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Purpose: The KIDSCREEN questionnaires were developed by a collaborative effort of European pediatric researchers for use in epidemiologic public health surveys, clinical intervention studies, and research projects. The article gives an overview of the development of the tool, summarizes its extensive applications in Europe, and describes the development of a new computerized adaptive test (KIDS-CAT) based on KIDSCREEN experiences. Methods: The KIDSCREEN versions (self-report and proxy versions with 52, 27, and 10 items) were simultaneously developed in 13 different European countries to warrant cross-cultural applicability, using methods based on classical test theory (CTT: descriptive statistics, CFA and MAP, internal consistency, retest reliability measures) and item response theory (IRT: Rasch modeling, DIF analyses, etc.). The KIDS-CAT was developed (in cooperation with the US pediatric PROMIS project) based on archival data of European KIDSCREEN health surveys using IRT more extensively (IRC). Results: Research has shown that the KIDSCREEN is a reliable, valid, sensitive, and conceptually/linguistically appropriate QoL measure in 38 countries/languages by now. European and national norm data are available. New insights from KIDSCREEN studies stimulate pediatric health care. Based on KIDSCREEN, the Kids-CAT promises to facilitate a very efficient, precise, as well as reliable and valid assessment of QoL. Conclusions: The KIDSCREEN has standardized QoL measurement in Europe in children as a valid and cross-cultural comparable tool. The Kids-CAT has the potential to further advance pediatric health measurement and care via Internet application. [ABSTRACT FROM AUTHOR]

Patient-reported outcomes (PROs) play an increasingly important role in clinical practice and research. Modern psychometric methods such as item response theory (IRT) enable the creation of item banks that support fixed-length forms as well as computerized adaptive testing (CAT), often resulting in improved measurement precision and responsiveness. Here we describe and discuss the case for developing an international core set of PROs building from the US PROMIS® network. PROMIS is a U.S.-based cooperative group of research sites and centers of excellence convened to develop and standardize PRO measures across studies and settings. If extended to a global collaboration, PROMIS has the potential to transform PRO measurement by creating a shared, unifying terminology and metric for reporting of common symptoms and functional life domains. Extending a common set of standardized PRO measures to the international community offers great potential for improving patient-centered research, clinical trials reporting, population monitoring, and health care worldwide. Benefits of such standardization include the possibility of: international syntheses (such as meta-analyses) of research findings; international population monitoring and policy development; health services administrators and planners access to relevant information on the populations they serve; better assessment and monitoring of patients by providers; and improved shared decision making. The goal of the current PROMIS International initiative is to ensure that item banks are translated and culturally adapted for use in adults and children in as many countries as possible. The process includes 3 key steps: translation/cultural adaptation, calibration, and validation. A universal translation, an approach focusing on commonalities, rather than differences across versions developed in regions or countries speaking the same language, is proposed to ensure conceptual equivalence for all items. International item calibration using nationally representative samples of adults and children within countries is essential to demonstrate that all items possess expected strong measurement properties. Finally, it is important to demonstrate that the PROMIS measures are valid, reliable and responsive to change when used in an international context. IRT item banking will allow for tailoring within countries and facilitate growth and evolution of PROs through contributions from the international measurement community. A number of opportunities and challenges of international development of PROs item banks are discussed. [ABSTRACT FROM AUTHOR]

This study examines the social determinants of psychosomatic complaints in young adolescents. Using data from the Health Behaviour in School-aged Children (HBSC) study, psychosomatic complaints are studied in 98,773 adolescents (11- and 13-year-olds; 48% 11-year-olds, 52% 13-year-olds; 52% females, 48% males) from 34 European countries. Individual-level determinants, including family-, peer- and school-related factors as well as country-level determinants (Human Development Index [HDI]) are considered. In line with existing evidence, results revealed more psychosomatic complaints in young adolescents experiencing stress inducing familial-, peer- and school-related factors. Negative effects of poor friendships, negative class climate, school pressure, and high media use were more pronounced for girls. After controlling for these factors, a higher HDI was related to a lower risk for psychosomatic complaints. Gender-specific intervention programs should aim at improving the quality of relationships, especially among peers, to prevent psychosomatic complaints among young adolescents. [ABSTRACT FROM PUBLISHER]

Purpose: To analyse the impact of overweight on HRQoL in a European sample of children and adolescents. Methods: Analyses were conducted using data on 17,159 children and adolescents aged 8-18 from 10 European countries (Germany, Spain, France, Netherlands, Austria, United Kingdom, Switzerland, Hungary, Czech Republic and Poland) participating in the KIDSCREEN Health Interview Survey. In the studied sample ( N = 13,041), there were slightly more girls (52.6%) than boys (47.4%). Gender- and age-specific cut-offs of Cole et al. (BMJ 320:1240, 2000) were used to define overweight and obesity. The two groups were collapsed into one 'overweight' category. HRQoL was assessed on 10 dimensions using the KIDSCREEN-52. Univariate analysis of covariance (ANCOVA) was performed for group comparisons (normal weight vs. overweight). Partial eta squared (η) was used as a measure of effect strength. Results: Overall, 14.2% ( N = 1,849) of the sample was overweight, with prevalence rates ranging between 9.4% in France and 17.6% in Spain. Across all countries, overweight children and adolescents had lower mean HRQoL scores than normal weight children and adolescents. The strongest HRQoL impairments emerged on the physical well-being (η = 0.012) and self-perception dimensions (η = 0.021), both P < 0.001. Conclusions: This is one of the first studies comparing the impact of HRQoL at European level using a generic and internationally valid HRQoL instrument, and the results show that, irrespective of national background, overweight children and adolescents are significantly impaired on their HRQoL, in particular on the physical well-being and the self-perception domain. [ABSTRACT FROM AUTHOR]

In this paper, we examined dimensions of child health-related quality of life in Greece in relation to parental assessments of neighbourhood social capital and social support networks. For the analysis, two main measures were used: (1) child self-reported health-related quality of life in ten dimensions, as measured by the KIDSCREEN questionnaire; (2) subjective measures of parental neighbourhood social capital and social support. Parental assessments of neighbourhood social capital and social support were both independently and positively associated with child self-reported health-related quality of life. However, they were not associated with the same dimensions of child well being, nor were they associated with all dimensions of child well being. These results suggest that greater attention in future research needs to be paid to the differential associations between the various dimensions of social capital and child health-related quality of life, with clear focus implications for social and health policies. [ABSTRACT FROM AUTHOR]

Purpose: To evaluate the effect of atomoxetine on quality of life (QoL) and family burden in children and adolescents with attention deficit/hyperactivity disorder (ADHD) and comorbid oppositional defiant (ODD) or conduct disorder (CD). Methods: This secondary analysis was based on a randomized, double-blind, 9-week study of atomoxetine (target dose 1.2 mg/kg body weight) versus placebo. The study included 180 patients (atomoxetine 121, placebo 59), aged 6-17 years. QoL was measured using the KINDL-R questionnaire. The total score encompasses six dimensions (or subscales) measuring QoL in terms of 'physical well-being', 'emotional well-being', 'self-esteem', 'friends', 'family', and 'school'. Family burden of illness was measured using the FaBel questionnaire. Results: With atomoxetine, the KINDL-R total score improved significantly ( P = 0.021) more than with placebo. This improvement also applied to the subscales except for 'physical well-being' (opposite effect) and 'school' (no effect). No significant treatment group differences were seen on the FaBel questionnaire. No differences were found between the fast and slow titration groups in terms of ADHD, ODD, and disruptive behavior severity. Furthermore, no such differences were observed for QoL and family burden. Conclusions: This study suggests positive effects of atomoxetine on quality of life, as measured by the KINDL-R scores on emotional well-being, self-esteem, friends and family, in children and adolescents with ADHD and comorbid ODD/CD. No significant treatment effects were seen on family burden, as measured by FaBel total score. [ABSTRACT FROM AUTHOR]

Objective: The aim of our prospective study was to assess the health-related quality of life (HRQOL) of children with mitral valve prolapse (MVP) and the impact of clinical symptoms on HRQOL. Methods: Sixty-seven patients with primary MVP aged 8-18 years were studied and compared with 31 healthy children. All children completed the polish version of KIDSCREEN-27. For searching occurrence and frequency of 18 clinical symptoms, authors' questionnaire was used. Results: The statistically significant difference was found only for one from five searching dimensions of HRQOL-physical well-being. In the remaining studied aspects of HRQOL, no statistically significant differences were found in comparison with the healthy children. The statistically significant moderate correlation between the number and frequency of clinical symptoms and physical well-being was found. Conclusions: In children with MVP, the lower self-assessment is observed mainly in evaluation of their health and own physical activity. The remaining studied dimensions of HRQOL are comparable with the healthy children. However, within the population of children suffering from MVP, the frequency of clinical symptoms impact upon the different HRQOL dimensions. Thus, MVP represents a heterogeneous population. Whether there are impairments of HRQOL largely depend on the severity and frequency of clinical symptoms. [ABSTRACT FROM AUTHOR]

Background: To assess the criterion and construct validity of the KIDSCREEN-10 well-being and health-related quality of life (HRQoL) score, a short version of the KIDSCREEN-52 and KIDSCREEN-27 instruments. Methods: The child self-report and parent report versions of the KIDSCREEN-10 were tested in a sample of 22,830 European children and adolescents aged 8-18 and their parents ( n = 16,237). Correlation with the KIDSCREEN-52 and associations with other generic HRQoL measures, physical and mental health, and socioeconomic status were examined. Score differences by age, gender, and country were investigated. Results: Correlations between the 10-item KIDSCREEN score and KIDSCREEN-52 scales ranged from r = 0.24 to 0.72 ( r = 0.27-0.72) for the self-report version (proxy-report version). Coefficients below r = 0.5 were observed for the KIDSCREEN-52 dimensions Financial Resources and Being Bullied only. Cronbach alpha was 0.82 (0.78), test-retest reliability was ICC = 0.70 (0.67) for the self- (proxy-)report version. Correlations between other children self-completed HRQoL questionnaires and KIDSCREEN-10 ranged from r = 0.43 to r = 0.63 for the KIDSCREEN children self-report and r = 0.22-0.40 for the KIDSCREEN parent proxy report. Known group differences in HRQoL between physically/mentally healthy and ill children were observed in the KIDSCREEN-10 self and proxy scores. Associations with self-reported psychosomatic complaints were r = −0.52 (−0.36) for the KIDSCREEN-10 self-report (proxy-report). Statistically significant differences in KIDSCREEN-10 self and proxy scores were found by socioeconomic status, age, and gender. Conclusions: Our results indicate that the KIDSCREEN-10 provides a valid measure of a general HRQoL factor in children and adolescents, but the instrument does not represent well most of the single dimensions of the original KIDSCREEN-52. Test-retest reliability was slightly below a priori defined thresholds. [ABSTRACT FROM AUTHOR]

To examine the feasibility, reliability, and validity of the newly developed EQ-5D-Y. The EQ-5D-Y was administered in population samples of children and adolescents in Germany, Italy, South Africa, Spain, and Sweden. Percentages of missing values and reported problems were calculated. Test–retest reliability was determined. Spearman’s rank correlation coefficients with other generic measures of HRQOL were calculated. Known groups’ validity was examined by comparing groups with a priori expected differences in HRQOL. Between 91 and 100% of the respondents provided valid scorings. Sweden had the lowest proportion of reported problems (1–24.9% across EQ-5D-Y dimensions), with the highest proportions in South Africa (2.8–47.3%) and Italy (4.3–39.0%). Percentages of agreement in test–retest reliability ranged between 69.8 and 99.7% in the EQ-5D-Y dimensions; Kappa coefficients were up to 0.67. Correlation coefficients with other measures of self-rated health indicated convergent validity (up to r = −0.56). Differences between groups classified according to presence of chronic conditions, self-rated overall health and psychological problems provided preliminary evidence of known groups’ validity. Results provide preliminary evidence of the instrument’s feasibility, reliability and validity. Further study is required in clinical samples and for possible future applications in economic analyses. [ABSTRACT FROM AUTHOR]

To develop a self-report version of the EQ-5D for younger respondents, named the EQ-5D-Y (Youth); to test its comprehensibility for children and adolescents and to compare results obtained using the standard adult EQ-5D and the EQ-5D-Y. An international task force revised the content of EQ-5D and wording to ensure relevance and clarity for young respondents. Children’s and adolescents’ understanding of the EQ-5D-Y was tested in cognitive interviews after the instrument was translated into German, Italian, Spanish and Swedish. Differences between the EQ-5D and the EQ-5D-Y regarding frequencies of reported problems were investigated in Germany, Spain and South Africa. The content of the EQ-5D dimensions proved to be appropriate for the measurement of HRQOL in young respondents. The wording of the questionnaire had to be adapted which led to small changes in the meaning of some items and answer options. The adapted EQ-5D-Y was satisfactorily understood by children and adolescents in different countries. It was better accepted and proved more feasible than the EQ-5D. The administration of the EQ-5D and of the EQ-5D-Y causes differences in frequencies of reported problems. The newly developed EQ-5D-Y is a useful tool to measure HRQOL in young people in an age-appropriate manner. [ABSTRACT FROM AUTHOR]

Abstract: The frequency of health care use is crucial for adolescent well-being and health systems. The present study was the first to test a set of variables in a representative sample of Greek adolescents in order to identify factors that predict health care use and contribute to improving health service planning. Questionnaires were administered to a random sample of adolescents (N =1 194) aged 11–18 years and their parents (N =973) in 2003. Data from 894 participants with full data were analyzed. Parents'' education, adolescents'' chronic health needs, physical well-being and emotional/behavioural problems as well as parent-child relationship were independent predictors of health care use, although some factors, such as gender, age, type of residence, family affluence, social support and parental health status that previous research identified as predictors were not confirmed. Beyond the need of health care, other factors also play an important role in the utilization of health services by adolescents and their families. [Copyright &y& Elsevier]

Objective: To assess if the Rasch-scaled KIDSCREEN-52 generic health-related quality of life measure was valid in children with cerebral palsy (CP). Methods: The Rasch measurement properties and differential item functioning (DIF) of the KIDSCREEN-52 were examined in children with CP. Data were available from the KIDSCREEN project from 3219 children aged 8 to 12 years and 2126 parents in the general population; and from the SPARCLE project from 501 children aged 8 to 12 years with CP and 823 parents. Analysis used Zumbo's logistic regression DIF approach. Partial credit model analyses were conducted. Results: All items of the KIDSCREEN self-report version fitted the partial credit model (smallest P-value: 0.256). Only one item of the parent version did not fit the data well (smallest P-value 0.001). Statistically significant DIF was observed in some items, but was of substantial magnitude (Δ R2 = 0.046, 0.049) for only two items in two dimensions of the parent version. The practical impact of DIF was small. DIF-adjusted standardized mean differences between children with and without CP being 1.07 and 0.34 for the physical and school dimensions, respectively (unadjusted: 1.09 and 0.16). Conclusion: The KIDSCREEN-52 functions in a similar way in children with CP and in the general population. Comparisons of quality of life between such children are therefore likely to be valid. [ABSTRACT FROM AUTHOR]

Copyright of Journal of Orofacial Orthopedics/Fortschritte der Kieferorthopadie is the property of Springer Nature and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

The self-perceived health or health-related quality of life of children and adolescents is increasingly recognised as a relevant outcome in medical practice and public health research. Identifying children and adolescents with particularly low health-related quality of life allows for an early detection of hidden morbidity and health care needs. The present study investigates health-related quality of life in children and adolescents in Germany. In the Mental Health Module (BELLA study) of the German National Health Interview and Examination Survey for Children and Adolescents (KiGGS), the parents of 2,863 children and adolescents aged 7–17 years, and 1,700 children and adolescents aged 11–17 years completed the KINDL-R quality of life questionnaire. The reliability (Cronbach’s α = 0.86) and validity of the measurements using the parent-reported KINDL-R were confirmed. Means and percentiles were calculated for the total sample as well as for strata defined by age, sex, geographical region (east/west), migration status and socioeconomic status. Expected differences in health-related quality of life of children and adolescents from different social backgrounds and with different health statuses were demonstrated by differences in the KINDL-R scores (effect size d up to 1.29). This study provides representative, normative data (self-report and parent-report) on the test scores of health-related quality of life (KINDL-R) for the population of children and adolescents in Germany in general, as well as in sociodemographic and socioeconomic subpopulations. [ABSTRACT FROM AUTHOR]

Over the past decades the public health relevance of mental health conditions in children and adolescents has been of growing concern. However, so far no detailed epidemiological data has been available for a representative national sample in Germany. The present paper reports prevalence rates of general and specific mental health problems among children and adolescents in Germany and describes the link between symptoms and impairment as well as the treatment situation. The mental health module (BELLA study) examines mental health problems in a representative sub-sample of 2,863 families with children aged 7–17 from the National Health Interview and Examination Survey among Children and Adolescents (KiGGS). Mental health problems were determined using the extended version of the strengths and difficulties questionnaire (SDQ). Further standardised screening measures were employed to screen for anxiety disorders (SCARED), conduct disorder (CBCL), attention deficit-/hyperactivity disorder (FBB-HKS, Conners’ Scale) and depressive disorders (CES-DC). Furthermore, substance abuse and suicidal tendencies were assessed. Health-related quality of life (HRQoL) and health care use were determined. Overall, 14.5% of the children and adolescents aged 7–17 fulfilled the criteria for at least one specific mental health problem associated with impairment, or had an overall mental health problem indicated by an abnormal SDQ score and present impairment. However, high comorbidity was found in the children concerned. Symptoms of overall mental health problems were present in 8.6% of the children and 6.6% of the adolescents. This number was reduced to prevalence rates of 6.3 and 4.9% when additional impairment was taken as a criterion. Irrespective of the type of disorder, fewer than half of the children affected were reported as receiving treatment. However, for those suffering from mental health problems, large impairments in HRQoL were observed. The observed prevalence of mental health problems as well as their large impact on well-being and functioning calls for early prevention. This is especially important with regard to the large decrease in HRQoL in the children and adolescents affected. [ABSTRACT FROM AUTHOR]

The mental health of children and adolescents is an epidemiological outcome of considerable public health relevance. This is because of a comparatively high prevalence of mental health problems and disorders in children and adolescents. The ‘BELLA Study on Mental Health’, a modular component of the Health Interview and Examination Survey for Children and Adolescents conducted by the Robert Koch-Institute, assessed the prevalence of general and specific mental health problems in a representative sample of children and adolescents in Germany. Furthermore, determinants of mental health were studied in a developmental context. In the cross-sectional part of the study, participants were interviewed to assess the occurrence of risk factors and available assets (protective factors) for mental health, providing valuable data for health monitoring and planning. The sample was also repeatedly studied in a 2-year longitudinal design in order to estimate the effect size of risk and protective factors for mental health, and to analyse their combined effects on the process of mental health development. The BELLA study – as described in this supplement – supplies valuable estimates of the prevalence of mental health problems and disorders, identifies risk groups needing intervention, and describes the subjective health of children and adolescents in Germany. [ABSTRACT FROM AUTHOR]

The BELLA study on mental health and well-being in children and adolescents is the mental health module of the German Health Interview and Examination Survey for Children and Adolescents (KiGGS). The cross-sectional KiGGS survey collected comprehensive data on the health status of 17,641 children and adolescents, aged 0–17 years, living in Germany. The survey included physical examinations and tests, questionnaires filled in by parents and equivalent questionnaires for children aged 11 years or older. A computer-assisted personal interview was conducted by study physicians, and various laboratory tests, e.g. on blood and urine samples, were performed. The longitudinal BELLA study collected initial cross-sectional data from a representative KiGGS sub-sample of families with children aged 7–17 years. Of the 4,199 randomly selected families invited to participate in the BELLA study, 2,863 took part. A total of 48.5% of the participating children and adolescents were girls, 51.5% were boys. Within the BELLA study, trained interviewers conducted standardised telephone interviews with one parent and also the child, if it was at least 11 years old. Afterwards the families received additional questionnaires. The interviews and questionnaires included various standardised and ICD-10-oriented instruments examining overall mental health problems and associated burden, depression, anxiety, attention deficit-/hyperactivity and conduct disorders. Furthermore they covered a broad spectrum of aspects related to mental health and well-being, such as risk and protective factors and health-related quality of life. An analysis of the non-responders showed that the families who agreed to participate form a representative sample with respect to the German population. The sample deviated only slightly from the KiGGS sample structure regarding socioeconomic status and regarding parent-reported mental health problems. No such difference was observed for the children’s self-reported mental health. A weighting procedure was applied to correct for deviations from the sociodemographic and socioeconomic structure of the target population. [ABSTRACT FROM AUTHOR]

Objective: There are few health-related quality of life (HRQOL) instruments available that have been validated for use with Turkish children. The Kid-KINDL is a generic measure of children's (8-12 years) HRQOL, which contains 24 categorical items that assess 6 dimensions (physical well-being, emotional well-being, self-esteem, family, friends, and school). The Kid-KINDL is available in many languages. Following an elaborate translation procedure and cognitive focus group interviews, the Kid-KINDL was adopted into Turkish. This paper describes the psychometric properties of the new Turkish Kid-KINDL. Methods: In total, 1918 children aged 8-12 years at a school in Manisa completed the Kid-KINDL. A confirmatory approach was used for validity and reliability analysis. Using the Multi-trait/Multi-item analysis program (MAP) item-internal consistency and item-discriminant validity were calculated to confirm the instrument's structure. Likert scaling assumptions were tested and confirmatory factor analysis (CFA) was applied as well. After modification of 2 unsatisfactory items the Kid-KINDL was administered to a different group of 84 randomly selected children and the analyses were repeated. Results: Cronbach's alpha was 0.35-0.78 before and 0.54-0.78 after the scales was modified. MAP-scaling success was 60%-100% before and 90%-100% after the modification. CFA confirmed the Kid-KINDL structure for the original version (RMSEA = 0.077) was less than the modified version (RMSEA = 0.059), although for the latter the sample was rather small. Floor effects were negligible, and ceiling effects reached 19%. Conclusion: The results indicate that the Turkish Kid-KINDL was a reliable and factorially valid assessment of the children's HRQOL. The modifications made to the 2 unsatisfactory items increased the psychometric quality of the scale. [ABSTRACT FROM AUTHOR]

Copyright of Turk Psikiyatri Dergisi is the property of Turk Psikiyatri Dergisi and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

The strengths and difficulties questionnaire (SDQ) is a brief screening instrument that addresses negative and positive behavioural attributes of children and adolescents in the age range of 4–16 years and can be completed by parents, teachers, and as a self-report. Furthermore, the impact supplement of the extended SDQ surveys for perceived problems, impact, and burden. This paper aims to examine the psychometric properties of the parent form and to investigate differences in the SDQ scores for sociodemographic and socioeconomic subgroups. Patterns of association with other measures of mental health and descriptive comparison with the first normative sample are also reported. Within the BELLA study module of the German Health Interview and Examination Survey for Children and Adolescents (KiGGS), a total of 2,406 children and adolescents aged 7–16 years as well as their parents answered the items of the SDQ and the additional impact supplement. The internal consistency of scale responses was assessed via Cronbach’s α (alpha). Likert scale assumptions of sufficient and similar item-total correlation and item variance were investigated. The factorial validity of the SDQ measurement model was tested by means of exploratory and confirmatory factor analysis. Mean score differences between males and females, age groups (7–10 years vs. 11–16 years), and socioeconomic status groups (Winkler index) were examined via ANOVA. Factor analysis provided an exact replication of the original five-factor SDQ subscale structure. All subscales were sufficiently homogeneous. The mean total difficulties and SDQ subscale scores of the BELLA sample did not differ from the first German normative data. Younger children were more impaired on various SDQ scales than older children, girls were more emotionally affected, and boys showed more externalising problems. The present study confirmed the validity and reliability of the parent-reported SDQ scale structure. The SDQ was found to be a valid and helpful questionnaire for use in the framework of an epidemiological survey. [ABSTRACT FROM AUTHOR]

To examine and compare the psychometric properties of two short screening instruments for children and adolescents suffering from attention deficit-/ hyperactivity disorder (ADHD). The Conners’ Hyperactivity Index consists of ten items that assess symptoms of hyperactivity through self-report and parents’ proxy. The German ADHD Rating scale (FBB-HKS/ADHS) consists of 20 items that assess the severity and perceived burden of inattention, hyperactivity, and impulsiveness as defined by the ICD-10 and DSM-IV. Within the BELLA module of the German Health Interview and Examination Survey for Children and Adolescents (KiGGS), the parents of 2,863 children and adolescents rated the Conners’ Hyperactivity Index and the FBB-HKS. The internal consistency of item responses was assessed via Cronbach’s α and showed that both instrument scores were able to obtain a reliable measurement. The factorial validity of the FBB-HKS measurement model as well as the unidimensionality of the Conners’ scale was tested by means of exploratory and confirmatory factor analysis (EFA and CFA), indicating satisfactory goodness of fit for the FBB-HKS (RMSEA = 0.06) and some deviation from the unidimensionality assumption of the Conners’ scale. Stability of results across age could be confirmed with few exceptions. Mean scores differences were found between both sexes, age groups, and different socioeconomic status groups (Winkler-Index) with males, younger respondents, and children with low socioeconomic status displaying more ADHD-related behaviour. Correlation coefficients between the two instruments’ scores and other scales assessing emotional and behavioural problems hinted at convergent validity. Both instruments’ scores showed reliability as well as factorial and convergent / discriminant validity. The pros and cons of the two instruments as well as for which purpose and under which circumstances one of the measures can be favoured must be considered prior to applying such a measure. [ABSTRACT FROM AUTHOR]

Since prevalence rates of mental health problems in children and adolescents are high and of considerable relevance to public health, determinants of mental health, such as risk and protective factors, are of special interest. The present paper reports the frequencies and distributions of potential risk and protective factors and analyses their effects on children’s mental health. The BELLA study is the mental health module of the German National Health Interview and Examination Survey among Children and Adolescents (KiGGS). Mental health problems and their assumed determinants are examined in a representative sub-sample of 2,863 families with children and adolescents aged 7–17. In order to identify mental health problems, the extended version of the Strengths and Difficulties Questionnaire was administered. Data on psychosocial risk factors as well as on protective factors in terms of personal, familial and social resources were collected by questioning the parents and, from the age of 11 years upwards, the children themselves. Adverse family climate stands out particularly as a negative contributor to children’s mental health. When several risk factors occur simultaneously, the prevalence of mental health problems increases markedly. Conversely, pronounced individual, family and social resources coincide with a reduced occurrence of mental health problems, especially in children with a limited number of risk factors. The results suggest that differential prevention strategies are needed depending on the risk level: in the low risk group, to which most children belong, effective prevention programmes should define strengthening resources as a key objective. In the smaller group of children with a high number of risk factors, more complex intervention designs are required, which must consider the reduction of risks as well as strengthening resources. [ABSTRACT FROM AUTHOR]

The concept of health-related quality of life (HRQoL) involves the respondents’ perception of well-being and functioning in physical, emotional, mental, social, and everyday life areas. Research in the area of subjective health has resulted in the development of a multitude of HRQoL instruments that meet satisfying psychometric standards with regard to reliability, validity, and sensitivity of the scales. One frequently used generic measure for children and adolescents is the KINDL-R questionnaire developed by Ravens-Sieberer and Bullinger (Qual Life Res 7:399–407, 1998). Within the representative sample of the BELLA study, analyses regarding psychometric properties (namely reliability as well as discriminant and construct validity) are performed. Psychometric testing of the KINDL-R questionnaire reveals good scale utilisation and scale fit as well as moderate internal consistency. Correlations with the KIDSCREEN-52 subscales are shown. Differences in KINDL-R scores exist between chronically ill and healthy children as well as between SDQ problem scores. The KINDL-R is a suitable instrument for measuring HRQoL in children and adolescents through self-report. The testing of the instrument in a representative sample of German children and adolescents as well as their parents provides reference values extending the potential of the KINDL-R questionnaire. [ABSTRACT FROM AUTHOR]

To identify disordered eating behaviour and attitudes in a large representative population in order to determine the relationship with body weight status, and to assess associated psychopathology and health-related quality of life. A total of 11–17 year-old adolescents ( n = 1,895) were randomly selected from the national representative sample of 17,641 families participating in the German Health Interview and Examination Survey for Children and Adolescents (KiGGS). Weight and height were assessed by trained staff. Mental health problems and health-related quality of life were examined by means of a telephone interview and different questionnaires. Eating disordered behaviour and attitudes were identified by the SCOFF, an instrument consisting of five questions originally developed to screen for eating disorders in clinical settings. About one third of the girls and 15% of the boys reported disordered eating behaviour and attitudes, which were most prevalent in overweight youth. There was a significant association between the presence of disordered eating behaviour and psychopathology, which was comprised of internalising and externalising behavioural problems. In addition, adolescents with disordered eating behaviour reported reduced quality of life. The high prevalence of disordered eating in the general population of Germany is of great concern. Health professionals should not only be aware of disordered eating in underweight adolescents, but in all youth, especially overweight individuals. Disordered eating behaviour is associated with a wide range of psychopathological and psychosocial concerns. Thus, youngsters engaging in disordered eating behaviour should also be explored for other serious mental or social problems. [ABSTRACT FROM AUTHOR]

In Europe, a considerable proportion of children and adolescents is affected by depressive symptoms, impairing their everyday life and social functioning. The aim of this paper is to provide an overview of the depressive symptoms in children and adolescents in Germany, addressing risk factors, comorbidity, and impact of depressive symptoms on everyday life. In the BELLA study, the mental health module of the German Health Interview and Examination Survey for Children and Adolescents (KiGGS), a representative sample of young people aged 7–17 years was enrolled. Depressiveness, assessed by the CES-DC, as well as other mental health problems were examined in the context of risk and protective factors. Depressive symptoms showed high prevalence in parent- and self-reports. Higher depression scores were found in those with a high number of psychosocial risks existing in the family, and they decreased as the number of protective factors the children and adolescents had at their disposal increased. Although only half of the boys and girls with high depression scores were regarded as significantly impaired, all of them had a much higher risk for additional mental health problems. Furthermore, their health-related quality of life was limited compared to their peers who had low depression scores. To differentiate between clinically significant depression and milder forms, it is necessary to take into account the different perspectives of children and their parents. Prevention and intervention should acknowledge the widespread distribution of depressive symptoms in children and adolescents, the high comorbidity of depressive and other mental health problems and the impact of depression on the aspects of everyday life. [ABSTRACT FROM AUTHOR]

There is a lack of representative prevalence rates for attention deficit-/hyperactivity disorder (ADHD) according to DSM-IV criteria and hyperkinetic disorder (HD) according to ICD-10 criteria for German subjects. To report the results of analyses of categorical data on the prevalence rates of the symptoms of ADHD/HD and additional diagnostic criteria, as well as of the diagnoses of ADHD and HD according to symptoms and other diagnostic criteria, according to the ICD-10 and DSM-IV. Further, to report administrative prevalence rates of the diagnosis and rates of co-existing behavioural and emotional problems. Within the BELLA module of the German Health Interview and Examination Survey for Children and Adolescents (KiGGS), a representative sample of parents of 2,452 children and adolescents aged 7–17 years completed an ADHD symptom checklist (FBB-HKS/ADHS) and additional questionnaires for the assessment of coexisting behavioural and emotional problems. The prevalence rates for the diagnoses of ADHD according to DSM-IV criteria were 5.0% and the rate for HD according to ICD-10 criteria was 1.0%. Higher prevalence rates were found in boys and in younger children. The addition of other diagnostic criteria (impairment, pervasiveness, onset, duration) resulted in a significant decrease of the prevalence rates of ADHD and HD to 2.2 and 0.6%, respectively. Higher prevalence rates were found in families of lower socioeconomic status and families from urban areas. The lifetime administrative prevalence rate was 6.5%. Children with ADHD had an increased risk for coexisting behavioural and emotional problems, especially for aggressive and antisocial behaviour problems, but also for anxiety and mood problems. The results of the national sample are in line with community studies in other countries. The effects of the additional diagnostic criteria of impairment, situational pervasiveness, symptom onset and symptom duration on the prevalence rates have to be considered in other epidemiological studies. [ABSTRACT FROM AUTHOR]

The consideration of impairment plays a crucial role in detecting significant mental health problems in children whose symptoms do not meet diagnostic criteria. The assessment of impairment may be particularly relevant when only short screening instruments are applied in epidemiological surveys. Furthermore, differences between childrens’ and parents’ perceptions of present impairment and impairing symptoms are of interest with respect to treatment-seeking behaviour. The objectives were to assess parent- and self-reported impairment due to mental health problems in a representative sample of children and adolescents; to describe the characteristics of highly impaired children with normal symptom scores; and to investigate the associations between symptoms in different problem areas and impairment. The mental health module of the German Health Interview and Examination Survey for Children and Adolescents (the BELLA study) examined mental health in a representative sub-sample of 2,863 families with children aged 7–17. Self-reported and parent-reported symptoms of mental health problems and associated impairment were identified by the extended version of the strengths and difficulties questionnaire (SDQ) in children 11 years and older. Considerable levels of distress and functional impairment were found with 14.1% of the boys and 9.9% of the girls being severely impaired according to the parental reports. However, self-reported data shows a reversed gender-difference as well as lower levels of severe impairment (6.1% in boys; 10.0% in girls). Six percent of the sampled children suffer from pronounced impairment due to mental health problems but were not detected by screening for overall symptoms. Childrens’ and parents’ reports differed in regard to the association between reported symptom scores and associated impairment with children reporting higher impairment due to emotional problems. The assessment of impairment caused by mental health problems provides important information beyond the knowledge of symptoms and helps to identify an otherwise undetected high risk group. In the assessment of impairment, gender-specific issues have to be taken into account. Regarding the systematic differences between childrens’ and parents’ reports in the assessment of impairment, the child’s perspective should be given special attention. [ABSTRACT FROM AUTHOR]

Abstract: Objective: This study examines the effects of telephone and mail interview methods on the measurement of health-related quality of life. Study Design and Setting: One thousand six hundred ninety individuals aged 25–66 were interviewed randomly either by telephone or by mail. Health-related quality of life was assessed with the German SF-8. Results: Although respondents in the telephone survey were more willing to participate (77.4% vs. 47.5%) the difference in the accessibility of publicly available address and telephone records meant that overall more people were interviewed by mail than by telephone (53.2% vs. 46.8%). No differences occurred in terms of the sociodemographic makeup. Telephone respondents gave a more positive account of the mental dimension of their health-related quality of life; whereas mail interviews led to a better rating of the respondents'' physical well-being. Gender-specific analyses indicate a slight discrepancy in the influence of the method of interviewing on men and women. Further differences were identified concerning the variance in the existence of ceiling and floor effects and the correlation between items. Conclusion: Found differences are small but at least to be valued as relevant in certain settings. Therefore, we approve the use and development of factors of amendment. [Copyright &y& Elsevier]

Objective: This study assesses the reliability and validity of the European KIDSCREEN-52 generic health-related quality of life (HRQoL) questionnaire for children and adolescents. Research Design: The KIDSCREEN-52, which measures HRQoL in 10 dimensions, was administered to a representative sample of 22,827 children and adolescents (8 to 18 years) in 13 European countries. Psychometric properties were assessed using the Classical Test Theory approach, Rasch analysis, and structural equation modeling (SEM). A priori expected associations between KIDSCREEN scales and sociodemographic and health-related factors were examined. Test–retest reliability was assessed in 10 countries. Results: For the overall sample, Cronbach's alpha values ranged from 0.77 to 0.89. Scaling success (Multitrait Analysis Program) was >97.8% for all dimensions and Rasch analysis item fit (INFITmsq) ranged from 0.80 to 1.27. The intraclass correlation coefficients ranged from 0.56 to 0.77. No sizeable differential item functioning (DIF) was found by age, sex or health status. Four items showed DIF across countries. The specified SEM fitted the data well (root mean square error of approximation: 0.06, comparative fit index: 0.98). Correlation coefficients between Pediatric Quality of Life Inventory, Child Health and Illness Profile-Adolescent Edition, and Youth Quality of Life Instrument scales and KIDSCREEN dimensions assessing similar constructs were moderate for those ( r = 0.44 to 0.61). Statistically significant differences between children with and without physical and mental health problems (Children with Special Health Care Needs screener: d = 0.17 to 0.42, Strengths and Difficulties Questionnaire: d = 0.32 to 0.72) were found in all dimensions. All dimensions showed a gradient according to socioeconomic status. Conclusions: The KIDSCREEN-52 questionnaire has acceptable levels of reliability and validity. Further work is needed to assess longitudinal validity and sensitivity to change. [ABSTRACT FROM AUTHOR]

Background: Aimed to develop a unitary scoring system for the 'Health Behaviour in school-aged Children' (HBSC) symptom checklist that would facilitate cross-national comparisons and interpretation. Rasch measurement analysis and investigation of differential item functioning (DIF) were conducted. Methods: Data were obtained from the 'WHO collaborative study HBSC 2001/2002'. A total of 162 305 students aged 11, 13 and 15 years from 35 European and North American Countries were surveyed. Unidimensionality of the items and local independence were tested using means of confirmatory factor analysis. DIF across countries, age groups and gender was investigated using a logistic regression procedure. Item and person parameters were estimated according to the Rating Scale Model (RSM). Results: All items proved to be unidimensional. One item displayed noticeable DIF across countries and was discarded. The remaining items were functioning equally across subgroups. The RSM analysis resulted in Rasch model conform item parameter estimation. Infit mean square values between 0.84 and 1.35 revealed acceptable item fit. Conclusion: The control of DIF enables comparable and unbiased assessment of subjective health complaints across countries, age groups and gender. A scoring algorithm could be developed which enables a cross-cultural comparable and interval-scaled assessment of subjective health complaints. [ABSTRACT FROM AUTHOR]

Within the European Screening for and Promotion of Health-Related Quality of Life in Children and Adolescents—A European Public Health Perspective (KIDSCREEN) Study, emotional well-being and behaviour was examined in national representative samples of 22 000 children and adolescents aged 8 to 18. The proportion of children and adolescents showing signs of mental health problems (Strengths and Difficulties Questionnaire—SDQ) varied across countries and socio-demographic and socio-economic subgroups. Risk factors examined included adverse family climate, low socio-economic status, poor social support and decreased mental well-being of the parents. When several risk factors occur simultaneously, the prevalence of mental health problems increases markedly. Children and adolescents with mental health problems display distinctly impaired health-related quality of life (KIDSCREEN-10). Cross-cultural differences in the observed patterns of mental health problems were discussed. High-risk groups are cross-culturally characterized by poor social support and mental distress of parents. Strengthening social and familial resources should be a key objective, both in prevention and in interventions. Copyright © 2008 John Wiley & Sons, Ltd. [ABSTRACT FROM AUTHOR]

Background: Health-related quality of life measures are increasingly being used in evaluating health care outcome around the world. There is a demand for the development of quality of life measures to be used cross-culturally. The aim of this study is to evaluate the psychometric properties of the Taiwanese version of Kiddo-KINDL, a health-related quality of life questionnaire.Methods: The original German-version of Kiddo-KINDL was translated into Chinese (Taiwanese) via the forward/backward translation process. Psychometric testing was performed with a national sample of 1,985 healthy students between the ages of 12 and 16. Data were analyzed based on 1,675 usable questionnaires.Results: The reliability coefficients were alpha = 0.81 (overall) and -0.31 to 0.84 for six subscales. The subscales with low Cronbach's alpha were "school" and "friends." Test-retest reliability was 0.77. Convergent validity was examined with the broadly used Taiwanese version of the Adolescent Depressive Mood Self-Detecting Scale. The result was satisfactory. Construct validity was further examined with exploratory factor analysis. The six-factor solution explained 45.2% of the variance. The construct of Kiddo-KINDL (Taiwanese version) appeared to be appropriate for measuring health-related quality of life in healthy adolescents.Conclusions: Kiddo-KINDL (Taiwanese version) is a relatively reliable and valid questionnaire of adolescents' health-related quality of life. However, items in the "school" and "friends" subscales need to be further modified to be more culturally appropriate. [ABSTRACT FROM AUTHOR]

Health-related quality of life measures are increasingly being used in evaluating health care outcome around the world. There is a demand for the development of quality of life measures to be used cross-culturally. The aim of this study is to evaluate the psychometric properties of the Taiwanese version of Kiddo-KINDL®, a health-related quality of life questionnaire. The original German-version of Kiddo-KINDL® was translated into Chinese (Taiwanese) via the forward/backward translation process. Psychometric testing was performed with a national sample of 1,985 healthy students between the ages of 12 and 16. Data were analyzed based on 1,675 usable questionnaires. The reliability coefficients were α = 0.81 (overall) and −0.31 to 0.84 for six subscales. The subscales with low Cronbach’s α were “school” and “friends.” Test–retest reliability was 0.77. Convergent validity was examined with the broadly used Taiwanese version of the Adolescent Depressive Mood Self-Detecting Scale. The result was satisfactory. Construct validity was further examined with exploratory factor analysis. The six-factor solution explained 45.2% of the variance. The construct of Kiddo-KINDL® (Taiwanese version) appeared to be appropriate for measuring health-related quality of life in healthy adolescents. Kiddo-KINDL® (Taiwanese version) is a relatively reliable and valid questionnaire of adolescents’ health-related quality of life. However, items in the “school” and “friends” subscales need to be further modified to be more culturally appropriate. [ABSTRACT FROM AUTHOR]

The impact of the environment on the quality of life and health is considered to be important for adults as well as for children and adolescents. To include the subjective view of children and adolescents in this context, instruments for measuring the perception of the environment are needed. The new scale CANEP (Children's and Adolescents' Neighborhood Environment Perception) covers youths' perception of the neighborhood as safe, clean, quiet, and providing opportunities for social contacts with peers. Even if the external validation has not yet been fully completed, the characteristics and contents of the instrument seem plausible and promise to tell more about the relation between environment perception and the well being of the young. © 2007 Wiley Periodicals, Inc. [ABSTRACT FROM AUTHOR]

Objective: To assess the construct and criterion validity of the KIDSCREEN-27 health-related quality of life (HRQoL) questionnaire, a shorter version of the KIDSCREEN-52.Methods: The five-dimensional KIDSCREEN-27 was tested in a sample of 22,827. For criterion validity the correlation with and the percentage explained variance of the scores of the KIDSCREEN-52 instrument were examined. Construct validity was assessed by testing a priori expected associations with other generic HRQoL measures (YQOL-S, PedsQL, CHIP), indicators of physical and mental health, and socioeconomic status. Age and gender differences were investigated.Results: Correlation with corresponding scales of the KIDSCREEN-52 ranged from r = 0.63 to r = 0.96, and r2 ranged from 0.39 to 0.92. Correlations between other HRQoL questionnaires and KIDSCREEN-27 dimensions were moderate to high for those assessing similar constructs (r = 0.36 to 0.63). Statistically significant and sizeable differences between physically and mentally healthy and ill children were found in all KIDSCREEN-27 dimensions together with strong associations with psychosomatic complaints (r = -0.52). Most of the KIDSCREEN-27 dimensions showed a gradient according to socio-economic status, age and gender.Conclusions: The KIDSCREEN-27 seems to be a valid measure of HRQoL in children and adolescents. Further research is needed to assess longitudinal validity and sensitivity to change. [ABSTRACT FROM AUTHOR]

Objectives: The aim of this study is to assess the structural and cross-cultural validity of the KIDSCREEN-27 questionnaire.Methods: The 27-item version of the KIDSCREEN instrument was derived from a longer 52-item version and was administered to young people aged 8-18 years in 13 European countries in a cross-sectional survey. Structural and cross-cultural validity were tested using multitrait multi-item analysis, exploratory and confirmatory factor analysis, and Rasch analyses. Zumbo's logistic regression method was applied to assess differential item functioning (DIF) across countries. Reliability was assessed using Cronbach's alpha.Results: Responses were obtained from n = 22,827 respondents (response rate 68.9%). For the combined sample from all countries, exploratory factor analysis with procrustean rotations revealed a five-factor structure which explained 56.9% of the variance. Confirmatory factor analysis indicated an acceptable model fit (RMSEA = 0.068, CFI = 0.960). The unidimensionality of all dimensions was confirmed (INFIT: 0.81-1.15). Differential item functioning (DIF) results across the 13 countries showed that 5 items presented uniform DIF whereas 10 displayed non-uniform DIF. Reliability was acceptable (Cronbach's alpha = 0.78-0.84 for individual dimensions).Conclusions: There was substantial evidence for the cross-cultural equivalence of the KIDSCREEN-27 across the countries studied and the factor structure was highly replicable in individual countries. Further research is needed to correct scores based on DIF results. The KIDSCREEN-27 is a new short and promising tool for use in clinical and epidemiological studies. [ABSTRACT FROM AUTHOR]

Background: Quality of life (QoL) outcomes are useful in the assessment of physical, mental and social well-being and for informed healthcare decision making. However, few studies have evaluated QoL issues among Asian children due largely to the lack of culturally valid and reliable QoL questionnaires. Hence, we aimed to report the psychometric properties, in particular factor structure, of KINDL (Singapore) questionnaires among school-going children. Methods: Students aged 8-16 years from participating schools were selected by convenience sampling. Subjects self-completed KINDL-Kid (Singapore) and KINDL-Kiddo (Singapore) questionnaires, which were cross-culturally adapted from KINDL (Germany English) for use in Singapore. We evaluated floor and ceiling effects, internal consistency and performed factor analysis. Results: A total of 328 respondents (mean (SD) age: 9.6 (1.31) years; 67% female; 75% Chinese, 16% Malays, 9% Indians and others) completed KINDL-Kid while 1,026 respondents (mean (SD) age: 14.0 (1.00) years; 82% female; 82% Chinese, 12% Malays; 6% Indians and others) completed KINDL-Kiddo. Mean (SD) TOTAL QoL score was 65.5 (12.76) and 56.6 (11.92) for KINDL-Kid and KINDL-Kiddo, respectively. Floor and ceiling effects were important in five of six KINDL-Kid and two of six KINDL-Kiddo subscales. Reliability coefficients ranged from 0.40 to 0.71 (KINDLKid) and 0.44 to 0.84 (KINDL-Kiddo). Factor analysis generated eight and seven factors in KINDLKid and KINDL-Kiddo, respectively. Conclusion: KINDL-Kiddo exhibited good psychometric properties and may be used to assess QoL in this multi-ethnic English-speaking Asian population. However, psychometric properties of KINDL-Kid may need to be improved either by developing new items or modifying existing items. [ABSTRACT FROM AUTHOR]

This paper describes the development and psychometric properties of a condition-specific quality of life instrument for children with cerebral palsy (CP QOL-Child). A sample of 205 primary caregivers of children with CP aged 4 to 12 years (mean 8y 5mo) and 53 children aged 9 to 12 years completed the CP QOL-Child. The children (112 males, 93 females) were sampled across Gross Motor Function Classification System (GMFCS) levels (Level I=18%, II=28%, III=14%, IV=11%, V=27%). Primary caregivers also completed other measures of child health (Child Health Questionnaire; CHQ), QOL (KIDSCREEN), and functioning (GMFCS). Internal consistency ranged from 0.74 to 0.92 for primary caregivers and from 0.80 to 0.90 for child self-report. For primary caregivers, 2-week test-retest reliability ranged from 0.76 to 0.89. The validity of the CP QOL is supported by the pattern of correlations between CP QOL-Child scales with the CHQ, KIDSCREEN, and GMFCS. Preliminary statistics suggest that the child self-report questionnaire has acceptable psychometric properties. The questionnaire can be freely accessed at [ABSTRACT FROM AUTHOR]