Department of Psychology, Norwegian University of Science and Technology, Norway.
J Am Acad Child Adolesc Psychiatry. 2013 Jul;52(7):728-36. doi: 10.1016/j.jaac.2013.04.010. Epub 2013 Jun 3.
To examine screening efficiency for preschool psychopathology by comparing the Strengths and Difficulties Questionnaire findings against diagnostic information, and to determine the added value of impact scores and teacher information.
Using a 2-phase sampling design, a population-based sample of 845 children 4 years of age was recruited from community health check-ups in Trondheim, Norway, screen score stratified and oversampled for high screening scores. Blinded to screen ratings, DSM-IV diagnoses were assigned using the Preschool Age Psychiatric Assessment interview, against which the Strengths and Difficulties Questionnaire scores were compared through receiver operating characteristic analysis.
Emotional and behavioral disorders were identified through parent ratings with a specificity of 88.8% (range, 87.0%-90.6%) and a sensitivity of 65.1% (range, 51.6-78.6%). The negative predictive value was 97.9% (range, 96.8%-98.9%), whereas the positive predictive value was 24.2% (range, 18.0%-30.3%) at a prevalence of 5.2%. Parental ratings identified more behavioral disorders (79.3%) than emotional disorders (59.2%). Screening for any disorder was somewhat less efficient: specificity, 88.9% (range, 87.0%-90.7%); sensitivity, 54.2% (range, 41.8%-66.6%); negative predictive value, 96.4% (range, 95.0%-97.8%); and positive predictive value, 25.9% (range, 19.6%-32.2%) at a prevalence of 6.7%. The area under the curve (AUC) value was 0.83 (range, 0.76-0.90) for emotional and behavioral disorders and 0.76 (range, 0.68-0.83) for any disorder. The prediction accuracy was not improved by impact scores or teacher information.
The results indicate that preschoolers' emotional and behavioral disorders can be screened with the same efficiency as those of older children and adults. Other disorders were identified to a lesser extent. Further research should explore the potential of preschool screening to improve early detection and subsequent intervention.
通过比较优势和困难问卷（Strengths and Difficulties Questionnaire，SDQ）的发现与诊断信息，来检验学龄前儿童精神病理学的筛查效率，并确定影响评分和教师信息的附加价值。
使用 2 阶段抽样设计，从挪威特隆赫姆的社区健康检查中招募了 845 名 4 岁的儿童，他们的筛查分数进行分层并对高分进行了过采样。在不了解筛查评分的情况下，使用 DSM-IV 诊断使用学龄前儿童精神评估访谈进行分配，并通过接受者操作特征分析将 SDQ 评分与诊断结果进行比较。
通过家长评定发现情绪和行为障碍的特异性为 88.8%（范围，87.0%-90.6%），敏感性为 65.1%（范围，51.6%-78.6%）。阴性预测值为 97.9%（范围，96.8%-98.9%），而阳性预测值为 24.2%（范围，18.0%-30.3%），患病率为 5.2%。父母的评定发现更多的行为障碍（79.3%）而不是情绪障碍（59.2%）。筛查任何障碍的效率都稍低：特异性为 88.9%（范围，87.0%-90.7%）；敏感性为 54.2%（范围，41.8%-66.6%）；阴性预测值为 96.4%（范围，95.0%-97.8%）；阳性预测值为 25.9%（范围，19.6%-32.2%），患病率为 6.7%。情绪和行为障碍的曲线下面积（AUC）值为 0.83（范围，0.76-0.90），任何障碍的 AUC 值为 0.76（范围，0.68-0.83）。影响评分或教师信息并不能提高预测准确性。
结果表明，学龄前儿童的情绪和行为障碍可以与年龄较大的儿童和成人一样高效地进行筛查。其他障碍的识别程度较低。进一步的研究应该探索学龄前筛查的潜力，以提高早期发现和随后的干预效果。
