Journal of Oral Research and Review

: 2019  |  Volume : 11  |  Issue : 1  |  Page : 7--11

Assessment of child's mental health problems using Strengths and Difficulties Questionnaire

Miranda George, Shweta Chandak, Milind Wasnik, Sneha Khekade, Niharika Gahlod, Harshita Shukla 
 Department of Pedodontics and Preventive Dentistry, Swargiya Dadasaheb Kalmegh Smruti Dental College and Hospital, Nagpur, Maharashtra, India

Correspondence Address:
Miranda George
Department of Pedodontics and Preventive Dentistry, Swargiya Dadasaheb Kalmegh Smruti Dental College and Hospital, Nagpur, Maharashtra


Background: While a number of studies in the Western countries have provided estimates of prevalence for child psychiatric morbidity and associated risk factors, relatively little is known about child psychiatric problems and risk factors in developing countries like India. Aim: The aim of this study was to assess the patients' emotional status in an age group of 3–14 years to evaluate children's cooperative potential. Methodology: The Goodman's Strengths and Difficulties Questionnaire assessing the mental health status of the child was distributed to the Vidharbhan population attending the dental hospital. A cross-sectional survey including 168 children aged 3–14 years who were instructed how to fill the questions participated in the study. Results: Overall 53% of the children belonged to the normal category, whereas 33% and 14% were under abnormal and borderline categories, respectively. The abnormal category was slightly higher in the age groups of 3.1–5 (35%) and 11.1–14 (28%) years. Similar to certain studies, the mental health problems with males (52.9%) were higher than that of females (47.6%). Conclusion: Identifying the mental health problems of the child seeking dental treatment will help the dentist to formulate an idea of the child's emotional status at the time of treatment and thereby make proper amendments during the treatment procedure. There is a need for developing programs to train, sensitize, and mobilize teachers and parents regarding children's psychological, emotional, and behavioral problems, with special attention to the common population.

How to cite this article:
George M, Chandak S, Wasnik M, Khekade S, Gahlod N, Shukla H. Assessment of child's mental health problems using Strengths and Difficulties Questionnaire.J Oral Res Rev 2019;11:7-11

How to cite this URL:
George M, Chandak S, Wasnik M, Khekade S, Gahlod N, Shukla H. Assessment of child's mental health problems using Strengths and Difficulties Questionnaire. J Oral Res Rev [serial online] 2019 [cited 2019 Mar 20 ];11:7-11
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Anxiety and appraisal is a commonly dealt problem and a major aspect in child management encountered in a dental operatory. A pediatric dentist who treats children should be able to measure the emotional status of the child and the relevant problems associated with them for prompt and efficient treatment.[1]

Child behavior in the dental setting is a multifactorial phenomenon. Among the factors that influence the child's behavior is temperament. Although there is lack of consensus on the definition of the term, most experts refer to it as moods and behavior that originate from the child's biology and are based on the nervous system, manifesting themselves at the early stages of the evolution.[2]

A child's cooperativeness to the clinical procedures helps in setting forth the proper treatment plan. No single assessment method or tool is completely accurate in predicting a patient's behavior, but awareness of the multiple influences on a child's response to care can aid in treatment planning. Disruptive behaviors or behavioral problems are defined as behavioral excesses or deficits that cause harm to individuals themselves, to people relating with them (e.g., parents, relatives, teachers, and classmates), and to the society as a whole when more severe manifestations are present.[3] Initially, information can be gathered from the parent through questions regarding the child's cognitive level and temperament/personality characteristics.[4],[5] Anxiety and fear,[1],[6] reaction to strangers,[5] and behavior at previous medical/dental visits, as well as how the parent anticipates the child, will respond to future dental treatment.

The Strengths and Difficulties Questionnaire (SDQ) is a brief behavioral screening questionnaire that inquires 25 attributes, some positive and others negative (Goodman, 1997). The 25 items are divided between five scales of five items each, generating scores for conduct problems, inattention/hyperactivity, emotional symptoms, peer problems, and prosocial behavior; all scales but the last are summed to generate a total difficulties score.[7]

The questionnaire can be completed by parents or teachers. Extended versions of SDQ are also available which further inquire about the chronicity, distress, social impairment, and burden for others.

The purpose of this study was to assess the child's emotional status and co-operative potential for screening dental care.


A total of 200 child patients referring to the Department of Pedodontics and Preventive Dentistry, Swargiya Dadasaheb Kalmegh Smruti Dental College and Hospital, Nagpur, between the age group of 3–14 years, who were accompanied by their parents or guardians, on their first dental visit, were selected for the study. A total of 168 parents agreed to participate in the study. Only the children ready to fill the consent forms were included in the survey.

The questionnaires were distributed to the parents who had their first visit at the operatory. Complete instructions as to the pattern of the questions and the manner it had to be answered were explained in detail to the parents. A Hindi version of the questionnaire was provided for the ease of understating among the local public. The instructions given to the parents were as follows: to read the questions carefully and tick on one of the boxes adjacent to each question specifying “not true,” “somewhat true,” and “certainly true.” Confidentiality of the respondents was maintained with respect to questionnaires.

Assessment of children's mental health was conducted using the SDQ which includes questions on behavior-based attributes filled by the parents based on cutoff provided by Goodman.[7]

The questionnaire comprised 25 questions under the headings of conduct disorder (e.g., often fights with other children or bullies them), hyperactivity/inattention (e.g. restless, overactive, and cannot stay still for long), emotional symptoms (e.g., many fears, easily scared), prosocial behavior (e.g., often volunteers to help others such as parents, teachers, and other children), and peer relationship problem (e.g., picked on or bullied by other children). Each of the above-mentioned categories was provided with three options and scored accordingly. A score of 0 was assigned to the answer “not true,” a score of 1 to the answer “somewhat true,” and a score of 2 to “certainly true.”

Statistical analysis

The frequency distribution for the normal, borderline, and abnormal categories on the total SDQ and subsets was computed. Subscale ratings were tabulated based on the SDQ scores and converted into percentages with respect to gender, age, and the various behaviors shown in each age group.


Based on the results obtained from the study conducted in the Vidharbhan population of Central India, it was found that the mean age of the children in the study sample was 6.67 years [Table 1], with a gender distribution of 52.9% of males and 47.6% of females. Patients from all groups of socioeconomic status attending the dental hospital were included in the study. On analysis of the SDQ data, it was found that 53% of the children belonged to the normal category, whereas 33% and 14% were under abnormal and borderline categories, respectively [Table 2] and [Figure 1].{Table 1}{Table 2}{Figure 1}

On individual behavioral subset scores, 21% was rated abnormal under emotional subset, 15% on conduct problems, 12% on hyperactivity, 41% under peer pressure, and 8% on prosocial behavior subset. Furthermore, the percentage values under the normal grading were 28%, 14%, 12%, 17%, and 27% for emotional symptoms, conduct problems, hyperactivity, peer problems, and prosocial behavioral problems, respectively [Table 3].{Table 3}

Based on gender predilection, 36% of male children were rated as abnormal, and among females, the abnormal rate was 30. The normal and borderline percentage values for males were 48% and 16%, respectively, and those for females were 58% and 12%, respectively [Table 4], [Figure 2].{Table 4}{Figure 2}

Among the various age groups, the abnormal category rate was 25% in 5.1–7 years, 3% in 7.1–9 years, and 7% in 9.1–11 years. The abnormal category was slightly higher in the age groups of 3.1–5 and 11.1–14 years, being 35% and 28%, respectively. In the normal and borderline categories in the age group of 5.1–7 years, 31% and 25% values were noted, respectively. A highest percentage (50%) was observed in the age group of 9.1–11 years in the borderline category [Table 5], [Figure 3].{Table 5}{Figure 3}


This study aimed at finding the psychiatric morbidity in children in the age group of 3–14 years in the Vidharban population in Central India. Most studies report the prevalence of psychiatric morbidity among children from community samples between 10% and 20%.[8] It is also known that, when careful diagnostic criteria are used, studies point out more similarities than differences, such as a Brazilian study using the Diagnostic and Statistical Manual of Mental Disorders, 4th Edition to diagnose attention-deficit hyperactivity disorder found a 5.8% prevalence, most similar to the results found in other countries.[9]

In this study, the section of children under normal category was comparatively higher, being 54%, whereas that in the abnormal and borderline categories was 33% and 14%, respectively. In the Malaysian population, the statistics in the abnormal category showed 80% as reported by Pandiyan and Hedge.[10] These values vary depending on the instrument and the study design used. Screening tools yield higher results, whereas diagnostic interviews of the screened population often result in lower estimates.[10] A similar study performed in Karachi, Pakistan, showed 34% of children in the abnormal category, which is slightly similar to our study.[11]

Under the abnormal category subscale, peer problems and emotional problems account maximum values, being 41% and 21%, respectively. A recent study on Sri Lankan schoolchildren using similar method showed significantly higher rates of behavioral problems as compared to the British population.[12] The Malaysian study showed more of peer and conduct problems[10] and Brazilian study showed more of conduct problems.[13] This may be due to samples from economically backward class. It was also noted that the frequencies found in a Brazilian study were 30.8% for emotional symptoms, 17.7% for conduct problems, 16.8% for hyperactivity, and 18.7% for the total punctuation, which were very close to the frequencies obtained at the Gaza Strip.[14]

It was noted in Bangladesh[15] that 8.6% of the children had high punctuations for emotional symptoms, 3.1% for conduct problems, 6.2% for hyperactivity, and 13.0% for the total punctuation and, in the United Kingdom,[16] an abnormal total punctuation was observed in 10.5% of the sample. However, the cutoff punctuations used for the study were slightly different from those of the current study performed in India.

Male gender has been consistently reported in literature as a predictor of psychopathology. Our study also showed a higher male preponderance. A higher prevalence among boys was found in most studies except the one conducted in Alain which found a female preponderance.[17]

Unlike other questionnaires, the SDQ's greater emphasis on positive attributes was designed to increase the questionnaire's acceptability to the respondents.

Limitations of the study

A wide age range of 3–14 years has been selected which is not reliable as the mental status of the child drastically varies as age advances.

School type has not so far been reported in the literature searched by the authors except one study carried out in Brazil, where similar to our findings, the most striking difference by school type was the substantially higher prevalence of psychiatric disorders as a whole among children attending public schools as opposed to private schools.[13] The questionnaire was asked to be filled by the parents only and the analysis was based solely on their response, but this cannot be accepted as the child's behavior is different at different places, assuming that the teacher-filled response of the questionnaire would vary from that of the parents.


The findings of the current study suggest that it is beneficial to identify the mental health problems of the child seeking dental care as it may help the dentist to formulate an idea of the child's emotional status at the time of treatment. Furthermore, keeping in view the limitations of the present study, it is vital to carry out further research with multi-information for a better understanding into insights of the child's co-operative potential.

Financial support and sponsorship


Conflicts of interest

There are no conflicts of interest.


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