Resea ch A icle
Cu ing a Long S o y Sho ? The Clinical Rele ance o Asking
Pa en s, Nu ses, and Young Child en Themsel es o Iden i y
Child en’s Men al Heal h P oblems by One o Two Ques ions
Anne-Ma i Bo g,1,2 Raili Salmelin,3Ma i Joukamaa,3,4 and Tuula Tamminen1,2
1Depa men o Child Psychia y, School o Medicine, Uni e si y o Tampe e, 33014 Tampe e, Finland
2Depa men o Child Psychia y, Tampe e Uni e si y Hospi al, PL 2000, 33521 Tampe e, Finland
3School o Heal h Sciences, Uni e si y o Tampe e, 33014 Tampe e, Finland
4Depa men o Psychia y, Tampe e Uni e si y Hospi al, PL 2000, 33521 Tampe e, Finland
Co espondence should be add essed o Anne-Ma i Bo g; anne-ma [email p o ec ed]
Recei ed 4 July 2014; Re ised 28 No embe 2014; Accep ed 7 Decembe 2014; Published 31 Decembe 2014
Academic Edi o : Vei Roessne
Copy igh © 2014 Anne-Ma i Bo g e al. This is an open access a icle dis ibu ed unde he C ea i e Commons A ibu ion
License, which pe mi s un es ic ed use, dis ibu ion, and ep oduc ion in any medium, p o ided he o iginal wo k is p ope ly
ci ed.
Backg ound and Aims. Assessing young child en’s men al heal h is a c ucial and challenging ask. The aim o he s udy was o
e alua e he clinical ele ance o asking pa en s, nu ses, and young child en hemsel es o iden i y child en’s men al heal h p oblems
by only one o wo ques ions. Me hods.In egula heal hcheck-upso 4- o9-yea -oldchild en(𝑛 = 2682), pa en s and public
heal h nu ses assessed by one ques ion whe he he child had any emo ional o beha io al di icul ies. The child comple ed a
sel -e alua ion enqui y on his/he emo ional well-being. A s a i ied p opo ion o he pa icipa ing pa en s we e in i ed o a
diagnos ic in e iew. Resul s. Sensi i i ies we e ai ly good o he pa en s’ (68%), nu ses’ (65%), and hei combined (79%) one-
ques ion sc eens. Di icul ies iden i ied by pa en s and nu ses we e majo isks (OR 10–14) o any child psychia ic diso de s
(𝑃 < 0.001). The child’s sel -e alua ion was ela ed o 2- old o 3- old isks (𝑃 < 0.05) o any psychia ic diagnosis, o any
emo ional diagnosis, and o nega i e si ua ional ac o s. Conclusion. The one-ques ion sc een o pa en s and public heal h nu ses
oge he qui e adequa ely iden i ied he young child en wi h men al heal h p oblems. The child’s sel -e alua ion p o ided ele an
and complemen a y in o ma ion on his/he men al heal h and especially emo ional p oblems.
1. In oduc ion
Assessing young child en’s men al heal h is a challenging ask
in p ima y se ices. Child en’s men al heal h p oblems a e
a global bu den [1,2] bu , in gene al, hei comp ehensi e
sc eeningiss illini sin ancy.I isnecessa y ode elopand
documen alida ed and app op ia e me hods o sc eening
o child en’s ea ly men al heal h p oblems.
The e a e many special challenges in e alua ing young
child en’s men al heal h. Fi s ly, i is impo an o ancho
he child’s socioemo ional and beha iou al p oblems wi hin
he con ex o he child’s de elopmen al le el [3]. F on line
wo ke s and pa en s may ind i di icul o iden i y he child’s
psychopa hology om he ypical cou se o psychosocial
de elopmen . Secondly, he well-being o he child is depen-
den on he /his amily suppo and i canno be e alua ed
in isola ion om he well-being o he amily. In addi ion
o pa en s’ epo s, in o ma ion on he child’s symp oms
and impai men in o he signi ican social en i onmen s is
needed [4]. Thi dly, in e p e a ion and in eg a ing all o he
mul i-in o man and mul ime hod da a is di icul and ime
consuming.
E e y in o man ’s e alua ions coun because no single
in o man ’s a ings can be used as “a gold s anda d” by
which o measu e psychopa hology in child en [5]. Disc ep-
ancies a e common in di e en in o man s’ a ings o child
psychopa hology [5]. Child en’s beha iou is known o be
con ex dependen and pa en s’ and eache s’ epo s a e
usually assessed. Howe e , young child en a e a ely asked o
sel -e alua e hei well-being.
S anda dized sel - epo ques ionnai es a e usually ali-
da ed o school-aged child en o e 11 yea s old [6–8]. Young
Hindawi Publishing Co po a ion
e Scien ific Wo ld Jou nal
Volume 2014, A icle ID 286939, 11 pages
h p://dx.doi.o g/10.1155/2014/286939
2The Scien i ic Wo ld Jou nal
child en’s abili y o p o ide eliable and use ul in o ma ion
on hei moods and eelings has been ques ioned. E idence
sugges s ha any ag eemen be ween he child’s and adul s’
epo s is s onge wi h espec o ex e nalizing han o
in e nalizing p oblems [4]. In addi ion, child en end o
epo mo e emo ional symp oms han do hei pa en s o
eache s [4,9–11]. I has ecen ly been concluded ha using
only pa en al epo s o assessing child en’s emo ions esul s
in an unde es ima ion o emo ional p oblems [11]. Thus i
seems necessa y o u he de elop and assess sel - epo
me hods also o young child en.
S anda dized sc eening ques ionnai es o child en’s
men al heal h p oblems ha e been de eloped and some o
hem a e well documen ed [6,12,13]. The numbe o sc een-
ing ools a ailable o assessing social-emo ional unc ioning
in he in an - oddle pe iod and in p eschool-aged child en
has also g own [3]. Howe e , s anda dized ques ionnai es a e
seldom used egula ly and comp ehensi ely in moni o ing
child en’s men al heal h [14,15]. Ins ead, asking o dina y
ques ionso “Howa eyou,howdoyou eel?”o “Doyou
ha e some di icul ies o conce ns?” seems o be he p e alen
p ac ices among heal h ca e p o essionals. Ye he e is li le
e idence on how eliable and alid such o dina y conce n
ques ions a e in iden i ying he child en a isk o men al
heal h p oblems.
Asking pa en s and eache s e y sho ly, by only one
o a ew ques ions, abou hei pe cep ions o he child’s
beha iou al and emo ional di icul ies has been p o en use ul
in ecognising he child en wi h men al heal h p oblems
[13,16,17]. Fo d e al. (2005) ha e ound high alues
o speci ici y and nega i e p edic i e powe o pa en al
conce ns e alua ed by ou ques ions, in sc eening child
psychia ic diso de s [16]. In ha s udy, abou hal o he
child en o whom he pa en s epo ed a leas one p oblem
had a psychia ic diso de . The S eng hs and Di icul ies
Ques ionnai e (SDQ) is a widely used sho ques ionnai e in
assessing child en’s men al heal h [12,13]. In he i s ques ion
on he SDQ impac supplemen , he esponden s a e asked o
e alua e whe he he child has di icul ies in one o mo e o
he ollowing a eas: emo ions, concen a ion, beha iou , o
beingable oge onwi ho he people[18]. No ably, his one
ques ion has disc imina ed be ween communi y and clinical
samples almos as well as he whole SDQ measu e, and i
has also p edic ed child psychia ic diagnosis qui e accu a ely
[13,17].
Sc eeningcos e ec i ely o ea lyp oblemsinla ge
g oups o child en necessi a es mul is age sc eening p oce-
du es [3]. In he p esen s udy, he ocus o in e es was on
de eloping and es ing as b ie , simple, and easy- o-use a
i s -s age sc eening assessmen ool as possible o iden i y
child en a ele a ed isk o men al heal h p oblems. The
speci ic aims o he p esen s udy we e
(1) o assess he eliabili y and alidi y o a one-ques ion
sc een p esen ed o pa en s and public heal h nu ses
in e e yday clinical p ac ice in iden i ying child en
su e ing om men al heal h p oblems,
(2) o assess he clinical ele ance o di ec ly asking a
young child o e alua e his/he emo ional well-being.
2. Me hods
2.1. S udy Design. The s udy was a pa o a p ojec
called “De eloping Child en’s Men al Heal h Wo k,2007–
2009,” conduc ed in wo hospi al dis ic s in Finland om
Ma ch 2008 o Ma ch 2009. Al oge he 154 child heal h clinics
and school heal h ca e clinics pa icipa ed in 25 municipal-
i ies. The espec i e local e hics commi ees app o ed he
s udy. In o med consen was ob ained om all pa icipa ing
pa en s.
Public heal h nu ses in oduced he s udy o pa en s
making appoin men s o hei 4−9-yea -old child en’s eg-
ula heal h check-up. P io o he isi o he clinic he
s udy in o ma ion and ques ionnai es we e sen o in e es ed
pa en s a home: an in o med consen o m and a sociode-
mog aphic ques ionnai e including a pa en ’s one-ques ion
sc een and S eng hs and Di icul ies Ques ionnai es (SDQ)
o bo h pa en s. The pa icipa ing pa en s also asked he
child’s eache in p eschool educa ion o a school o comple e
heSDQ.Thepa en s e u nedall hese o ms o hepublic
heal h nu se when a ending he check-up. The design and
sample o his phase o he s udy ha e been desc ibed in mo e
de ail elsewhe e [19].
Du ing he heal h check-up he child comple ed a sel -
e alua ion enqui y abou his/he well-being wi h he help o
he public heal h nu se. In addi ion, he public heal h nu ses
comple ed a nu se’s one-ques ion sc een o e e y child
ha ing a heal h check-up. A e he check-up isi a eedback
ques ionnai e on he easibili y o he child’s sel -e alua ion
enqui y was comple ed anonymously by he pa icipa ing
pa en s and once by each public heal h nu se in ol ed in he
p ocess.
A subg oup o he pa icipa ing pa en s was in i ed o a
De elopmen and Well-Being Assessmen (DAWBA) in e -
iew. The SDQs we e used o di ide he child en in o sc een-
posi i e (sco ing a o abo e he B i ish 80 h pe cen ile cu o ,
acco ding o any in o man ) and sc een-nega i e (sco ing
below he B i ish 80 h pe cen ile cu o , acco ding o e e y
in o man ) subg oups a e he check-up isi . E e y pa en o
a sc een-posi i e child was in i ed o he DAWBA in e iew.
Fo e e y wo sc een-posi i e cases (a he beginning o he
s udy o e e y such case) a pa en o a sc een-nega i e child,
ma ched o child’s age g oup and gende , was in i ed o he
DAWBA. Wi h he pa en ’s pe mission he child’s eache
was also asked o comple e DAWBA as a ques ionnai e. The
in e iew phase o he s udy has been desc ibed in mo e de ail
elsewhe e [20].
2.2. Sample. The sample consis ed o 4- o 6-yea -old
p eschoole s in child heal h clinics and 7- o 9-yea -old
child en in school heal h ca e. Families no speaking Finnish
we e excluded om he s udy. Al oge he 4,178 eligible chil-
d en (49.5% gi ls) and hei pa en s we e in i ed o pa icipa e
in he s udy, 3/5 o hem being p eschoole s (𝑛=2,596), he
es being school-aged (𝑛=1,582). The pa icipa ion a e in
he o al sample was 64.2% (𝑛=2,682).
The pa icipa ing pa en s illed in he pa en ’s one-
ques ion sc een in 98.9% o he cases. O he 2,682 pa ici-
pa ing child en 97.8% comple ed he sel -e alua ion enqui y.
The Scien i ic Wo ld Jou nal 3
Bo h o hese enqui ies we e a ailable o 96.8% (𝑛=2,595) o
he pa icipa ing child en. The public heal h nu ses e u ned
he nu se’s one-ques ion sc een o 99.3% o pa icipan s.
Al oge he 646 pa en al DAWBA in e iews we e a ail-
able. O hese pa icipan s 67% we e p eschool-aged and 66%
we e boys. A eache ’s epo was a ailable o 75% (𝑛 = 486)
o he DAWBA pa icipan s.
Fi y- i e pe cen o he pa icipa ing pa en s and 68%
o he public heal h nu ses in ol ed in he p ocess (154/225)
comple ed he eedback ques ionnai e on he easibili y o he
child’s sel -e alua ion enqui y.
2.3. Measu es. The SDQ is a sc eening ques ionnai e o 4- o
16-yea -olds o be comple ed by pa en s, eache s, and by 11-
o 16-yea -old child en hemsel es [7,12,13]. In his s udy he
Finnish e sion o he me hod, including bo h he symp om
ques ionnai e and he impac supplemen , was collec ed [18].
The SDQ symp om ques ionnai e consis s o 25 i ems
o ming i e subscales: emo ional symp oms, conduc p ob-
lems, hype ac i i y/ina en ion di icul ies, pee ela ionship
p oblems,andp osocialbeha iou .Thei emsa esco edas
1 o “somewha ue” and, depending on he i em, as 0 o 2
o “no ue” o “ce ainly ue” and o analysis hey we e
ecoded as 0 o 2 o inc easing se e i y. The sco es om all
he subscales excep o he p osocial scale a e summed o a
o al di icul ies sco e in he ange 0–40. Goodman [7]has
p oposed he 80 h and 90 h pe cen iles as p o isional cu o s
o “bo de line” and “abno mal.”
The i s ques ion on he pa en and eache e sion o
he SDQ impac supplemen asks, “O e all, do you hink ha
you child/ his child has di icul ies in one o mo e o he
ollowing a eas: emo ions, concen a ion, beha iou o being
able o ge on wi h o he people?” The answe ing al e na i es
a e No, Yes—mino di icul ies, Yes—de ini e di icul ies, and
Yes—se e e di icul ies. The es o he impac supplemen
ques ions enqui e, i di icul ies a e epo ed, abou he
du a ion o ch onici y o he di icul ies, o e all dis ess,
social impai men , and bu den o o he s. The i s ques ion
wasusedin heanalyseso hep esen s udy.O he wise, he
eliabili y and alidi y p ope ies o he ex ended e sion o
he SDQ in he sample o Finnish 4–9-yea -old child en ha e
been ep esen ed elsewhe e [19,20].
In hepa en ’sone-ques ionsc een,pa en swe easked
o assess whe he hei child had any emo ional p oblems o
any di icul ies in beha iou , concen a ion, o social skills.
The enqui y was answe ed on a ou -s ep scale (no di icul ies,
no many di icul ies, qui e many di icul ies, and e y many
di icul ies). The enqui y was sligh ly modi ied om he i s
ques ion on he pa en ’s SDQ impac supplemen .
In he nu se’s one-ques ion sc een, public heal h nu ses
assessed, based on clinical e alua ion, whe he he child had,
o e all, di icul ies in one o mo e o he ollowing a eas:
emo ions, beha iou , concen a ion, o being able o ge on
wi h o he people. This was consis en wi h he i s ques ion
in he pa en ’s and eache ’s SDQ impac supplemen . The
enqui y was answe ed on a i e-s ep scale (no, yes/mino
di icul ies, yes/de ini e di icul ies, yes/se e e di icul ies, and
canno say). The las answe ing op ion was added o he
o iginal al e na i es o he abo emen ioned ques ion on he
SDQ.
The child’s sel -e alua ion enqui y on emo ional well-being
was de eloped o his s udy and consis ed o wo ques ions;
see Figu e 1. The w i en esponse al e na i es had isual
analogues in he o m o acial exp essions. The public heal h
nu se ead he ques ions and esponse al e na i es o he child
e eni he/shecould ead.Thechildchoseandma kedwi ha
c oss he answe bes desc ibing his/he eelings.
The DAWBA me hod [21] consis s o a semis uc u ed
in e iew, which can be adminis e ed o he pa en s o
child en aged 5 o 17 and o child en o e 11 yea s hemsel es;
he e is also a b ie e ques ionnai e e sion o eache s. The
s uc u ed ques ions co e mos child psychia ic diso de s
and closely ollow he diagnos ic c i e ia acco ding o he
ICD-10 and DSM-IV. I de ini e symp oms a e iden i ied,
pa en s a e asked o desc ibe he p oblems in mo e de ail.
Acco ding o he esponses o all a ailable in o man s
on he s uc u ed ques ions, he DAWBA p og am assigns
each child o a le el o an o dinal-scale measu e which
ep esen s he p e alence o any diagnosis in epidemiological
samples [22]. The ca ego iza ion o his p edic i e measu e
o e ed o he clinical a e is <1% ( e y low), <5% (low),
≥20% (mode a e), and ≥75% (high) [23]. To decide on
de ini i e diagnoses a clinical a e hen e iews all ele an
in o ma ion: he s uc u ed, closed, and open accoun s o
all a ailable in o man s and he compu e -p edic ed le el o
p e alence o any diagnosis.
The i s au ho e iewed all he in e iews and assigned
he diagnoses acco ding o ICD-10. The diagnoses we e
placed in i e ca ego ies: emo ional, conduc , hype ac i i y,
and o he diagnoses (Tic/Tou e e, pe asi e de elopmen al
diso de s, and no o he wise speci ied men al diso de s)
and si ua ional ac o s (Z61 p oblems ela ed o nega i e
li e e en s in childhood, Z62 o he p oblems ela ed o
upb inging, and Z63 o he p oblems ela ed o p ima y sup-
po g oup, including amily ci cums ances). The a e was
ained by p ac ising wi h he cases in he aining manual
[23] and pa icipa ing in a wo-day aining cou se. When
he diagnoses we e unce ain, a consensus diagnosis was
ob ained by a consul a ion g oup o ou expe ienced child
psychia is s. The equency o diagnoses se by he a e was
compa ed wi h he compu e -p edic ed le el o p e alence
o any diagnosis. The associa ions we e s a is ically highly
signi ican (𝑃 < 0.001) be ween all pai s o he ollowing
g oups: in he low p e alence g oup (<5%) 3% o he child en
we eassigned odiagnoses,in hemode a ep e alenceg oup
(≥20%) 38%, and in he high p e alence g oup (≥75%) 93%
o he child en.
In he eedback ques ionnai e on he easibili y o he
child’s sel -e alua ion enqui y, pa en s and public heal h
nu seswe easkedhowapp op ia e hisme hodwasinassess-
ing he psychosocial well-being o he child ( e y good/ ai ly
good/no good, no poo / a he poo / e y poo ). In addi ion,
hepublicheal hnu seswe easked o epo howlong,on
a e age, o he nea es i e minu es, i ook o comple e he
child’s sel -e alua ion enqui y and how bu densome hey
ound i (no a all/no e y/ a he / e y bu densome).
4The Scien i ic Wo ld Jou nal
Child’s sel -e alua ion enqui y on emo ional well-being
How a e you?
Please choose he pic u e ha bes desc ibes you li e and eelings. Then ma k he answe wi h a c oss (X)
abo e he pic u e you ha e chosen.
(1) I almos always
eel sad o
mise able.
(2) I o en eel sad o
mise able.
(3) I ha e equally
many happy and
mise able momen s.
(4) I am qui e o en
happy and in a good
mood.
(5) I am e y o en
happy and in a good
mood.
Wha do you expec o you nea u u e? Wha will you li e be like?
Please choose he pic u e ha bes desc ibes how you eel. Then ma k he answe wi h a c oss (X) abo e he
pic u e you ha e chosen.
(1) I hink my u u e
will be e y nice
and happy.
(2) I hink my u u e
will be ai ly nice
and happy.
(3) I don’ eally
wo y abou u u e.
(4) I suspec ha
some bad hings a e
going o happen o
me.
(5) I suspec ha
many bad hings a e
going o happen o
me.
Thank you o you answe s!
Figu e 1: Child’s sel -e alua ion enqui y on emo ional well-being.
2.4. S a is ical Analyses. The dis ibu ions o he mul ica e-
go y pa en ’s and nu se’s one-ques ion sc eens and he child’s
sel -e alua ion ques ions a e exp essed as pe cen ages, and
c oss-in o man ag eemen s be ween hem we e examined
wi h he 𝛾coe icien . Because o he equi emen s o u he
analysis (examina ion o alidi y p ope ies and logis ic
eg essions) hese ques ions we e dicho omised in such a
way ha he uppe ca ego y would include child en wi h he
s onges conce ns and s ill be la ge enough o he analysis
(see Table 1). Consequen ly, he ca ego ies we e as ollows: he
pa en ’s one-ques ion sc een, no/no many di icul ies e sus
qui e many/ e y many di icul ies; he nu se’s one-ques ion
sc een, no/mino di icul ies e sus de ini e/se e e di icul-
ies; he i s ques ion o he child’s sel -e alua ion enqui y
(Howa eyou?), e y/qui eo enhappy/asmanyhappyas
mise able momen s e sus o en/almos always sad; and he
second ques ion (Wha do you expec ?), e y/ ai ly nice and
happy u u e, do no eally wo y e sus some bad/many bad
hings a e going o happen o me. Fu he mo e, he answe s
o he wo child’s sel -e alua ion ques ions we e combined as
posi i e in bo h ques ions e sus o he combina ions.
The DAWBA compu e -p edic ed le el o any child
psychia ic diagnosis, dicho omised, acco ding o he same
p inciples as abo e, as <75% e sus ≥75% (high p e alence
le el), was used as he gold s anda d in assessing he alidi y
p ope ies (sensi i i y, speci ici y, and posi i e and nega i e
p edic i e alues [PPV, NPV]) o he abo emen ioned one-
ques ion sc een o he pa en , nu se, and child. All ele an
wo- a iable analyses we e conduc ed by compa ing bo h age
and gende g oups o s a i ying by hem.
The DAWBA a iable and he exis ence o any o selec ed
speci ic diagnoses assigned by he a e we e, one a a ime,
used as ou come a iables in a se o logis ic eg ession
analyses. In he i s se he only explana o y a iable was
one o he one-ques ion sc een a iables (pa en , nu se, and
child) a a ime, and he en e -me hod used hus p oduced
unadjus ed odds a ios (OR) o hem. In he second se
o logis ic eg ession analyses, he explana o y a iables
comp ised all one-ques ion sc eens, gende , age g oup, and
hei in e ac ion. To de e mine he s onges ac o s a ec ing
he espec i e ou come a iable, backwa ds s epwise me hod
was used.
𝑃 alues <0.05 a e conside ed o show s a is ical signi -
icance. The s a is ical analyses we e accomplished wi h SPSS
. 19.
The Scien i ic Wo ld Jou nal 5
Table 1: Dis ibu ions o answe s in he pa en s’ and nu ses’ one-ques ion sc een and child’s sel -e alua ion in a communi y sample o Finnish 4–9-yea -old child en.
To al sample 𝜒2P eschoole s School-aged child en 𝜒2
All Boys Gi ls d 1All Boys Gi ls All Boys Gi ls d 1
%%%𝑃2%%%%%%𝑃3
Pa en ’s one-ques ion sc een (𝑛=2652) (𝑛= 1295) (𝑛= 1357) 80.79 (𝑛= 1757) (𝑛=867) (𝑛=890) (𝑛=895) (𝑛=428) (𝑛= 467) 13.88
No di icul ies 47.0 38.7 55.0 2 46.3 38.2 51.2 48.5 39.7 56.5 2
No many di icul ies 46.6 52.4 41.0 <0.001 48.4 54.4 42.6 43.0 48.4 30.1 0.001
Qui e many/ e y many di icul ies 6.4 8.9 4.0 5.3 7.4 3.3 8.5 11.9 5.4
Nu se’s one-ques ion sc een4(𝑛=2602) (𝑛=1269) (𝑛= 1333) 81.73 (𝑛=1722) (𝑛=847) (𝑛=875) (𝑛=880) (𝑛=422) (𝑛=458) 0.37
No di icul ies 75.5 67.8 82.8 2 75.2 68.5 81.7 76.1 66.6 84.9 2
Yes—mino di icul ies 17.7 22.5 13.1 <0.001 18.0 22.1 14.1 17.0 23.2 11.4 ns.
Yes—de ini e/se e e di icul ies 6.8 9.7 4.1 6.8 9.4 4.2 6.8 10.2 3.7
Child’s sel -e alua ion
How a e you? (𝑛=2623) (𝑛=1287) (𝑛= 1336) 22.86 (𝑛=1739) (𝑛=860) (𝑛=879) (𝑛=884) (𝑛=427) (𝑛= 457) 446.33
Ve y o en happy 54.0 51.4 56.4 3 68.0 66.3 69.6 26.5 21.5 31.1 3
Qui e o en happy 28.9 28.0 29.7 <0.001 18.5 17.1 19.8 49.3 49.9 48.8 <0.001
Equally many happy and lousy momen s 15.1 17.7 12.5 10.9 13.0 8.9 23.2 27.2 19.5
O en/almos always sad 2.1 2.9 1.3 2.6 3.6 1.7 1.0 1.4 0.7
Wha do you expec o you nea u u e? (𝑛=2620) (𝑛=1284) (𝑛= 1336) 10.16 (𝑛=1737) (𝑛=858) (𝑛= 879) (𝑛=883) (𝑛=426) (𝑛= 457) 115.01
Ve y nice and happy days 50.1 48.5 51.6 3 55.8 55.4 56.3 38.8 34.7 42.7 3
Qui e nice and happy days 29.4 28.8 30.0 <0.017 23.0 22.3 23.8 42.0 42.0 42.0 <0.001
No bo he ing 15.7 18.0 13.5 15.4 17.0 13.9 16.2 20.0 12.7
Some/many bad hings a e going o happen 4.8 4.7 4.9 5.7 5.4 6.0 2.9 3.3 2.6
1d : deg ees o eedom.
2Tes ed be ween gende s.
3Tes ed be ween age g oups.
4Answe ing al e na i es “do no know” and “canno say” ex ac ed om analyses (𝑛=80).

6The Scien i ic Wo ld Jou nal
3. Resul s
3.1. Dis ibu ions o Pa en s’ and Nu ses’ Pe cep ions and
Child en’s Sel -E alua ions. Table 1 shows he dis ibu ions o
pa en s’ and nu ses’ pe cep ions o he child’s di icul ies and
child en’s sel -e alua ions in he o al sample, s a i ied by
gende andageg oups.Six ose enpe cen o hechild en
we ee alua edbybo h hepa en sand hepublicheal h
nu ses o ha e de ini e o se e e di icul ies. Acco ding o
bo h se s o in o man s’ epo s he p opo ion o boys ha ing
such di icul ies was a leas wice ha o gi ls (𝑃 < 0.001)in
he o al sample and in bo h age g oups. In addi ion, in pa -
en ’s e alua ions, he school-aged child en we e e alua ed o
ha e mo e commonly di icul ies (8.5%) han he p eschool-
aged child en (5.3%). The public heal h nu ses could no say
o did no know abou he child’s si ua ion in 3.0% (𝑛=80)
o he cases.
O he child en 2.1% e alua ed hemsel es as eeling o en
o almos always sad o mise able (Table 1). Boys epo ed
such nega i e eelings wice as commonly as gi ls (𝑃<
0.001). Boys also epo ed mo e commonly han gi ls ha ing
“as many happy and mise able momen s.” In he second
ques ion, 4.8% o child en expec ed some o many bad hings
o happen. Younge child en epo ed mo e commonly han
olde child en nega i e eelings and u u e expec a ions.
C oss-in o man ag eemen be ween he pa en s’ and
nu ses’ pe cep ions was ai ly good (𝛾= 0.73) in he o al
sample. The ag eemen s be ween child’s sel -e alua ion and
adul s’ e alua ions we e e y low (child-pa en 𝛾=0.10and
child-nu se 𝛾=0.15).
The ag eemen be ween he pa en - a ed one-ques ion
sc een and he i s ques ion on he SDQ impac supplemen
was 𝛾=0.92.
3.2. Validi y o he One-Ques ion Sc een agains he Diagnos ic
Assessmen . The sensi i i y o he dicho omized pa en ’s and
nu se’s one-ques ion sc een agains he DAWBA compu e -
p edic ed high p e alence le el o any diagnosis was ai ly
good (68% and 65%, esp., Table 2). The espec i e speci ici-
ies we e high (87-88%). PPVs we e low and NPVs high. The
sensi i i y and PPV o he child’s sel -e alua ion enqui ies
we e e y low (7–26%) and he speci ici y and NPV high (89–
98%).
The sensi i i ies o he adul in o man s’ pe cep ions we e
conside ably highe and he speci ici ies somewha lowe o
boys han o gi ls (Table 2). In addi ion, he sensi i i ies
we e highe o olde han o younge child en. The e we e
no di e ences in he alues be ween he gende s ega ding
he child’s sel -e alua ion ques ions excep in he second
ques ion, whe e he sensi i i y o gi ls was highe han o
boys(18% e sus6%).ThePPVandNPVo henu se’sone-
ques ion sc een and he child’s sel -e alua ion ques ions we e
lowe o boys han o gi ls, con a y o he esul s o he
pa en ’s esponses.
Combining wo o h ee o he in o man s’ epo s p o-
duced highe sensi i i y han any o he espec i e single
in o man s’ epo s. In he o al sample, he sensi i i y o he
combined child’s sel -e alua ion was 14% and he speci ici y
was 93%. The sensi i i y o bo h he combina ion o he
pa en ’s and nu se’s pe cep ions and ha o combining all
h ee in o man s’ epo s was 79%, he espec i e speci ici ies
being 80% and 75%.
3.3. Risks o Child Psychia ic Diso de s Rela ed o he One-
Ques ion Sc eens. I pa en s o nu ses iden i ied di icul ies
he odds a ios o any and selec ed speci ic child psychia ic
diso de s we e all s a is ically highly signi ican (𝑃 < 0.001,
Table 3). The highes odds a io (OR) ela ed o di icul ies
iden i ied by pa en s was ha o a DAWBA compu e -
p edic ed high p e alence le el (≥75%) o a child psychia ic
diagnosis (OR 14.4), and he lowes (OR 4.5) was ha o an
emo ional diagnosis. Nu se’s assessmen o de ini e o se e e
di icul ies was mos s ongly associa ed wi h a hype ac i i y
diagnosis (OR 34.4) and leas s ongly wi h an emo ional
diagnosis (OR 4.0).
The nega i e a ing in he combined child’s sel -
e alua ion was s a is ically signi ican ly (𝑃 < 0.05)associa ed
wi h a DAWBA compu e -p edic ed high p e alence le el
o any diagnosis (OR 2.2), wi h any DAWBA- a e assigned
diagnosis (OR 2.4), wi h any emo ional diagnosis (OR 3.0),
and wi h nega i e si ua ional ac o s (OR 3.2).
Examining he e ec s o he e alua ions o all h ee
in o man s simul aneously by backwa ds s epwise logis ic
eg ession e ealed ha he di icul ies iden i ied by pa en s
and nu ses emained he s onges and signi ican isk ac o s
o allchildou comes(OR2.7–7.1),excep inp edic inga
hype ac i i y diagnosis, whe e only di icul ies iden i ied by
he nu ses emained s a is ically signi ican (OR 20.9); see
Table 4. The child’s sel -e alua ion emained a s a is ically
signi ican isk ac o o any emo ional diagnosis (OR 2.7)
and o nega i e si ua ional ac o s (OR 2.9). Gi ls had highe
isk han boys o any emo ional diagnosis (OR 2.3) and
school-aged child en had highe isk han p eschoole s o
any assigned diagnoses (OR 1.8).
3.4. Feedback on he Child’s Sel -E alua ion Enqui y. The
child’s sel -e alua ion enqui y was conside ed o be e y o
ai ly age-app op ia e o assessing he child’s psychosocial
well-being by 63% o he pa en s and by 71% o he public
heal h nu ses in he o al sample. Eigh pe cen o he
pa en sand9%o hepublicheal hnu sese alua ed he
app op ia eness o he enqui y o be a he o e y poo .
Fou een pe cen o he pa en s had no opinion on he
subjec .
Mos (96%) public heal h nu ses ound he wo ques ions
no e y o no a all bu densome. Almos all (99%) he public
heal h nu ses comple ed he enqui y wi h he child en in 10
minu es o less.
4. Discussion
The main esul s o he s udy sugges ed ha he one-ques ion
sc een p esen ed o pa en s and public heal h nu ses o e s
a alid and clinically ele an guide in iden i ying child en
su e ing om men al heal h p oblems. I is also use ul o hea
he young child’s own pe spec i e when ying o iden i y
child en a high isk, especially o emo ional p oblems.
The Scien i ic Wo ld Jou nal 7
Table 2: Sensi i i y, speci ici y, and posi i e (PPV) and nega i e (NPV) p edic i e alues o he pa en ’s and nu se’s one-ques ion sc een and child’s sel -e alua ion ques ions (no o mild
conce ns/p oblems e sus mo e se e e op ions) calcula ed agains he DAWBA compu e -p edic ed p e alence le el o any diagnosis (<75% e sus ≥75%) in a sample o Finnish 4–9-yea -old
child en.
High p e alence le el o diagnosis
To al sample Boys Gi ls P eschoole s School-aged child en
Sens1Spec2PPV3NPV4Sens1Spec2PPV3NPV4Sens1Spec2PPV3NPV4Sens1Spec2PPV3NPV4Sens1Spec2PPV3NPV4
%%%%%%%%%%%%%%%%%%%%
Pa en ’s one-ques ion
sc een
(𝑛=637) (𝑛=423) (𝑛=214) (𝑛=424) (𝑛=213)
68 87 41 95 73 86 45 96 50 89 30 95 70 90 44 96 65 82 39 93
Nu se’s one-ques ion sc een (𝑛=622) (𝑛= 411) (𝑛= 211) (𝑛=414) (𝑛=208)
65 88 41 95 69 85 42 95 56 92 40 96 72 88 42 97 55 87 40 92
Child’s sel -e alua ion
How a e you? (𝑛=629) (𝑛=418) (𝑛= 211) (𝑛=418) (𝑛= 211)
7 98 26 89 8 97 25 88 6 99 33 92 10 97 29 91 3 98 20 86
Wha do you expec o
you nea u u e?
(𝑛=628) (𝑛=417) (𝑛= 211) (𝑛=418) (𝑛=210)
9 94 16 89 6 95 14 87 18 93 19 93 10 94 15 91 7 96 20 86
Combined Child’s
sel -e alua ion
(𝑛=629) (𝑛=418) (𝑛= 211) (𝑛=418) (𝑛= 211)
14 93 20 90 13 93 21 88 18 93 19 93 18 92 19 91 10 95 23 86
Combined pa en ’s and
nu se’s one-ques ion sc een
(𝑛=613) (𝑛=405) (𝑛=208) (𝑛=407) (𝑛=206)
79 80 34 97 85 77 36 97 61 84 27 96 84 82 35 98 72 75 32 94
1Sensi i i y; 2speci ici y; 3posi i e p edic i e alue; 4nega i e p edic i e alue.
8The Scien i ic Wo ld Jou nal
Table 3: The odds a ios (OR) o child ou comes ela ed o pa en ’s and nu se’s e alua ion o he child’s di icul ies and child’s sel -e alua ion
o emo ional well-being acco ding o DAWBA assessmen in a sample o Finnish 4–9-yea -old child en (𝑛=646).TheORo eachsepa a e
e alua ion (no o mild di icul ies/conce ns e sus mo e se e e op ions) o each ou come measu e is shown.
Compu e -p edic ed
p e alence1
Ra e -assigned child psychia ic ICD-10 diagnosis
Any Emo ional Conduc Hype ac i i y O he 2Si ua ional
ac o s3
OR
(95% CI)
OR
(95% CI)
OR
(95% CI)
OR
(95% CI)
OR
(95% CI)
OR
(95% CI)
OR
(95% CI)
Pa en ’s conce n enqui y 14.4∗∗
(8.4–24.9)
9.9∗∗
(6.3–15.6)
4.5∗∗
(2.6–19.2)
9.9∗∗
(5.1–18.9)
8.1∗∗
(3.9–16.8)
9.7∗∗
(4.0–23.2)
7.3 ∗∗
(3.8–14.0)
Nu se’s conce n enqui y 13.6∗∗
(7.8–23.5)
12.4∗∗
(7.8–19.7)
4.0∗∗
(2.2–7.1)
10.0∗∗
(5.2–19.3)
34.3∗∗
(12.9–91.1)
5.8∗∗
(2.5–13.3)
8.2∗∗
(4.2–16.0)
Child’s sel -e alua ion
( wo ques ions combined)
2.2∗
(1.1–4.7)
2.4∗
(1.3–4.5)
3.0∗
(1.4–6.5)
2.0
(0.85–5.0)
1.2
(0.4–4.2)
1.1
(0.3–5.0)
3.2∗
(1.4–7.5)
1P e alence le el <75%/≥75%.
2Tic/Tou e e, pe asi e de elopmen al diso de s, and no o he wise speci ied men al diso de s.
3Fac o s in luencing heal h s a us and con ac wi h heal h se ices (ICD-10): Z61 p oblems ela ed o nega i e li e e en s in childhood, Z62 o he p oblems
ela ed o upb inging, and Z63 o he p oblems ela ed o p ima y suppo g oup, including amily ci cums ances.
∗𝑃<0.05.
∗∗𝑃<0.001.
Table 4: The odds a ios (OR) o child ou comes ela ed o he combined e ec s o he pa en ’s and nu se’s one-ques ion sc een and he
child’s sel -e alua ion o emo ional well-being as well as child’s gende and age g oup. The OR o he a iables emaining in he model a he
las s ep o each backwa ds s epwise logis ic eg ession a e shown.
Va iables en e ed in o each
model
Compu e -p edic ed
p e alence1
(𝑛=68)
Ra e -assigned child psychia ic ICD-10 diagnosis
Any
(𝑛=117)
Emo ional
(𝑛=53)
Conduc
(𝑛=41)
Hype ac i i y
(𝑛=32)
O he 2
(𝑛=23)
Si ua ional
ac o s3
(𝑛=38)
OR
(95% CI)
OR
(95% CI)
OR
(95% CI)
OR
(95% CI)
OR
(95% CI)
OR
(95% CI)
OR
(95% CI)
Pa en ’s one-ques ion sc een46.7∗∗
(3.6–12.7)
4.3∗∗
(2.5–7.4)
2.7∗
(1.3–5.5)
4.4∗
(2.0–9.6)
2.1
(0.9–5.1)
4.7∗
(1.7–13.0)
4.0∗
(1.8–8.9)
Nu se’s one-ques ion sc een46.6∗∗
(3.5–12.5)
7.1 ∗∗
(4.1–12.1)
2.9∗
(1.4–5.9)
4.9∗∗
(2.3–10.7)
20.9∗∗
(7.2–60.4)
3.1∗
(1.1–8.4)
3.5∗
(1.6–7.7)
Child’s sel -e alua ion4
(combined)
2.1
(1.0–4.6)
2.7∗
(1.2–6.2)
2.9∗
(1.1–7.4)
Child’s gende 52.3∗
(1.3–4.3)
0.4
(0.1–1.1)
Child’s age61.8∗
(1.1–2.9)
2.5
(1.0–6.2)
Gende ∗age —7—7
1P e alence le el <75%/≥75%.
2Tic/Tou e e, pe asi e de elopmen al diso de s, and no o he wise speci ied men al diso de s.
3Fac o s in luencing heal h s a us and con ac wi h heal h se ices (ICD-10): Z61 p oblems ela ed o nega i e li e e en s in childhood, Z62 o he p oblems
ela ed o upb inging, and Z63 o he p oblems ela ed o p ima y suppo g oup, including amily ci cums ances.
4No o mild di icul ies/conce ns e sus mo e se e e op ions.
5Gi ls e sus boys.
6School-aged e sus p eschool child en.
7The a iable emained in he model bu OR could no be compu ed because he e we e oo ew cases in some o he subg oups.
∗𝑃<0.05.
∗∗𝑃<0.001.
O he child en ha ing egula heal h check-ups 6-7%
we e e alua ed by he pa en s o he public heal h nu ses in
his s udy o ha e de ini e o se e e di icul ies. In a B i ish
epidemiological sample 9.5% o pa en s epo ed conce ns
abou hei child’s emo ions, beha iou , o ac i i y le el
[24]. The p esen inding compa es closely wi h ea lie 5–
24% equencies o psychia ic symp oms o diso de s in
popula ion samples o young child en [20,25–28]. As in
some ea lie s udies boys we e mo e commonly han gi ls
epo ed o ha e di icul ies [25,28,29] o any diso de [28].
The Scien i ic Wo ld Jou nal 9
The p esen inding ha olde child en had mo e pa en -
a ed di icul ies han younge child en should be conside ed
p elimina y. The ea lie indings on di e ences be ween he
sco e dis ibu ions spli by compa able age g oups ha e been
inconsis en acco ding o he compu e ised mul icul u al
no ms o he SDQ [18].
In he p esen s udy only 2% o child en e alua ed
hemsel es as eeling o en o almos always sad o mise able.
The child’s sel - epo ed equency o emo ional p oblems in
hiss udywaslowe haninea lie s udieswi h alida ed
assessmen me hods [30,31]. Recen ly, 12–16% o Belgian
5- o 10-yea -old child en epo ed emo ional p oblems,
such as ange , anxie y, and sadness, in a sho sel - epo
ques ionnai e [11]. Fu he s udies a e needed on young
child en’s sel - epo ed equencies o emo ional p oblems in
communi y and clinic samples.
The c oss-in o man ag eemen be ween he pa en ’s
and public heal h nu se’s pe cep ions was ai ly good bu
he ag eemen s be ween child’s sel -e alua ion and adul s’
e alua ions we e e y low. In he p esen s udy, i was no
ou pu pose o compa e he child’s and he adul s’ epo s
because adul in o man s answe ed a simila ques ion on
o e all di icul ies whe eas he child’s ques ions ocused on
his/he emo ional well-being and expec a ions. Howe e ,
he weak co ela ion be ween he pa en ’s and he child’s
e alua ions was in conco dance wi h ea lie s udies [4,10,
11]. As expec ed, he ag eemen be ween he pa en ’s one-
ques ion sc een and he i s ques ion on he SDQ impac
supplemen was high. The p esen one-ques ion sc een was
only sligh ly modi ied om he o iginal abo emen ioned
ques ion on he SDQ.
The single ques ion o he pa en and public heal h nu se
had an adequa e capaci y o disc imina e be ween he low-
isk and high- isk child en in he sample. The child’s sel -
e alua ion, howe e , was no sensi i e o iden i ying high-
isk child en. The one-ques ion sc een o he pa en and
public heal h nu se de ec ed wo- hi ds o he child en wi h
a psychia ic diso de and he speci ici y, he p opo ion o
ue nega i es, o he adul s’ e alua ions was high. O he
child en iden i ied as ha ing di icul ies, 41% had a compu e -
p edic ed DAWBA diagnosis and o hose child en iden i ied
as ha ing no di icul ies only 5% had a espec i e diagnosis.
Thus he pa en ’s and public heal h nu se’s pe cep ions o
di icul ies we e ound o be ai ly good and e alua ions o
no conce n abou he child’s si ua ion we e qui e accu a e.
The p esen alues o sensi i i y and speci ici y o he
one-ques ion sc een o pa en s concu closely wi h ea lie
esul s on he alidi y alues o sc eening ques ionnai es
[6,12,32]. We eplica ed he ea lie inding ha a single
ques ion on whe he he child has emo ional o beha iou al
di icul ies disc imina es almos as well as a whole ques ion-
nai e comp ising many i ems be ween low- isk and high-
isk child en [13]. Fu he in o ma ion was also gained on
he e ec o combining wo o h ee di e en in o man s’
answe s, which was ound o p oduce highe sensi i i y
aluescompa ed oasinglein o man ’s epo .Thepa en s
and nu ses oge he iden i ied ou - i hs o he child en wi h
a psychia ic diagnosis. Ob iously, he combined pa en ’s and
publicheal hnu se’sone-ques ionsc eenseemed obeagood
indica ion o a mo e comp ehensi e e alua ion o he child’s
men al heal h.
Di icul ies iden i ied by pa en s and nu ses we e ound o
be s ong and s a is ically signi ican isk ac o s o any child
psychia ic diso de s. The highes odds a io o pa en al
pe cep ion o di icul ies was ound o any child psychia ic
diagnosis (OR 14.4) and o public heal h nu se’s espec i e
pe cep ion o a hype ac i i y diagnosis (OR 34.4). Bo h
in o man s’ conce ns had he lowes OR o an emo ional
diagnosis, being s ill a ou old o i e old isk. Di icul ies
iden i ied by pa en s and nu ses emained he s onges
isk ac o s o mos o he child’s ou comes when all he
p edic o s, including child’s age and gende , we e aken in o
accoun . The p esen s ong associa ion be ween di icul ies
iden i ied by pa en s and a child’s psychia ic diagnosis is
compa able o he ea lie inding o a s ong associa ion (OR
16) be ween high sco es on he SDQ pa en epo and a
child psychia ic diso de [12]. The p esen esul s sugges
ha he one-ques ion sc een o pa en s and public heal h
nu ses yields alida ed and supplemen a y in o ma ion on
he child’s isks o men al diso de s.
When he young child en epo ed low mood o neg-
a i e expec a ions his was ela ed (𝑃 < 0.05) o ele a ed
isks o a psychia ic diso de , emo ional diso de s, and
nega i e si ua ional ac o s in he amily. When aking all
he isk ac o s in o accoun , he child’s sel -e alua ion
emained as a s a is ically signi ican h ee old isk o any
emo ional diagnosis and o nega i e si ua ional ac o s. Fo
an emo ional diagnosis gi ls we e ound o ha e a wo old
isk compa ed o boys. Olde child en had a wo old isk
o any assigned diagnoses compa ed o younge child en.
The p esen indings con i med ha he young child’s sel -
e alua ion yields ele an and complemen a y in o ma ion
on he child’s emo ional well-being om he child’s inne
pe spec i e.
Al hough he sc eening p ope ies o he one-ques ion
sc een we e qui e adequa e, one- i h o he child en wi h a
child psychia ic diso de we e no iden i ied by hei pa en s
o public heal h nu ses. The clinicians should emembe ha
e en i hey use a s anda dized sc eening me hod he e will
emain a p opo ion o hese “ alse nega i e” child en. I is
a special challenge o y o iden i y hese child en in need
o psychosocial suppo . In addi ion, wha e e sc eening
me hodwasusedi needs obeadminis e edsys ema ically
in o de o p oduce eliable esul s.
Se e al limi a ions should be no ed in he s udy. The
child’s sel -e alua ion enqui y had no been es ed be o e,
and he e o e u he s udies a e needed on he psychome ic
sc eening p ope ies o simila b ie sc eening assessmen s
o child en. Possible e ec s o he mode a e pa icipa ion
a esin he i s phaseandin hein e iewphaseo hes udy
as well as limi a ions ela ed o diagnos ic p ocedu es ha e
been discussed elsewhe e [19,20].
The s eng hs o he s udy we e he mul i-in o man
app oach and he la ge sample o young child en. The s udy
was conduc ed in an e e yday clinical se ing o child en’s
egula heal h check-ups, hus imp o ing he usabili y o he
esul s. The disc imina i e alidi y p ope ies o he single
ques ions we e assessed agains a diagnos ic assessmen as