School-based Screening for Mental Health Difficulties in Primary Grade Children: Psychometrics, Incremental Validity, and Patterns of Co-occurring Difficulties

The demand for childrenâ s mental health services in Ontario exceeds available resources and, as a result, alternative approaches such as delivering mental health services in the school system may be needed. Within the school system, universal screening has been recommended as a method of identifying mental health difficulties early and beginning to provide intervention. If schools are to implement such screening programs, they must select appropriate screening measures and informants and be prepared to meet the needs of the children identified as at-risk. This process is complicated by high rates of co-occurrence among mental health difficulties, social and academic difficulties. The overall goal of this dissertation is to contribute to knowledge in the area of school-based mental health screening in terms of instruments, informants and the predominant patterns of co-occurring difficulties in elementary school children. Three studies will be presented, all of which involve the same community sample of 501 children in Grades 1 to 3. In the first study, confirmatory factor analysis was used to examine the construct validity of the Strengths and Difficulties Questionnaire (SDQ), a potentially useful screening measure that has received little research attention in Canada. The results support the five-factor structure of parent and teacher SDQ ratings. Adequate internal consistency and inter-rater agreement were also found. The second study used negative binomial regression to test the hypothesis that parent ratings of symptoms as well as parent and teacher ratings of impairment contribute to more accurate screening than teacher symptom ratings alone. The results suggest that the most useful combination of screening data includes teacher symptom and impairment ratings and parent impairment ratings. The third study used latent class analysis to identify patterns of co-occurrence among some of the most common childhood difficulties: internalizing, externalizing, inattention/hyperactivity, social, and reading difficulties. The results indicate that a significant number of non-referred elementary school children experience difficulties in two or more important aspects of functioning. Collectively, these findings provide an important foundation that may guide future research on and implementation of school-based mental health screening in terms of selecting measures and informants and anticipating potential patterns of need in young children.Ph.D