Cutting a long story short? The clinical relevance of asking parents, nurses, and young children themselves to identify children's mental health problems by one or two questions

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