Research Article

iMedPub Journals 2017

ACTA PSYCHOPATHOLOGICA
http://www.imedpub.com ISSN 2469-6676 Vol. 3 No. 1: 4

DOI: 10.4172/2469-6676.100076

Factor Structure of the Urdu Version of the Cecilia A Essau1*,

Farah Qadir2,
Strengths and Difficulties Questionnaire in Aneela Maqsood2,
Pakistani Adolescents Najam us-Sahar2,
Nadia Bukhtawer2,
Bilge Uzun Ozer3,
Abstract Regina Pauli1 and
Catherine Gilvarry1
The Strengths and Difficulties Questionnaire (SDQ) is a widely used brief screening
measure for general difficulties and positive attributes in children and adolescents. 1 Department of Psychology, University of
The main aim of this study was to examine the psychometric properties and factor Roehampton University, London SW15
structure of the Urdu translated version of the SDQ (SDQ-U) among Pakistani 5PU, UK
adolescents. A total of 1277 adolescents (708 boys and 569 girls), aged 13-17 2 Fatima Jinnah Women University,
years, participated in the study. The adolescents were recruited from 13 schools Rawalpindi 46000, Pakistan
in Rawalpindi, Pakistan. In addition to the SDQ, the adolescents completed the 3 Bahcesehir University, 34349 Beşiktaş/
Spence Children’s Anxiety Scale (SCAS). The internal consistency of the SDQ-U total İstanbul, Turkey
difficulties was good, with a Cronbach’s alpha of 0.70. Confirmatory factor analysis
showed that the three-compared to the five-factor model provided a better fit.
The SDQ-U total scores correlated significantly with the SCAS total scores and with
all its subscales. The SDQ-U proved to be a reliable and valid measure of emotional Corresponding author:
and behavioural problems in the Pakistani context. Cecilia A Essau
Keywords: Spence Children Anxiety Scale (SCAS); Psychometric properties;
Pakistan; Adolescents
 c.essau@roehampton.ac.uk

Received: February 20, 2016; Accepted: March 05, 2017; Published: March 14, 2017 Department of Psychology, University of
Roehampton, Whitelands College, London
SW15 5PU, UK.

Introduction
One in five adolescents in developed countries are estimated to Tel: +44(0)2083923647
have emotional and behavioural problems that cause impairment
in their daily functioning [1,2]. However, many symptoms of
mental health problems are often undetected, leaving these
adolescents not being treated for their mental health problems Citation: Essau CA, Qadir F, Maqsood A, et
[2,3]. When left untreated, mental health problems that have al. Factor Structure of the Urdu Version of
their onset during adolescence tend to persist and may lead to the Strengths and Difficulties Questionnaire
psychosocial impairment and severe forms of mental disorders in Pakistani Adolescents. Acta Psychopathol.
in adulthood [4,5]. These findings underline the importance of 2017, 3:1.
having a reliable and valid screening scale for early detection of
mental health problems and identifying targets for prevention [6].
The Strength and Difficulties Questionnaire (SDQ) was developed behavioural problems among adolescents in developing countries
in response to the need for a brief and reliable screening like Pakistan where financial and human resources for youth
instrument to measure common emotional and behavioural mental health services are limited. First, the SDQ is user friendly
problems in children and adolescents [7] so that high risk cases because of its length and its simplicity [7]. Second, the SDQ has
could be selected for further assessment and treatment. three versions (teacher, parent, and self-report) which enable
the use of multiple informants to screen the presence of mental
Since its publication in 1997 [7], the SDQ has been translated into
more than 70 languages and is widely used in both clinical and health problems from childhood to adolescence [7]. The present
community settings throughout the world. Several characteristics study was based on the self-report version of the SDQ. Third, the
of the SDQ make it a useful scale for screening emotional and SDQ is publicly available (http://www.sdqinfo.org) which can be

© Under License of Creative Commons Attribution 3.0 License | This article is available from: www.psychopathology.imedpub.com 1
 2017
ACTA PSYCHOPATHOLOGICA
ISSN 2469-6676 Vol. 3 No. 1: 4

used without incurring any expense. Finally, the SDQ has been of SDQ-U and its subscales with emotional symptoms.
reported to have good reliability and validity [8-15].
In the original paper describing the development of the SDQ
Method
[16] the internal consistency for the total difficulty score was Participants
reported to be satisfactory with a mean Cronbach of 0.73.
Studies conducted in Australia [10], Cyprus [9], the Netherlands A total of 1277 adolescents (55.4% boys and 44.6% girls) were
[11,12,14], China [15], France [8], Germany [9], Sweden [9], and recruited from 13 schools in Rawalpindi, Pakistan. From a
Italy [9,13] have reported the Cronbach’s Alpha for the total SDQ complete list of schools that was acquired from the Directorate
difficulty scores to range from 0.70 to 0.81. of Federal Government Educational Institutions (Cantt/Garrison),
“active data” software was used to randomly select the schools
The test–retest reliability coefficients have also been reported to and the classes within the schools from the list of total schools.
be high, ranging from 0.60 to 0.71, for retest intervals between Participants’ ages ranged between 13 and 17 years (mean=14.67
two and six months [15,16]. The internal consistency of the years; standard deviation=1.25). Almost all the children (99.6%)
subscales was acceptable for emotional symptoms (0.63-0.78), reported Islam as their religious affiliation. Most adolescents
hyperactivity-inattention (0.66–0.73), and pro-social behaviour (76.3%) reported their ethnicity as Punjabi, followed by Pathan
(0.59-0.87). The Cronbach’s Alphas for two of its subscales were (11.3%). The familial arrangement seemed congruent to Pakistani
low: conduct problems (0.41–0.67) and peer problems (0.27- society where majority of the mothers were housewives (90.2%),
0.52) [10-12,14,15]. Overall, these findings have shown the SDQ while the fathers (94.8%) were employed outside of the home.
to be a reliable scale, but have called into question some of the Furthermore, almost half of the fathers (44.2%) and only 29% of
subscales. the mothers have 11-16 years of education.
As originally reported by Goodman [7], the SDQ has factor Procedure
structures which correspond to four domains of difficulties
(i.e., conduct problems, hyperactivity/inattention, emotional The ethical approval for the study was obtained from the
symptoms, peer problems) and one domain of personal strengths “Research Committee” of Fatima Jinnah Women University,
(i.e., pro-social behaviour). Although some studies [11,16-18] Pakistan. Meetings with Directorate, Federal Government
using exploratory factor analyses (EFA) have provided support Educational Institutions (Cantt/Garrison), Rawalpindi Cantt,
for the original five-factor structure [7], other studies that used were held to secure formal permission to contact adolescents
a confirmatory factor analysis (CFA) have reported inconsistent within schools/colleges premises. The adolescents completed
findings. Support for the five-factor solution that corresponds with questionnaires in their classroom and one research assistant
the proposed subscales of hyperactivity-inattention, emotional and one of the research team members in Pakistan (AM, NS, NB)
symptoms, peer problems, conduct problems, and pro-social were available to provide assistance if necessary and to ensure
behaviour have been reported in several factor analytic studies independent responding.
conducted in community samples in Australia [10], England [16],
Germany, the Netherlands [11], Sweden [18,19], China [15],
Instruments
and Norway [20]. However, the five-factor structure has not The Strengths and Difficulties Questionnaire (SDQ) [7] Urdu
always fit the other translated versions of the SDQ. For example, version [22] was used to assess general difficulties and positive
American [21], and Italian studies [18] conducted in community attributes that are divided into five subscales: conduct problems,
samples found the best-fitting factor solution involved three hyperactivity-inattention, emotional symptoms, peer problems,
factors comprised of externalizing, internalizing, and pro-social and pro-social behaviour. It has 25 items, with each of the
behaviour. In a recent study by Essau et al. [9] conducted in five subscales containing five items which are rated on a three-point
European countries, the three-factor model fit somewhat better Likert-type scale (0=Not true, 1=Somewhat true, or 2=Certainly
than the five-factor model. However, the factor structure differed true). To generate a subscale score, each subscale was calculated
across countries, with the three-factor model showing better fit by adding scores on the relevant items (after reversing indicated
indices in Cyprus, whereas the five-factor model fitted better in items). A total difficulties score can be calculated by adding the
Germany. Fit indices for the UK, Sweden, and Italy were poor for scores of the four difficulties subscales (emotional symptoms,
both models. conduct problems, hyperactivity–inattention, and peer
problems), with higher scores reflecting greater difficulties. By
Although the Urdu version of the SDQ (SDQ-U) has been used in
contrast, higher scores on the pro-social behaviour subscale
several studies in Pakistan [22-25], to our knowledge no studies
indicate more strength. The SDQ also contains an extended set
have examined its factor structure. Thus, it remains unclear at this
of items measuring the impact of mental health problem (called
time whether the factor structure of the SDQ as determined by
“impact supplement”) on everyday life. The Urdu version of
Goodman [7] can be applied to adolescents in Pakistan. Therefore,
the self-report form of the SDQ (SDQ-U) was downloaded from
the main aim of this study was to examine the psychometric
http://www.sdqinfo.com.
properties and factor structure of the Urdu translation of the
self-report version of the SDQ (SDQ-U) in adolescents in Pakistan. The Spence Children’s Anxiety Scale (SCAS) [26] is a 38-item
The more specific aims were: (1) to examine the factor structure measure of symptoms of anxiety disorders based on the criteria
in Pakistan; (2) to investigate the reliability and validity of the of DSM-IV in children and adolescents. The SCAS consists of
(SDQ-U); and (3) to examine the correlations among the measure six subscales: separation anxiety, social phobia, obsessive-

2 This article is available from: www.psychopathology.imedpub.com

 2017
ACTA PSYCHOPATHOLOGICA
ISSN 2469-6676 Vol. 3 No. 1: 4

compulsive disorder, panic/agoraphobia, physical injury fears, and Table 1 Demographics characteristics of participants (n=1277).
generalized anxiety disorder. Each item is rated on a four-point Characteristic N (%)
scale in terms of its frequency from “never” (0) to “always” (3).
Internal consistency and test–retest reliability of the SCAS have Girl 569 -44.6
Gender
been reported as satisfactory, with Cronbach’s alpha generally Boy 708 -55.4
well above 0.70 and a test–retest correlation coefficient of 0.60 Grades 7-8 594 -46.5
[26]. In the present study, the Cronbach’s alpha for the total SCAS Grades Grades 9-10 609 -47.7
was 0.87. Grades 11-12 74 -5.8
Not employed/Home
SCAS was translated into Urdu by four bilinguals (research Mother’s 1134 -90.2
Makers
team members) with special focus on content equivalence with employment status
Employed 120 -9.5
the original version. The translated items were evaluated by a
Father’s Not employed 49 -3.8
committee of five experts. This process helped to select most employment status Employed 1196 -94.8
suitable URDU translation of the items. The refined Urdu version
0-5 years 324 -27.2
was then given to another group of five bilinguals for back
Mother’s 6-10 years 410 -34.5
translation. For evaluation, a follow up committee approach was
educational level 11-16 years 345 -29
adopted to critically evaluate the appropriateness of the Urdu
Don’t know 111 -9.3
version. Since diffusion in Urdu language is quite high, therefore
certain words from English language were retained, examples 0-5 years 111 111 (9.3)
are Dentist (item 23), train (item 28), shopping centers (item Father’s educational 6-10 years 448 448 (37.6)
30), switch (item 14) and toilet (item 7). Five experts examined level 11-16 years 526 526 (44.2)
the face validity of the translated version. All the experts and Don’t know 106 106 (8.9)
committee members were senior faculty members in a Pakistani 1262
Islam 1262
University and had extensive knowledge of the subject. Religion (99.6)
Christianity 5 5 (0.4)
Results Punjabi 935 935 (76.3)
Pathan 138 138 (11.3)
The mean and standard deviation of the study variables are listed Ethnicity Sindhi 6 6 (0.5)
on Table 1. The mean of the total SDQ-U was 10.58 (SD=4.8).
Balochi 2 2 (0.2)
The mean of the SDQ-U pro-social behaviour, internalizing and
Others 145 145 (11.8)
externalizing problems subscales were 9.41 (SD=1.8), 4.99
(SD=2.9), and 5.59 (SD=2.7), respectively. The mean of the SCAS analysis. Graphical and numerical inspection of sample data
subscales ranged from 4.76 (for physical fear) to 10.29 for OCD. suggested that sample distribution exhibited moderate kurtosis
and did not severely deviate from normality. Sample data did not
Construct validity of SDQ-U include outliers. The results of the Kaiser-Meyer-Olkin measure of
A series of preliminary analyses were performed before sampling adequacy (KMO=0.82) and the Bartlett’s test of sphericity
conducting reliability and validity analyses of the SDQ-U. The (BTS=1517, p<0.001) indicated that the data were suitable for
distribution of responses across the rating scale for each item was factor analysis. An oblique rotation with the Kaiser Normalization
examined. Screening of the data was also performed, including procedure was performed to facilitate the interpretability of
analysis of the normality of each variable, skewness and kurtosis, results. Three criteria were used to determine the number
outliers, and missing data. Normality was within the accepted of factors to rotate: the priori hypothesis stemming from the
level (± 3.29) of skewness and kurtosis. Following Tabachnick original study that the measure has three or five main factors, the
and Fidel [27], replacement of missing values with the mean was scree-test together with the eigenvalues and interpretability of
done if each variable has at least 5% missing value. In the present the factor solution. The scree plot and eigenvalues indicated that
data, more than 5% of the given responses had missing values. the five-dimensionality was not suitable for the Pakistani sample.
Thus, each item with missing values was removed from the Consequently, three factors were oblimin rotated. Oblimin
further analysis. After removing the missing values, 1033 cases rotation of a principal axis produced a three-factor solution
remained. explaining 31.5% of the total variance. The first factor accounted
for 16.2% of the total variance. The second and the third factors
As reviewed above, several studies have reported either the
explained 10.1% and 5.1% of the total variance, respectively.
five-factor and three-factor structure of the SDQ. Therefore, the
The results of the factor analysis showed that the present factor
Exploratory Factor Analysis was initially run to evaluate the overall
structure does not match up with the Goodman’s study [7] which
factor structure of 25 items SDQ-U. Thereafter, confirmatory
had reported five main factors.
factor analysis was conducted. In order to conduct exploratory
and confirmatory factor analysis, the data were randomly divided Confirmatory factor analysis
into two by utilizing SPSS 22 splitting data.
A confirmatory factor analysis was conducted by using the AMOS
Exploratory factor analysis 22.0 programme on the three factors, 25 items model as in the
earlier studies [ 9]. The analysis was performed on the separate
A total of 506 cases were subjected to a principal component

© Under License of Creative Commons Attribution 3.0 License 3

 2017
ACTA PSYCHOPATHOLOGICA
ISSN 2469-6676 Vol. 3 No. 1: 4

sample with 527 cases. Results revealed that Chi-square test Two-way MANOVA was also conducted to examine gender and
was significant indicating good fit (χ2=545.49, df=269). Because age differences on the total SDQ-U and its subscales. A significant
the χ2 statistics is easily influenced by the sample size, multiple multivariate effect of gender on the total SDQ-U, F (3, 1023)=4.28,
goodness of fit indices was also used to evaluate the fit between p=0.01, and on the internalizing problems, F (3, 1023)=10.29,
the model and the sample data [28]. The goodness-of-fit index p=0.001 was found (Table 3).
(GFI, value above 0.90), the adjusted goodness-of-fit index (AGFI,
value above 0.80), and the root mean square error approximation Discussion
(RMSEA, value smaller than 0.10) are suggested as criteria for The present study examined the factor structure and the
acceptable fit [29,30]. Thus, confirmatory factor analysis for psychometric properties of the Urdu version of the SDQ (SDQ-U).
the three factor model for the SDQ-U was tested. The results of The generalizability of the five-factor model as originally proposed
the analysis yielded a good fit (χ2=545.49, df=269, χ2/df=2.02; by Goodman [32] has been controversial. In the present study,
GFI=0.92; AGFI=0.91; RMSEA=0.044 90%, CI=0.050–0.066). The the three-factor models that consisted of pro-social behaviour,
fit indices suggested that a three factor solution with 25 items internalizing and externalizing problems provided a better fit than
was a good fit for the sample data. the five-factor model for the Pakistani adolescents. Our previous
Discriminant validity study showed differences in the factor structures across five
European countries, with a better fit being found in Cyprus for
To provide further evidence for the validity of the scores, the three-factor similar to the present study; in other countries
discriminant validity was established using the non-missing (e.g. Germany), the five-factor structure had a better fit [9] and
sample of 1033 participants. The Pearson’s correlations among in the UK, Sweden, and Italy, the fit indices were relatively poor
the participants' SDQ-U Scale and the SCAS scores were in the for both models. Why the factor structure for the SDQ differs
expected direction. As shown in Table 2, the total SCAS scores across countries is not clear, although it could be that differences
correlated significantly with the total SDQ-U scores and with in socialization practices and cultural values (e.g., social norms,
all its difficulty subscales. This finding indicated that the higher educational and parenting practice) might have accounted for
the difficulty scores, the higher the anxiety symptoms. Of all the these inconsistent findings.
SDQ-U subscales, the strongest correlation coefficients were
found between SDQ-U internalising problems and with both the To examine the discriminant validity of the SDQ-U, correlation
total SCAS (r=0.49, p<0.01) and all its subscales, with correlation coefficients were calculated between the SDQ-U and the SCAS.
coefficients ranging from 0.24 to 0.44. Consistent with previous studies [9], the total and the subscales
scores of both these measures were significantly correlated.
Reliability Within the SDQ-U subscales, the strongest correlation was found
The internal consistency of the SDQ-U total difficulties was found between emotional symptoms and total anxiety symptoms.
to be adequate, with a Cronbach’s alpha of 0.70. The Cronbach’s Our findings also showed significant positive correlations
alpha for the SDQ-U pro-social behaviour subscale was much between externalizing and internalizing problems; thus, in
lower, indicating that some items do not fit with the rest of the line with numerous previous studies, this finding suggested
items on this subscale. Of all the difficulty subscales, internalising the high comorbidity both within the internalizing problems
problems had the highest internal consistency coefficients (0.61), (i.e., between anxiety and depression) [12,26,33], as well as
followed by externalising problems (0.52). As the reversed items between internalizing (i.e., anxiety/depression) and externalizing
have been reported to confound the SDQ factors [13,31], the problems (i.e., conduct problems/hyperactivity) [34]. The internal
internal consistency of the SDQ-U total difficulties score and the consistency of the total SDQ-U was good, replicating numerous
three factors were analysed without the reversed items (i.e., studies [8,10-15].
items 7, 11, 14, 21 and 25). The internal consistency values of Compared to previous studies conducted in several European
the total difficulties score (Cronbach’s alpha=0.71) and the pro- countries [9], the adolescents in Pakistan reported higher levels
social behaviour subscale (Cronbach’s alpha=0.65) improved of internalizing and externalising problems. While it is not
after removing the reversed items. the focus of this study to explain why there is this high level
of internalizing and externalising problems among Pakistani
Age and sex differences in SDQ-U adolescents, this finding could have been attributed to high
Two-way MANOVA was conducted to examine gender and age academic stress, poverty and political instability in Pakistan.
differences on the total SDQ-U and its subscales. A significant Future studies are needed to investigate whether this speculation
multivariate effect of gender on SDQ-U was found, F (3, could be supported. Gender differences were found for the total
1017)=6.55, p=0.02 partial η2=0.02, Wilks’ Lambda=0.98. A SDQ-U and the internalising subscale, indicating that significantly
univariate analysis indicated differences in the total SDQ-U, F more girls than boys reported higher levels of difficulty and
(1, 1023)=12.34, p=0.01, and in internalizing problems, F (1, internalising problems. The finding that girls had higher difficulty
1023)=30.39, p=0.001. These findings suggested that girls, and internalising problems than boys were in line with numerous
compared to boys, reported significantly higher levels on total previous studies [9]. Unlike previous studies [35,36] that reported
difficulty and in internalising problems. Results revealed neither higher levels of externalizing problems in boys, the present study
an age difference nor gender x age interaction on any of SDQ-U did not find any gender difference for externalizing problems.
subscales. The possible reason for this discrepancy was unclear although

4 This article is available from: www.psychopathology.imedpub.com

 2017
ACTA PSYCHOPATHOLOGICA
ISSN 2469-6676 Vol. 3 No. 1: 4

Table 2 Means and standard deviations of the study variables by gender and age groups.
13-14 years Mean
Study variables Total Mean (SD) Male Mean (SD) Female Mean (SD) 15-17 years Mean (SD)
(SD)
SDQ-U
Total SDQ-U 10.58 (4.8) 10.11 (4.8) 11.13 (4.9) 10.48 (5.0) 10.65 (4.7)
Internalising 4.99 (2.9) 4.53 (2.8) 5.53 (2.9) 5.02 (3.0) 4.96 (2.9)
Externalising 5.59 (2.9) 5.58 (2.7) 5.59 (2.6) 5.46 (2.7) 5.69 (2.7)
Pro-social behavior 9.41 (1.8) 9.48 (1.9) 9.33 (1.7) 9.49 (1.7) 9.35 (1.9)
SCAS
Total SCAS 41.42 (15.9) 36.56 (13.9) 47.08 (16.3) 41.74 (16.7) 41.16 (15.4)
Separation anxiety 7.02 (3.6) 6.07 (3.2) 8.13 (3.7) 7.34 (3.9) 6.74 (3.4)
Social anxiety 6.88 (3.8) 5.99 (3.5) 7.92 (3.8) 6.70 (3.9) 7.07 (3.7)
OCD 10.29 (3.7) 10.55 (3.7) 9.97 (3.8) 9.81 (3.8) 10.72 (3.6)
Panic 5.07 (4.2) 4.25 (3.9) 6.03 (4.3) 5.35 (4.3) 4.81 (4.0)
Physical fear 4.76 (3.5) 3.15 (2.7) 6.63 (3.4) 5.02 (3.5) 4.51 (3.5)
Generalised anxiety 7.40 (3.3) 6.55 (3.0) 8.40 (3.4) 7.53 (3.5) 7.31 (3.2)

SCAS: Spence Children’s Anxiety Scale; SDQ-U: Urdu Version of the Strength and Difficulties Questionnaire; OCD: Obsessive-Compulsive Disorder

Table 3 Correlations between SDQ and SCAS.

1 2 3 4 5 6 7 8 9 10
1. Tot SDQ - - - - - - - - - -
2. ProSocBeh -0.11** - - - - - - - - -
3. IntProb 0.87** -0.02 - - - - - - - -
4. ExtProb 0.85** -0.18** 0.48** - - - - - - -
5. TotSCAS 0.45** 0.04** 0.49** 0.28** - - - - - -
6. SepAnx 0.23** 0.04 0.28** 0.11** 0.75** - - - - -
7. SocPho 0.39** 0.02 0.39** 0.27** 0.75** 0.47** - - - -
8. OCD 0.24** 0.05 0.24** 0.17** 0.60** 0.32** 0.37** - - -
9. PanAtAg 0.45** 0.04 0.47** 0.29** 0.77** 0.46** 0.48** 0.33** - -
10. PhyInjF 0.22** 0.001 0.26** 0.10** 0.68** 0.51** 0.40** 0.17** 0.45** -
11. GenAnx 0.43** 0.001 0.44** 0.28** 0.78** 0.48** 0.53** 0.42** 0.52** 0.45**
SDQ: Strength and Difficulties Questionnaire; SCAS: Spence Children’s Anxiety Scale; Tot SDQ: Total SDQ scores; Pro Soc Beh: Prosocial Behaviour; Int
Prob: Internalizing Problems; Ext Prob: Externalizing Problems; Tot SCAS: Total SCAS Scores; Sep Anx: Separation Anxiety; Soc Pho: Social Phobia; OCD:
Obsessive-Compulsive Disorder; Pan/Ag: Panic/Agoraphobia; PhyInjF: Physical Injury Fears; Gen Anx: Generalized Anxiety Disorder

it could have been because of social desirability. Specifically, emotional and behavioural symptoms were assessed by means
because behaviour related to conduct or peer problems are of questionnaires. Future studies might employ clinical diagnostic
frowned upon in collectivistic culture, it is likely that boys are interviews in order to examine how impairing the reported
only willing to admit these behaviours partially. The present symptoms are and to further establish the validity of adolescent
study found the adolescents to have reported higher level of psychopathology among adolescents in Pakistan. Finally, the SDQ
pro-social behaviours, when compared to previous studies. This has not been normed on a Pakistani sample, thus, the present
finding was not unexpected because Pakistani culture is related study has to rely on normative information from the United
to a collectivistic value orientation, which is positively related to Kingdom. These limitations notwithstanding, our findings support
pro-social behaviour [37]. the usefulness of the SDQ as an efficient way of screening for
emotional and behavioural problems in children and adolescents
The findings of the present study need to be interpreted in
in Pakistan.
light of its limitations. First, our participants were made up of a
convenience sample of 13 to 17 year olds who were recruited from
urban schools in Pakistan. Although a seemingly representative Acknowledgment
of urban youth in Pakistan, use of such samples may have This study is part of a research project on “Anxiety among
implications for the generalizability of our findings to adolescents adolescents in Pakistan: From epidemiology to prevention”,
in other regions in Pakistan. Furthermore, the present study was funded by the Higher Education Commission, Pakistan and the
restricted to adolescents aged 13-17 years, and therefore the
British Council INSPIRE (International Strategic Partnerships
findings may not generalize to younger age groups. Second, the
data were based solely on the adolescents’ self-report and no in Research and Education) Strategic Partnerships 2011 fund
clinical interviews were used to confirm this self-report measure. to University of Roehampton, UK and Fatima Jinnah Women
Further test of its validity (i.e., convergent and discriminant) University, Pakistan. Project managed by Cecilia A. Essau and
should be examined by using parent or teacher reports. Third, Farah Qadir.

© Under License of Creative Commons Attribution 3.0 License 5

 2017
ACTA PSYCHOPATHOLOGICA
ISSN 2469-6676 Vol. 3 No. 1: 4

References the strengths and difficulties questionnaire-hebrew version. Front

Psychiatry 1: 151.
1 Costello E, Egger H, Angold A (2005) 10 year research update review:
18 Smedje H, Broman JE, Hetta J, von Knorring AL (1999) Psychometric
the epidemiology of child and adolescent psychiatric disorders: I.
properties of a Swedish version of the “strengths and difficulties
Methods and public health burden. J Am Acad Child Adolesc Psy 44:
questionnaire”. Eur Child Adoles Psy 8: 63-70.
972-986.
19 Klasen H, Woerner W, Rothenberger A, Goodman R (2003) German
2 Merikangas KR, He JP, Brody D, Fisher PW, Bourdon K, et al. (2010)
version of the Strength and Difficulties Questionnaire -overview
Prevalence and treatment of mental disorders among US children in
and evaluation of initial validation and normative results. Prax
the 2001-2004 NHANES. Pediatrics 125: 75-81.
Kinderpsychol K 52: 491-502.
3 Essau CA (2005) Use of mental health services among adolescents
20 Richter J, Sagatun A, Heyerdahl S, Oppedal B, Roysamb E (2011) The
with anxiety and depressive disorders. Depress Anxiety 22: 130-137.
strengths and difficulties questionnaire self-report: an analysis of its
4 Essau CA, Lewinsohn PM, Olaya B, Seeley JR (2014) Anxiety disorders structure in a multi-ethnic urban adolescent sample. J Child Psychol
in adolescents and psychosocial outcomes at age 30. J Affect Disord Psychiatry 52: 1002-1011.
163: 125-132.
21 Dickey WC, Blumberg SJ (2004) Revisiting the factor structure of the
5 Woodward LJ, Fergusson DM (2001) Life course outcomes of young strengths and difficulties questionnaire: United States. J Am Acad
people with anxiety disorders in adolescence. J Am Acad Child Child Adolesc Psy 43: 1159-1167.
Adolesc Psy 40: 1086-1093.
22 Samad L, Hollis C, Prince M, Goodman R (2005) Child and adolescent
6 Opler M, Sodhi D, Zaveri D, Madhusoodanan S (2010) Primary psychopathology in a developing country: testing the validity of the
psychiatric prevention in children and adolescents. Ann Clin strength and difficulty questionnaire. Int J Meth Psych Res 14: 158-
Psychiatry 22: 220-234. 166.
7 Goodman R (1997) The strengths and difficulties questionnaire: a 23 Syed E, Abdul Hussein S, Mahmud S (2007) Screening for emotional
research note. J Child Psychol Psychiatry 38: 581-586. and behavioural problems amongst 5 to 11 year old school children
in Karachi, Pakistan. Soc Psych Psych Epid 42: 421-427.
8 Capron C, Therond C, Duyme M (2007) Psychometric properties
of the french version of the self-report and teacher strengths and 24 Syed EU, Hussein SA, Azam SI, Khan AG (2009) Comparison of Urdu
difficulties questionnaire. Eur J Psychol Assess 23: 79-88. version of strengths and difficulties questionnaire (SDQ) and the child
behaviour check list amongst primary school children in Karachi. J
9 Essau CA, Olaya Guzmán B, Anastassiou-Hadjicharalambous X, Pauli
Coll Physicians Surgeons Pakistan 19: 375.
G, Gilvarry C, et al. (2012) Psychometric properties of the strength
and difficulties questionnaire from five European countries. Int J 25 Syed EU, Hussein SA, Haidry SZ (2009) Prevalence of emotional and
Meth Psych Res 21: 232-245. behavioural problems among primary school children in Karachi,
Pakistan-multi informant survey. Indian J Paediatr 76: 623-627.
10 Hawes D, Dadds MR (2004) Australian data and psychometric
properties of the strengths and difficulties questionnaire. Aust NZ J 26 Spence SH (1997) The structure of anxiety symptoms among children:
Psychiat 38: 644-651. a confirmatory factor analytic study. J Abnorm Psychol 106: 280-297.
11 Muris P, Meesters C, van den Berg F (2003) The strengths and 27 Tabachnick BG, Fidell LS (2001) Using multivariate statistics. Boston:
difficulties questionnaire further evidence for its reliability and Allyn and Bacon.
validity in a community sample of Dutch children and adolescents.
28 Bentler PM, Bonett DG (1980) Significance tests and goodness of fit
Eur Child Adoles Psy 12: 1-8.
in the analysis of covariance structures. Psychol Bull 88: 588-606.
12 Muris P, Meesters C, Eijkelenboom A, Vincken M (2004) The self-
29 Brown M, Cudeck R (1993) Alternative ways of assessing model fit.
report version of the strengths and difficulties questionnaire: its
In Bollen K, Long J Testing Structural Equation Models, pp: 136-162.
psychometric properties in 8 to 13-year-old non-clinical children. Brit
J Clin Psychol 43: 437-448. 30 Schumacker RE, Lomax RG (1996) A Beginner’s Guide to Structural
Equation Modeling. Mahwah, New Jersey: Lawrence Erlbaum
13 Riso DD, Salcuni S, Chessa D, Raudino A, Lis A, et al. (2010) The
Associates.
strengths and difficulties questionnaire: early evidence of its
reliability and validity in a community sample of Italian children. Pers 31 Palmieri P, Smith G (2007) Examining the structural validity of the
Indiv Differ 49: 570-575. strengths and difficulties questionnaire (SDQ) in a US sample of
custodial grandmothers. Psychol Assessment 19: 189-198.
14 van Widenfelt BM, Goedhart AW, Treffers PD, Goodman R (2003)
Dutch version of the strengths and difficulties questionnaire (SDQ). 32 Goodman R (1999) The extended version of the strengths and
Eur Child Adoles Psy 12: 281-289. difficulties questionnaire as a guide to child psychiatric caseness and
consequent burden. J Child Psychol Psychiatry 40: 791-799.
15 Yao S, Zhang C, Zhu X, Jing X, McWhinnie CM, et al. (2009) Measuring
adolescent psychopathology: psychometric properties of the self- 33 Ishikawa S, Sato H, Sasagawa S (2009) Anxiety disorder symptoms
report strengths and difficulties questionnaire in a sample of chinese in Japanese children and adolescents. J Anxiety Disord 23: 104-111.
adolescents. J Adolescent Health 45: 55-62.
34 Cunningham NR, Ollendick TH (2010) Comorbidity of anxiety and
16 Goodman R (2001) Psychometric properties of the strengths and conduct problems in children: implications for clinical research and
difficulties questionnaire. J Am Acad Child Adolesc Psy 40: 1337- practice. Clin Child Fam Psych 13: 333-347.
1345.
35 Leadbeater BJ, Kupermin GP, Blatt SJ (1999) A multivariate model
17 Mansbach-Kleinfeld I, Apter A, Farbstein I, Levine SZ, Ponizovsky of gender differences in adolescents’ internalizing and externalizing
AM (2010) A population-based psychometric validation study of problems. Dev Psychol 35:1268-1282.

6 This article is available from: www.psychopathology.imedpub.com

 2017
ACTA PSYCHOPATHOLOGICA
ISSN 2469-6676 Vol. 3 No. 1: 4

36 Mellor D (2005) Normative data for the Strengths and Difficulties 37 Triandis HC (2001) Individualism-collectivism and personality. J Pers
Questionnaire in Australia. Aust Psychol 40: 215-222. 69: 907-924.

© Under License of Creative Commons Attribution 3.0 License 7