title: Developing a brief cross-culturally validated screening tool for externalizing disorders in children.
abstract: OBJECTIVE
  Most screening instruments for externalizing disorders have been developed and validated in Western children. We developed and validated a brief screening instrument for predicting externalizing disorders in native Dutch children as well as in non-Dutch immigrant children, using predictors that can be easily obtained from teachers.
  
  
  METHODS
  Teachers completed the Strengths and Difficulties Questionnaire for an ethnic diverse sample of 2,185 children ages 6 to 10 years. In a stratified subsample, 254 children and their parents were additionally interviewed regarding psychiatric disorders and sociodemographic data. In this group, stepwise logistic regression was used to derive a score from sex and all items of the Hyperactivity and Conduct Problems Scale of the Strengths and Difficulties Questionnaire, for predicting a best-estimate diagnosis of any externalizing disorder. The accuracy of the score was compared between native Dutch and non-Dutch immigrant children.
  
  
  RESULTS
  Ninety-one cases of externalizing disorders were identified. An externalizing disorder could be predicted by the items restless, obeys, lies, and concentrates. Sex and ethnicity did not contribute to a prediction of an externalizing disorder. The area under the receiver operating characteristic was 0.84 (95% confidence interval 0.79-0.89), indicating good discriminatory power with no substantial differences between native Dutch and non-Dutch immigrant children.
  
  
  CONCLUSIONS
  Externalizing disorders in both native Dutch and non-Dutch immigrant children can be predicted with a scoring rule, based on only four items that can be easily assessed by teachers. Before this internally validated prediction tool can be implemented, external validation in another sample is necessary.
authors.affiliation: Dr. Zwirs is with the Faculty of Law, Erasmus University of Rotterdam; Dr. Schulpen is with the Department of Pediatrics, University Medical Center Utrecht; Dr. Burger is with the Departments of Epidemiology and Psychiatry, University Medical Center Groningen; and Dr. Buitelaar is with the Department of Psychiatry and the Academic Center for Child and Adolescent Psychiatry, Radboud University Nijmegen Medical Center.. Electronic address: Zwirs@frg.eur.nl.
authors.forename: Barbara W C
authors.initials: BWC
authors.lastname: Zwirs
authors.affiliation: Dr. Zwirs is with the Faculty of Law, Erasmus University of Rotterdam; Dr. Schulpen is with the Department of Pediatrics, University Medical Center Utrecht; Dr. Burger is with the Departments of Epidemiology and Psychiatry, University Medical Center Groningen; and Dr. Buitelaar is with the Department of Psychiatry and the Academic Center for Child and Adolescent Psychiatry, Radboud University Nijmegen Medical Center.
authors.forename: Huibert
authors.initials: H
authors.lastname: Burger
authors.affiliation: Dr. Zwirs is with the Faculty of Law, Erasmus University of Rotterdam; Dr. Schulpen is with the Department of Pediatrics, University Medical Center Utrecht; Dr. Burger is with the Departments of Epidemiology and Psychiatry, University Medical Center Groningen; and Dr. Buitelaar is with the Department of Psychiatry and the Academic Center for Child and Adolescent Psychiatry, Radboud University Nijmegen Medical Center.
authors.forename: Tom W J
authors.initials: TWJ
authors.lastname: Schulpen
authors.affiliation: Dr. Zwirs is with the Faculty of Law, Erasmus University of Rotterdam; Dr. Schulpen is with the Department of Pediatrics, University Medical Center Utrecht; Dr. Burger is with the Departments of Epidemiology and Psychiatry, University Medical Center Groningen; and Dr. Buitelaar is with the Department of Psychiatry and the Academic Center for Child and Adolescent Psychiatry, Radboud University Nijmegen Medical Center.
authors.forename: Jan K
authors.initials: JK
authors.lastname: Buitelaar
mesh_terms: D019958:Attention Deficit and Disruptive Behavior Disorders / Q000208:ethnology / Q000517:prevention & control*; D002648:Child; D018864:Cultural Diversity; D054242:Emigrants and Immigrants / Q000523:psychology; D005260:Female; D006801:Humans; D016015:Logistic Models; D008297:Male; D008403:Mass Screening; D008960:Models, Psychological; D015999:Multivariate Analysis; D009426:Netherlands; D011581:Psychological Tests; D015203:Reproducibility of Results; D012572:School Health Services; D012680:Sensitivity and Specificity