The Strengths and Difficulties Questionnaire: U.S. Normative Data and Psychometric Properties

Objective: To evaluate the Strengths and Difficulties Questionnaire in a U.S. national population sample of children and adolescents, develop normative scoring bands, and test the association of high-scoring groups with service contacts or use for mental health reasons. Method: An Americanized version of the Strengths and Difficulties Questionnaire parent report was administered to parents of 10,367 4- to 17-year-olds in the 2001 National Health Interview Survey. Scoring bands were developed to differentiate low, medium, and high levels of emotional or behavioral difficulties. Children at high risk of serious difficulties were identified by three different scoring methods: (1) high symptom scores, (2) parental perception of definite or severe difficulties, and (3) high symptoms plus impairment. These ratings were validated against service contact or use and other well-established demographic and broader risk factors for child emotional and behavioral problems. Results: Results indicated good acceptability and internal consistency. Normative scoring bands were similar, though not identical, to the original British bands. Results of each scoring method had a strong association with service contact/use. Conclusions: This study supports the usefulness of the Strengths and Difficulties Questionnaire as an effective and efficient screener for child and adolescent mental health problems in the United States.