We used the child benefit register to select a nationally representative sample of 10 438 children aged 5-15 years from Great Britain. The Development and Well Being Assessment combined information from parents, teachers, and young people aged 11 and older to diagnose psychiatric disorders according to the Diagnostic and Statistical Manual of Mental Disorders
, fourth edition.5
Parents completed the Strengths and Difficulties Questionnaire, which generates total difficulties and impact scores.6
The latter indicates the level of distress and related impairment in family life, peer relationships, academic functioning, and leisure activities.
Parents were also asked whether their child had “hyperactivity,” “behavioural problems,” and “emotional problems” and whether teachers had complained about the child's concentration, activity level, or impulsiveness. We cross tabulated parents responses to these questions with the presence of psychiatric disorder to elicit ways in which clinicians might assess which children require referral.
The negative predictive power and specificity of parental opinions were high, suggesting that clinicians can mostly be reassured by a lack of parental concern (). About half of the children that parents were worried about had a psychiatric disorder; almost three quarters of parents reported problems in more than one area. Many of the children identified as having difficulties by parents will have significant problems even if they fall below the threshold for a psychiatric diagnosis. The Strengths and Difficulties Questionnaire total symptoms and impact scores were much higher in the “parent concerned but no diagnosis” group (n = 396) than the “no parental concern” group (n = 9477), (symptom score 13.9 (standard deviation 5.3) v 7.5 (4.9), t = 26, P < 0.001; impact score 0.9 (1.4) v 0.2 (0.7), t = 11, P < 0.001).
Accuracy of parental concerns about their child's emotions, behaviour, and activity level. Values are percentages (95% confidence intervals)
Parents were most accurate at identifying conduct disorders, and those children reported to have behavioural problems were also most likely to have any sort of psychiatric disorder. However, nearly half of the children reported to have emotional problems or hyperactivity also had a psychiatric disorder. Parental reports of teacher concerns were more predictive of attention-deficit/hyperactivity disorder than parental concern alone; positive predictive power was particularly high when both the parent and teacher were concerned.