % n % n % % n
Female 33 56 32 63 22 38 25 46 32 51 33 53 24 55
Male 26 44 19 37 36 62 29 54 31 49 29 47 20 45
Total N= 59 N = = 51 N= 58 7V= 54 N= 63 N =62 N=U
N= 391 15% 13% 15% 14% 16% 16% 11%
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Procedures
During a school staff meeting in the fall of 2017, a school-based mental health professional distributed the U.S. version of the SDQ teacher form to all K-6 teachers. The teacher form for students ages 4-10 was given to teachers of kindergarten through fifth grade.
The teacher form for students ages 11-17 was given to sixth grade teachers. Any item differences were deemed negligible for later statistical analysis, as items closely resembled each other on both forms (e.g., “Shares readily with other children, for example toys, treats, pencils” on the ages 4-10 form reads “Shares readily with other youth, for example pens, books, food” on the ages 11-17 form; the term children on the ages 4-10 form is often changed to youth on the ages 11-17 form). Each teacher filled out the questionnaire for every student in his or her class. If teachers were not present at the meeting, they were given the questionnaires to complete independently within a few weeks of the meeting.
All of the school’s K-6 teachers participated and provided complete data on all of their students. The screener was conducted as a routine procedure in the school, initiated by the mental health professional with the permission of her principal. Because of this, teachers were required to complete the questionnaires as a part of their job and no additional consent considerations were needed. Permission to use the data was obtained from the community mental health center through which the school-based clinician was employed, as well as from the school principal. To protect student and teacher confidentiality, de-identified data was provided to the researcher for analysis.
Measures
The U.S. versions of the SDQ teacher forms for students ages 4-10 and ages 11-17 were used in this study. All forms of the SDQ contain 25 items that assess student mental health and behavior. Five scales are measured by five items each. The five scales are as follows: emotional
13


problems, conduct problems, hyperactivity-inattention, peer relationship problems, and prosocial behavior. The first four of these scales are used to calculate a total difficulties score. Items are scored on a 3-point scale {not true, somewhat true, or certainly true). Some items are reverse scored; thus, some items rated as certainly true may receive a score of 2 (e.g., “Often fights with other children or bullies”), while others with the same rating may receive a score of 0 (e.g., “Generally well behaved, usually does what adults request”). Higher scores on the difficulty scales indicate greater difficulty, whereas higher scores on the prosocial scale indicate greater prosocial behaviors. SDQ scores are interpreted using either a three-category classification system, with scores falling into normal, borderline, or abnormal ranges, or a newer four-category classification system, with scores falling into close to average, slightly raised (or slightly lowered), high (or low), and very high (or very low) ranges. Whether scores represent problems or prosocial behaviors must be considered when using this latter system.
As noted earlier, a large body of research exists on the psychometric properties of the SDQ. Specific findings vary by form, population, and method of assessment used. However, overall the SDQ appears to produce generally valid and reliable results (see Achenbach et al. 2008 and Stone, Otten, Engels, Vermulst, & Janssens, 2010 for comprehensive reviews).
Data Analysis
Statistical analysis was used to examine the reliability and validity of the SDQ. Descriptive statistics, including measures of central tendency and variation, were calculated at the item and domain levels. Reliability was assessed using Cronbach’s alpha. Difference by sex and grade were explored through t-tests and one-way analysis of variance (ANOVA), respectively. These statistical analyses were performed using SPSS software (Statistical Package for the Social Sciences, release 25.0).
14


A confirmatory factor analysis (CFA) was conducted to confirm whether Goodman’s (2001) originally proposed five-factor model or a one-, two-, three-, or four-factor model best explains the data from the U.S. version of the SDQ teacher form. CFA was selected because this form of analysis is best utilized when there is already a well-established idea of an instrument’s underlying constructs (Levine, 2005). CFA was conducted with AMOS 25 (Arbuckle, 2017) using raw scores. Full-information maximum likelihood estimation was used to handle missing data. Model fit was assessed using chi-square, the Comparative Fit Index (CFI), and the Root Mean Square Error of Approximation (RMSEA). CFI compares the theoretical model to a null model and is considered sufficient with values of 0.90 and above (Bender & Bonnett, 1980). RMSEA is sensitive to parsimony of the model with values of 0.10 and below considered acceptable (MacCallum, Browne, & Sugawara, 1996).
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CHAPTER IV
RESULTS
Descriptive Statistics
SDQ item scores range from 0 to 2. Higher scores indicate greater difficulties, except for on the prosocial scale. On this scale, higher scores indicate greater prosocial behavior. Looking across items, teachers reported that students struggle most with being easily distracted (Item 15, M= 0.93), thinking things out before acting (Item 21, M= 0.83), and maintaining sufficient attention to see work through to the end (Item 25, M= 0.81). The least frequent difficulties reported by teachers include students being picked on or bullied by other children (Item 19, M = 0.28) and stealing (Item 22, M= 0.14). Among prosocial behaviors, teachers reported that students are best at being kind to younger children (Item 17, M= 1.63) but are least inclined to offer help to others (Item 20, M= 1.36). Item statistics can be seen in Table 2.
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Table 2. Summary of Means and Standard Deviations for SDQ Items
Item # and Associated Scale M SD N
1 Prosocial 1.44 0.67 391
2 Hyperactivity 0.77 0.84 391
3 Emotional 0.36 0.63 391
4 Prosocial 1.43 0.66 391
5 Conduct 0.43 0.71 391
6 Peer 0.42 0.69 391
7 Conduct 0.54 0.71 391
8 Emotional 0.46 0.67 391
9 Prosocial 1.51 0.62 391
10 Hyperactivity 0.69 0.81 391
11 Peer 0.40 0.62 391
12 Conduct 0.44 0.72 391
13 Emotional 0.43 0.69 391
14 Peer 0.41 0.59 391
15 Hyperactivity 0.93 0.84 391
16 Emotional 0.46 0.69 391
17 Prosocial 1.63 0.54 391
18 Conduct 0.35 0.65 391
19 Peer 0.28 0.57 391
20 Prosocial 1.36 0.71 391
21 Hyperactivity 0.83 0.76 391
22 Conduct 0.14 0.43 391
23 Peer 0.33 0.55 391
24 Emotional 0.30 0.58 391
25 Hyperactivity 0.81 0.81 391
Scores for each of the five scales range from 0 to 10. The total difficulties score ranges from 0 to 40. Again, higher scores indicate greater difficulties, with the exception of the prosocial scale, which is the reverse. Across the scales, teachers reported that students exhibit the most challenges in the area of hyperactivity-inattention (M= 4.03). They reported that peer
relationship problems were the least difficult for students (M= 1.83). According to teachers, most students do not appear to be experiencing a great deal of mental health or behavioral challenges, as indicated by the total difficulties mean score of 9.77. Scale statistics are provided in Table 3.
17


Table 3. Summary of Means, Standard Deviations, and Intercorrelations for SDQ Scales
Scale N M SD 1 2 3 4 5
1. Emotion 5 2.02 2.46
2. Conduct 5 1.90 2.50 40**
3. Hyperactivity 5 4.03 3.48 44** 70**
4. Peer 5 1.83 2.01 49** 40** .35**
5. Prosocial 5 7.38 2.57 _ 39** - .65** -.62** _ 4^**
6. Total Difficulties 20 9.77 8.15 73** 82** .86** 00^^ _09^^
(excludes Prosocial)______________________________________________________________________
** p < 0.001
Acceptability of items was analyzed by looking at correlations to the whole measure. A correlation of .40 indicated an acceptable item. A total of eight items did not achieve correlations of .40 and above, suggesting that these items may be problematic either conceptually or in how they are phrased (Leech, Barrett, & Morgan, 2015). Three of these items were associated with the prosocial scale: “Helpful if someone is hurt, upset, or ill” (Item 9,r = -.39); “Kind to younger children” (Item 17, r = -.38); and “Offers help to others (parents, teachers, other children)” (Item 20, r = -.36). Three items were associated with the peer relationship problems scale: “Rather solitary, prefers to play alone” (Item 6,r= .26); “Has at least one good friend” (Item 11, r = .37); and “Gets along better with adults than other children” (Item 23, r = . 19). Item 3, “Often complains of headaches, stomach-aches or sickness” (r = .37) is part of the emotional problems scale, and Item 22, “Steals from home, school, or elsewhere,” (r = .32) is part of the conduct problems scale.
All scales were significantly correlated, p < .001 (see Table 3 above). Excluding correlations related to the total difficulties score, the strongest correlation was between the hyperactivity-inattention scale and the conduct scale, r(389) = 0.70,/) < .001. The other difficulties scales demonstrated moderate, positive relationships ranging from .35 to .49. As expected, the prosocial scale was negatively correlated to the various difficulties scales, showing moderate strength between -.39 to -.65.
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Reliability analysis was conducted with Cronbach’s alpha. The overall alpha was high at .77. Cronbach’s alphas for all but the peer relationships problem scale were above .70, thus showing good internal consistency. The peer relationships scale alpha suggests minimally adequate reliability at .69. See Table 4 for reliability statistics.
Table 4, Cronbach’s Alphas for SDQ Scales
Scale Cronbach’s Alpha
1. Emotion .81
2. Conduct .82
3. Hyperactivity .91
4. Peer .69
5. Prosocial .86
6. Total Difficulties .90
Differences by Sex
Independent-sample t-tests were conducted to determine if there were differences in scale scores and total difficulties scores across sex. Sex was defined and labeled as follows: (0) female and (1) male. Scores for each of the five scales range from 0 to 10. Total difficulties scores range from 0 to 40.
The null hypothesis states that there is no difference between groups while the alternative hypothesis states that there is a difference between groups. Assumptions were tested; normality was violated on all but the hyperactivity and prosocial scales, and homogeneity of variance (HoV) was violated on the hyperactivity scale. Independent-sample t-tests are robust to the normality violation because the sample size was large (n = 391) and robust to the HoV violation because the group sample sizes are within a ratio of 1:1.5. For scales with HoV violations, the unequal variance t-test was used.
Scale mean scores and standard deviations separated by sex are presented in Table 6. Males scored significantly higher than females on the conduct scale, t(389) = -2.11, p = .04 and the hyperactivity-inattention scale, /(389) = -6.09, p < .001. Results for the peer relationships problems scale revealed that males were rated by teachers as demonstrating significantly more
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social concerns than their female counterparts, /(389) = -2.18,/) = .03. On the total difficulties scale, males scored significantly higher than female students, /(389) = -4.05,/> < .001. The prosocial scale is the only scale on which females scored significantly higher than male students,
/(389) = 3.15,/) = .002. No significant sex differences were found on the emotional symptoms scale.
Table 6, Scale Mean Score and Standard Deviation by Sex
Males Females
n = 190 « = 201
Scale M SD M SD
Emotional 2.15 2.50 1.90 2.42
Conduct 2.17 2.52 2.64 2.46
Hyperactivity 5.08 3.58 3.03 3.07
Peer 2.06 2/10 1.62 1.90
Prosocial 6.96 2.61 7.78 2.49
Total Difficulties 11.45 7.99 8.18 7.99
(excludes
Prosocial)
Differences by Grade Level
One-way ANOVAs were conducted to determine if there was a difference in teacher ratings of students on the various scales across grade levels taught. Grades were defined and labeled as follows: (0) kindergarten, (1) first grade, (2) second grade, (3) third grade, (4) fourth
grade, (5) fifth grade, and (6) sixth grade. Scores for each of the five scales range from 0 to 10,
and the total difficulties scores range from 0 to 40.
The null hypothesis states that there is no difference between groups while the alternative hypothesis states there is a difference between groups. Assumptions were tested, and normality was violated on all but the hyperactivity scale. ANOVA is robust to this violation because the
sample size was large (n = 391).
The ANOVA revealed a significant main effect for grade on the following SDQ scales:
emotional symptoms, A(6,384) = 4.55,/) < .001; peer relationship problems, A(6,384) = 4.13,/) <
.001; and prosocial behavior, A(6,384) = 5.38,/) < .001. No differences were found for the
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conduct problems, hyperactivity-inattention, and total difficulties scales. See Table 7 for the mean score and standard deviation for each scale by grade.
Table 7, Scale Mean Score and Standard Deviation by Grade
n = K = 59 n 1 = 51 n 2 = 58 n z 3 = 54 n â–  4 = 63 5 n = 62 6 n = 44
Scale M SD M SD M SD M SD M SD M SD M SD
Emotional 1.49 1.99 1.80 2.19 1.57 2.62 3.00 2.80 1.40 2.25 2.15 2.60 3.07 2.12
Conduct 1.85 2.59 1.57 2.46 1.86 2.75 1.44 2.25 1.86 2.33 2.18 2.57 2.59 2.51
Elyper. 4.31 3.38 3.27 3.61 4.29 3.62 3.72 3.40 3.94 3.69 3.90 3.32 4.84 3.24
Peer 1.66 1.80 2.49 2.19 1.43 1.97 1.15 1.57 1.51 2.09 2.34 2.03 2.41 2.05
Prosocial 6.29 2.49 8.20 2.54 7.47 2.61 8.35 2.15 7.79 2.50 6.79 2.60 6.84 2.53
Total Diff. (excludes Prosocial) 9.31 7.52 9.14 8.70 9.16 9.42 9.31 7.93 8.70 7.95 10.56 8.07 12.91 6.73
Tukey’s post hoc analysis indicated that on the emotional symptoms scale,
kindergarteners scored significantly lower than students in third (p = .02) and sixth grade (p =
.02). Second graders also scored significantly lower than students in third (p = .03) and sixth
grade (p = .03). Third graders scored significantly higher than fourth graders (p = .006) and
sixth graders scored significantly higher than fourth graders (p = .008). On the peer
relationships problems scale, students in first grade scored significantly higher than students in
third grade (p = .009), while students in third grade scored significantly lower than students in
the fifth {p = .02) and sixth grades (p = .03), Finally, kindergarteners were rated as exhibiting
significantly less prosocial behaviors than students in the first (p = .001), third (p < .001), and
fourth (p = .02) grades. First graders scored significantly higher on prosocial behaviors than
students in fifth grade (p = .05), while third graders scored significantly higher than students in
the fifth {p = .05) and sixth grades (p = .05).
Factor Structure
Since there are multiple models of the SDQ discussed in the literature, multiple
confirmatory factor analysis (CFA) models were examined to test to the measure’s structure. The
first CFA model attempted was the one-factor model with all items loading onto a single
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construct. As seen in Figure 1, the one-factor model consisted of 25 items. The model results show that this was not a good fit to the data, x2(275) = 2,563.62,p < .001; RMSEA= 0.15; CFI = 0.58.
The second model attempted was the five-factor model (see Figure 2). This model is well supported in the literature using principal components analysis and exploratory factor analysis (e.g., Becker et al., 2006; R. Goodman, 2001; Hawes & Dadds, 2004; Matsuishi et al. 2008; Smedje, Broman, Hetta, & Von Knorring, 1999; Woemer, Becker, & Rothenberger, 2004).
There are 5 factors with 5 items each. This model demonstrated better fit, x2 (265) = 1,243.46, p < .001; RMSEA= 0.10; CFI = 0.82. Items 6 and 23, both in the Peer factor, showed poor fit with
22


factor loadings below 0.40. The model rerun without these demonstrated better fit, x2 (220) = l,048.23,/i < .001; RMSEA= 0.10; CFI = 0.84.
The third model attempted was the two-factor model (see Figure 3). This model is also well supported in the literature using confirmatory factor analysis (e.g., Ezpeleta, Granero, de la Osa, Penelo, & Domenech, 2013; A. Goodman, Lamping, & Ploubidis, 2010; Niclasen, Skovgaard, Andersen, Somhovd, & Obel, 2013). Here there are 2 factors with 10 items each. Factor 1 is made up of the Peer and Emotional factors and factor 2 includes the Hyperactivity and Conduct items. Prosocial items were removed from this model; they did not load together and either failed to load onto any factor or cross-loaded onto other factors. This model
23


demonstrated better fit, x2(169) = 1,168.02,p< .001; RMSEA= 0.12; CFI = 0.76. Items 22 and 23 had factor loadings less than 0.40. These items were removed, and the model was rerun. Without these two items, the model fit was slightly better, x2(169) = 1006.11,p < .001; RMSEA = 0.13; CFI = 0.78.
Figure 3. Theoretical Two-Factor Model
A fourth model was explored with three factors. As seen in Figure 4, this model is the same as the two-factor model but adds back the prosocial items in a separate factor. A three-factor model is supported in the literature (e.g., Cefai, Camilleri, Cooper, & Said, 2011; Dickey and Blumberg, 2004). Items 22 and 23 were removed due to not loading in this model either. Model fit is only slightly better than the two-factor model, x2 (227) = 1402.84, p < .001; RMSEA= 0.12; CFI = 0.78.
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Figure 4. Theoretical Three-Factor Model
The final model attempted was the four-factor model (see Figure 5). This model was attempted as the two-factor model dropped the prosocial items, grouping the other four factors into two constructs. In this model, four factors were attempted without the prosocial items. This model also demonstrated better fit, x2(164) = 878.74, p < .001; RMSEA= 0.11; CFI = 0.83. Items 6 and 23 also had poor fit and were removed. Without these, the four-factor model fit statistics are comparable to the five-factor model, x2(129) = 715.-5,p <.001; RMSEA= 0.11; CFI = 0.85.
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Table 5 compares each of the five models. The single factor model showed very poor fit,
confirming a multidimensional construct. All chi-square values were significant. No model met
the CFI requirement of 0.90 and above to demonstrate a good model fit although the five-factor
and the four-factor models were closest at 0.84 and 0.85, respectively. Only the five-factor model
met the RMSEA requirement of 0.10 and below demonstrating good fit.
Table 5, Model Comparison
Model Chi-square CFI RMSEA
One factor 2,563.62 0.58 0.15
Five factor 1,243.46 0.84 0.10
Two factor 1,168.02 0.78 0.13
Three factor 1,402.84 0.78 0.12
Four factor 878.74 0.85 0.11
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CHAPTER V
DISCUSSION
The purpose of this study was to analyze the validity of the U.S. version of the SDQ teacher form as screener of mental health and behavior concerns. The study was necessitated by the growing use of the SDQ in the United States. It extends the limited research on the SDQ’s use in U.S schools by encompassing a much wider grade range within its sample than has been previously undertaken. Furthermore, this study’s sample is racially, linguistically, and socioeconomically similar to two of the three U.S.-based studies of the teacher form (Downs et al., 2012; Hill & Hughes, 2007), allowing for comparison between the clinical samples used in those studies and the community sample of the current study.
This study found the U.S. version of the SDQ teacher form to have generally strong internal reliability, with an overall alpha of .77. Scale alphas ranged from .69 to .91. These findings are consistent with those found by Hills & Hughes (2007), who identified barely-to-sufficiently-acceptable scale alphas ranging from .64 to .89 on the U.S. version of the SDQ teacher form. While Downs et al. (2012) found the total difficulties scale to have high internal reliability for both Spanish- and English- speaking American students (a = .82, a = .87, respectively), the conduct problems scale and peer relationship problems scales were not always adequate across sex and language groups. For example, poor internal consistency was found on the conduct scale when teachers assessed Spanish-speaking males (Downs et al., 2012). Yu et al. (2016) similarly found low reliability on the conduct problems and peer relationship problems scales when investigating the U.S. version of the SDQ teacher form on a sample of Asian-American children. Thus, while the overall reliability of the U.S. version of the SDQ teacher form appears sound when used with culturally and linguistically diverse students, a closer investigation into how well the subscales reliably assess certain constructs is warranted.
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Several noteworthy differences were found across sexes. In alignment with other studies conducted both nationally and internationally on the teacher form of the SDQ (e.g., Downs et al., 2012; Van Leeuwen et al., 2006), males were rated as having significantly more total difficulties than females, and females were rated as demonstrating significantly more prosocial behaviors. Furthermore, males scored significantly higher than females on almost all of the difficulty scales—conduct problems, hyperactivity-inattention, and peer relationship problems. This is not surprising, as the prevalence rates for related diagnoses, such as oppositional defiant disorder and attention-deficit/hyperactivity disorder, are higher for male children than female children (American Psychiatric Association, 2013). Furthermore, young males’ peer relationships are often more physical and less emotionally supportive and intimate than female peer relationships (Rose & Rudolph, 2006). In contrast, females have been found to engage in more prosocial interactions, defined by peer conversation and self-disclosure, than their male counterparts (Rose & Rudolph, 2006). These patterns of male and female differences in the areas of externalizing behaviors and prosocial interaction are further supported in research on children from low-socioeconomic backgrounds (Coolahan, Fantuzzo, Mendez, & McDermott, 2000; Lutz,
Fantuzzo, & McDermott 2002).
In addition to sex differences, grade differences were also revealed. Students in lower grades demonstrated less prosocial behavior than those in grades above them. Such results are in line with existing SDQ research on age differences (e.g., Downs et al., 2012), as well as developmental psychology literature, which suggests that as children become older, they develop the cognitive and linguistic skills that help them navigate increasingly complex social situations (Fortuna & Knafo, 2014). Another significant difference across grades was found relating to the emotional problems scale. Children in higher grades generally exhibited more emotional symptoms related to depression and anxiety than those in lower grades. Interestingly, Downs et
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al. (2012) did not find a significant difference when looking at emotional symptoms across age on the U.S. version of the SDQ teacher form. This may be due to the small age range examined (ages 3-5). The reason for the difference in this study is hard to determine since the onset of depression and anxiety is not age-dependent. It may be that the symptoms assessed on the SDQ (e.g., Item 8 “Many worries or often seems worried”; Item 13 “Often unhappy, depressed or tearful”) are easier for teachers to identify in older children, who may communicate these feelings more clearly through language and demeanor. Indeed, depression in particular can be hard to recognize in young children, as symptoms may present as irritability rather than sadness (American Psychiatric Association, 2013). Finally, while significant differences were found in peer relationship problems between third-grade students and students in first and fifth grades, the differences do not reveal an overarching pattern and are difficult to interpret. An examination into the characteristics of the third-grade students and their teachers may be useful in shedding light onto these findings.
A confirmatory factor analysis found the five-factor model hypothesized by R. Goodman (2001) to be the best fit among the models tested. However, fit indices disagree, making it challenging to evaluate the overall adequacy of the model. The five-factor model was the only model that met the RMSEA requirement of 0.10 and below, indicating barely acceptable fit. No model met the CFI cutoff of 0.90, though the five-factor and four-factor models came closest at 0.84 and 0.85. While all three studies on the U.S. version of the SDQ teacher form found adequate-to-minimally-adequate fit for the five-factor structure (Downs et al. 2012; Hill & Hughes, 2007; Yu et al., 2016), often with item modifications, they used a stricter RMSEA cutoff for acceptable fit (< 0.08). If measured by this cutoff, no model in this study provided adequate fit.
29


Item 6 (“Rather solitary, prefers to play alone”) and Item 23 (“Gets along better with adults than with other children”) showed poor fit on both the five- and four-factor models, and removal of the items improved overall fit. These two items had the lowest item-total correlations and are part of the peer relationship problems scale, which was the only scale that showed low reliability. Thus, it appears that Items 6 and 23 are particularly problematic and may not be interpreted by teachers as reflections of the construct of peer relationship problems when considering students of diverse ethnicities. While no studies of the U.S. version of the SDQ found similar problems with these items on the teacher form, Yu et al. (2016) identified a nonsignificant factor loading for Item 23 on the parent form. The researchers concluded that interpretation of Item 23 may be culturally bound, noting, “It is possible that ‘gets along better with adults than with other children’ is not necessarily an abnormal phenomenon for young children in the eyes of Chinese or Korean parents due to the greater focus on parent-child emotional interdependence” (Yu et al., 2016, p. 609). Item 23 may be similarly culturally influenced when considering the largely Hispanic population in this study’s sample. Halgunseth, Ispa, and Rudy (2006) explain that many Mexican-American families emphasize the value of respecting elders to their children. Thus, teachers may interpret this item through a lens of respectfulness toward adults, which is considered a positive quality, rather than perceiving stronger adult relationships as a symptom of a student’s inability to bond with peers. Regarding Item 6, the wording “prefers to play alone” appears problematic. Preference suggests choice, and teachers could interpret the item as measuring a student’s social inclinations rather than as an indicator of peer problems.
Item 22 (“Steals from home, school or elsewhere”), which is part of the conduct scale, was found to have inadequate factor loadings on the two-factor and four-factor models and its removal improved fit. Yu et al. (2016) also found Item 22 problematic on the U.S. version of the
30


SDQ teacher form. Like Items 6 and 23, Item 22 had a low item-total correlation. It is possible that teachers may not have knowledge of whether the student steals outside of school. Revising the item to reflect what teachers see in the school setting may improve item reliability. Implications
Overall, the U.S. version of the SDQ teacher form is reliable as a whole, but its validity for use with culturally, linguistically, and socio-economically diverse students is questionable. This study found barely adequate fit for the five-factor model proposed by R. Goodman (2001). The peer relationship problems scale contains items that may be ineffectively worded and questionable from a cultural standpoint. Furthermore, the assessment of peer relationship problems, conduct problems, and prosocial behavior has been found to be inconsistent in this study and others (Downs et al., 2012; Yu et al., 2016). It is therefore recommended that only the total difficulties score be considered when screening for mental health and behavioral concerns with diverse student populations; subscale scores, particularly those related to conduct and peer relationship problems, should be interpreted with caution when identifying specific areas of difficulty. The prosocial scale should also be interpreted with caution when investigating prosocial behaviors.
School psychologists and other school professionals looking for a brief, psychometrically sound screening instrument may find some benefit in utilizing the U.S. version of the SDQ teacher form to flag students that may be struggling behaviorally or emotionally. However, the tool’s ability to pinpoint specific problem areas is poor. Thus, the U.S. version of the SDQ teacher form should be used in conjunction with other sources of information to inform decisions about identification and intervention within a Multi-Tiered System of Support.
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Limitations and Future Research
Several limitations are acknowledged for this study. The study’s sample is not representative of U.S. national demographics. Thus, generalizability of results is restricted to populations similar to that on which this study is based. Furthermore, this study only investigated elementary-aged children in grades K-6. As the tool is available for use with students up to age 17, a wider age span should be considered in future research. Demographic information about the teachers, while unavailable in this study, would be helpful in determining if teachers’ racial, ethnic, linguistic, sex, or socio-economic differences or similarities to students affect how they rate students.
This study focused on the reliability and factor validity of the U.S. version of the SDQ with specific attention to cultural considerations. Investigation into other psychometric properties of the SDQ, such as discriminant and predictive validity, were beyond the scope of this study but should be considered in future investigations. In addition, while this study provides insight into the validity of the U.S. version of the SDQ teacher form, evaluation of the psychometric properties of the parent and self-report forms is needed. Interrater reliability should be assessed across all forms, as multiple-informant assessment is an integral part of comprehensive assessment.
Conclusion
In sum, though this study inherently contains some limitations, it offers valuable information on the usefulness of the U.S. version of the SDQ teacher form to screen for mental health and behavioral concerns in a diverse student population. While potentially valuable as a broad screener of difficulties, caution must be taken when interpreting specific domains of difficulty and prosocial behavior. Indeed, changes to specific items may increase validity and reliability. With the growing need to find psychometrically sound mental health screeners that
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can be conveniently integrated into school settings, it is worthwhile to consider how improvements to the U.S. version of the SDQ teacher form could enhance its utility and, consequently, increase the chances that students in need will be identified and receive the they need as early as possible.


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