Sufficiency of current practice: How well does the Strengths and Difficulties Questionnaire detect clinically elevated posttraumatic stress, anxiety, and depression symptoms in children in care?

Background: It is well-established that children living in care are at far greater risk of mental health difficulties than their peers. This includes common and trauma-specific mental health conditions, including depression, anxiety and posttraumatic stress disorder (PTSD). In England, the mental health of children in care is monitored using the caregiver-report Strengths and Difficulties Questionnaire (SDQ). Our aim was to understand the sufficiency of current screening practices for children in care. We investigated how sensitive the SDQ was to clinically elevated PTSD, anxiety, and depression symptoms. Methods: The sample included 491 children aged 10-18 years old, under local authority care, and their caregiver where available ( Results: Most of the sample scored above clinical threshold on at least one measure. Caregiver-reported SDQ scores were weakly correlated with child self-reported PTSD, anxiety, and depression scores, while self-reported SDQ scores were moderately correlated with their self-report on the other symptom scales. A large proportion of children scoring in the clinical range on the anxiety (44%), depression (46%), or PTSD (48%) symptoms measures did not score in the carer-report SDQ clinical range. Similar patterns were found using the self-report SDQ, with somewhat higher detection rates found when combining self- and carer-report SDQ. Conclusion: Relying only on the carer-report SDQ as a mental health screening tool is likely inadequate to detect mental health symptomology in children in care. Whilst this was never the purpose of the SDQ, it is how it is commonly used in practice. We discuss the benefits of including children's voices and disorder-specific screening tools (e.g., for PTSD) into mental health assessments for children living in care.