Journal of Abnormal Child Psychology, Vol. 27, No. 1, 1999, pp.

17-24

Comparing the Strengths and Difficulties Questionnaire

and the Child Behavior Checklist: Is Small Beautiful?

Robert Goodman1,2 and Stephen Scott1

Received November 18, 1997; revision received May 12, 1998; accepted September 3, 1998

The Strengths and Difficulties Questionnaire (SDQ) is a brief behavioral screening ques-
tionnaire that can be completed in 5 minutes by the parents or teachers of children aged 4
to 16; there is a self-report version for 11- to 16-year-olds. In this study, mothers completed
the SDQ and the Child Behavior Checklist (CBCL) on 132 children aged 4 through 7 and
drawn from psychiatric and dental clinics. Scores from the SDQ and CBCL were highly
correlated and equally able to discriminate psychiatric from dental cases. As judged against
a semistructured interview, the SDQ was significantly better than the CBCL at detecting
inattention and hyperactivity, and at least as good at detecting internalizing and externalizing
problems. Mothers of low-risk children were twice as likely to prefer the SDQ.
KEY WORDS: Child psychopathology; prosocial behavior; questionnaires; validity; acceptability.

INTRODUCTION thinks that the young person has a problem, and if

The Strengths and Difficulties Questionnaire
(SDQ) is a brief behavioral screening questionnaire
that asks about 25 attributes, some positive and oth-
ers negative (Goodman, 1997). The 25 items are di-
vided between five scales of five items each,
generating scores for Conduct Problems, Inattention-
Hyperactivity, Emotional Symptoms, Peer Problems,
and Prosocial Behavior; all scales but the last are
summed to generate a Total Difficulties score. The
same questionnaire can be completed by the parents
or teachers of 4- to 16-year-olds (Goodman, 1997)
and there is a parallel self-report version for com-
pletion by 11- to 16-year-olds (Goodman, Meltzer, &
Bailey, 1998). Extended versions of the SDQ include
an impact supplement that asks if the respondent
This article was received and initially reviewed under the editor-
ship of Donald K. Routh.
1
Department of Child and Adolescent Psychiatry, Institute of Psy-
chiatry, London, United Kingdom.
2
Address all correspondence, including requests for sample ques-
tionnaires, to Robert Goodman, Ph.D., Department of Child and
Adolescent Psychiatry, Institute of Psychiatry, De Crespigny Park,
London SE5 8AF, United Kingdom.
so, enquires further about chronicity, distress, social
impairment, and burden for others (Goodman, in
press).
The SDQ is available in over 30 languages and
is being widely used in epidemiological, developmen-
tal, and clinical research, as well as in routine clinical
and educational practice. Since the same is true of
the longer established Child Behavior Checklist
(CBCL; Achenbach, 1991a), it is clearly important to
compare the properties of the SDQ and CBCL in
order to facilitate communication between re-
searchers and practitioners using each measure. In-
formation on the relative merits of each could also
influence choice of instrument.
The SDQ and CBCL differ in several respects
that could alter their psychometric properties. One
of the most obvious differences is in length—the
SDQ has 25 items as compared with the CBCL's
118 items on psychopathology alone. Was the
SDQ's brevity achieved at the cost of reduced va-
lidity?
A second difference between the SDQ and
CBCL is that the SDQ items were selected on the

17
0091-0627/99/0200-OOnS16.00/0 © 1999 Plenum Publishing Corporation
18
basis of nosological concepts as well as factor analy-
ses. The relevant concepts are those that underpin
the Diagnostic and Statistical Manual of Mental Dis-
orders (4th ed.) (DSM-IV; American Psychiatric As-
sociation, 1994) and ICD-10 (World H e a l t h
Organization, 1993) classifications of childhood psy-
chopathology. For example, the five items on the
SDQ's Inattention-Hyperactivity scale were deliber-
ately selected to tap inattention (two items), hyper-
activity (two items), and impulsivity (one item)
because these are the key symptom domains for a
DSM-IV diagnosis of attention-deficit/hyperactivity
disorder (ADHD; APA, 1994) or for an ICD-10 di-
agnosis of hyperkinesis (World Health Organization,
1993). By contrast, the CBCLs Attention Problems
scale includes several items that have no conceptual
link with the current diagnostic criteria for ADHD
or hyperkinesis, e.g., "Nervous, highstrung, or tense."
The fact that the SDQ was designed on the basis of
theory as well as previous factor analyses does not
seem to have undermined its factor structure; factor
analyses on an independent community sample have
confirmed that each of the five scales corresponds to
a distinct factor (Smedje, Broman, Hetta & von
Knorring, in press). Does the SDQ's reliance on di-
agnostic concepts as well as factor analyses influence
its validity?
A further difference between the SDQ and
CBCL is that, whereas the CBCL's psychopathology
scales are based entirely on parental endorsements
of negative items (e.g., "Can't concentrate, can't pay
attention for long"), some of the comparable items
contributing to the SDQ's psychopathology scales are
phrased positively (e.g. "Sees tasks through to the
end, good attention span"). The SDQ's greater em-
phasis on positive attributes was designed to increase
the questionnaire's acceptability to respondents. Was
this successful?
Though there have not previously been any di-
rect comparisons of the SDQ and the CBCL, indirect
evidence suggests that they are probably roughly
equivalent. Scores derived from the CBCL and the
Rutter parent questionnaire (Rutter, Tizard, & Whit-
more, 1970) correlate highly with one another and
are of comparable predictive validity (Berg, Lucas,
& McGuire, 1992; Fombonne, 1989). Since scores
from the SDQ and Rutter questionnaires are also
highly correlated and of comparable predictive valid-
ity (Goodman, 1997), it seems reasonable to infer
that the SDQ and the CBCL are themselves highly
correlated and of comparable validity. This study was
Goodman and Scott
the first direct test of how the SDQ and CBCL com-
pare.
METHOD
Overview
SDQ and CBCL questionnaires were completed
by the mothers of 132 children aged 4 through 7
years. One part of the sample was from a low-psy-
chiatric-risk population, being recruited from a chil-
dren's dental clinic. The other part came from a
high-psychiatric-risk population, being recruited from
three child psychiatric clinics. The predictive validity
of the two questionnaires was examined by estab-
lishing how well each questionnaire was able to dis-
tinguish between the low- and high-risk samples, as
indexed by the area under receiver operating char-
acteristic (ROC) curves. Parental preference was
only established for the dental sample. Detailed in-
terviews with parents about their children's psycho-
pathology were only carried out for the psychiatric
sample.
Low-Risk Sample
The mothers of children attending a children's
department of a London dental hospital were asked
to complete the two questionnaires while awaiting
their clinic appointments if their children were aged
from 4 years, 0 months, to 7 years, 11 months. Most
of the mothers approached did agree to take part,
though the proportion of refusals was not systemati-
cally recorded since, as explained subsequently, the
statistical analyses did not require the sample to be
representative. Completed questionnaires were ob-
tained on 71 children.
High-Risk Sample
As part of an ongoing study evaluating the ef-
fectiveness of parent management training, parents
from three child psychiatric clinics in and around
London were recruited if they had children aged be-
tween 3 and 8 years referred with externalizing prob-
lems in the absence of severe language problems or
known mental retardation. The high-risk sample for
the present study consists of the first 61 children
aged from 4 years, 0 months, to 7 years, 11 months,
Comparison of SDQ and CBCL
whose parents were enroled in parent training
groups. Children aged 3 years were excluded from
the present study since neither the SDQ nor the
CBCL questionnaire was designed for children under
the age of 4,
Questionnaires
Mothers were administered the SDQ (Good-
man, 1997) and CBCL (Achenbach, 1991a) in ran-
dom order on a single occasion. For the psychiatric
sample, the questionnaires were obtained prior to
the intervention. Both questionnaires were scored
in the standard manner (Achenbach, 1991a; Good-
man, 1997). Sample copies (in a wide range of lan-
guages) and scoring instructions are available on
request.
While the psychometric properties of the
CBCL are well known and conveniently summa-
rized (Achenbach, 1991a), reports of the psy-
chometric properties of the SDQ are divided
between several recent papers, warranting a brief
summary. Given the well-established validity and
reliability of the Rutter questionnaires (Elander &
Rutter, 1996), high correlations between the SDQ
and Rutter questionnaires provided evidence for
the concurrent validity of the informant-rated
SDQ; receiver operating characteristic analyses
also showed that the Rutter questionnaire and
SDQ were of comparable predictive validity
(Goodman, 1997). The internal reliabilities of par-
ent-completed SDQ scales were investigated in a
Swedish general population sample (N = 900),
with Cronbach's alpha being .76 for Total score,
.75 for Inattention-Hyperactivity, .70 for Prosocial
Behavior, .61 for Emotional Symptoms, .54 for
Conduct Problems, and .51 for Peer Problems
(Smedje et al., in press). Test-retest reliabilities
have been examined in a British general popula-
tion sample; when parents of 34 of these children
completed SDQs on two occasions between 3 and
4 weeks apart, the intraclass correlations were .85
for Total score, .75 for Inattention-Hyperactivity,
.81 for Prosocial Behavior, .70 for Emotional
Symptoms, .74 for Conduct Problems, and .83 for
Peer Problems (Goodman, in press; Goodman, un-
published observations). Smedje et al. (1998) re-
ported a test-retest reliability of .96 for total score
over a 2-week period in their small pilot sample
(N = 15).
19
Questionnaire Preference
Immediately after completing both questionnaires,
mothers of the low-risk sample were asked to tick a
box indicating which of the two questionnaires they
preferred. To avoid response bias related to the order
in which the questionnaires were listed in the prefer-
ence question, the order of listing was randomized.
Parent Interview
Within a week of completing the two question-
naires, the mothers of all 61 children in the psychi-
atric sample were a d m i n i s t e r e d a v a l i d a t e d
semistructured interview about their child's emo-
tional and behavioral symptoms: the Parental Ac-
count of Child Symptoms (PACS; Taylor, Schacher,
Thorley, & Wieselberg, 1986). The PACS interviews
were administered by trained interviewers who were
blind to the questionnaire scores. Parents were asked
for detailed descriptions of their children's behavior
over the previous year, with interviewers then rating
the severity and frequency of these behaviors on the
basis of their training and written criteria. The Inat-
tention-Hyperactivity scale was scored in the stand-
ard manner by summing the frequency and severity
items for attention span (time spent on a single ac-
tivity rated separately for four different kinds of ac-
tivity), restlessness (moving about during the same
activities), fidgetiness (movements of parts of the
body during the same activities), and activity level
(rated for structured situations such as mealtimes
and car journeys). Similarly, the Externalizing scale
was calculated from items concerning temper tan-
trums, lying, stealing, defiance, disobedience,
truanting, and destructiveness. The Internalizing
scale was calculated from items on misery, worrying,
fears, hypochondriasis, and obsessionality. In the
original validation study, interrater reliabilities for
pairs of raters ranged from .92 to .95 for the Inat-
tention-Hyperactivity scale, from .89 to .95 for the
Externalizing scale, and from .79 to .90 for the In-
ternalizing scale (Taylor et al., 1986). Additional nor-
mative data on this interview are presented in Taylor,
Sandberg, Thorley, and Giles (1991).
Statistical Analyses
Using analyses of receiver operating charac-
teristic curves to compare the discriminant validity of
20 Goodman and Scott
Comparison of SDQ and CBCL
the two questionnaires does not depend on the rep-
resentativeness of the two samples; it assumes only
that psychiatric disorder is commoner in the high-risk
than the low-risk group. Since the ROC curves for
the SDQ and CBCL were derived from the same set
of patients, the statistical comparison of the areas un-
der these ROC curves allowed for the paired nature
of the data (Hanley & McNeil, 1983). Comparisons
of correlations also allowed for the paired nature of
the data, using structural equation modeling (EQS;
Bentler, 1989) to examine whether constraining the
correlations to be the same resulted in a significantly
poorer fit. For example, when an SDQ-interview cor-
relation differed from the corresponding CBCL-in-
terview correlation, the significance of this difference
was examined by comparing two different structural
equation models: one allowing the correlations to be
different and the other constraining the correlations
to be equal. The difference in correlations was sig-
nificant if the goodness of fit of the constrained
model was significantly poorer than that of the un-
constrained model (Dunn, Everitt, & Pickles, 1993).
RESULTS
Age and Gender
The two samples did not differ significantly in
age: The mean age (SD) of the psychiatric sample
was 6.0 years (1.1) while that of the dental sample
was 6.2 years (1.2) (t = 0.60, 130 df, n.s.). Though
the proportion of males was higher in the psychiatric
sample (74%, 45/61) than in the dental sample (56%,
40/71), the difference was not significant (continuity-
adjusted i2 = 3.62, 1 df, p = .06). The results re-
ported here are for boys and girls combined, but a
similar pattern of results emerged when boys and
girls were analyzed separately.
Discriminating Between Low-Risk and High-Risk
Samples
Using both questionnaires, there were substan-
tial mean differences in the scores obtained by the
low-risk and high-risk samples (Table I). The relative
ability of the SDQ and CBCL to distinguish between
these two samples can be judged from the areas un-
der the receiver operating characteristic curves for
equivalent scales (Table I). As a guide to interpreta-
21
tion, the area under the curve would be 1.0 for a
measure that discriminated perfectly, and .5 for a
measure that discriminated with no better than
chance accuracy. Both questionnaires discriminated
well, with an area under the curve of around .95 for
Total and Externalizing scales. In no instance did the
area under the curve for the equivalent SDQ and
CBCL scales differ significantly.
SDQ-CBCL Correlations
Table II shows the correlations between the
equivalent SDQ and CBCL scales. All correlations
were statistically significant (p < .001). Though the
Prosocial scale of the SDQ and the competence scale
of the CBCL share a focus on positive attributes,
they were not considered to be equivalent scales
since they differ so markedly in item content.
Correlation with Interview Scores
For children in the psychiatric sample, it was
possible to examine how well the questionnaire
scores predicted detailed investigator-based ratings
of internalizing symptoms, inattention-hyperactivity,
and externalizing problems, derived from semistruc-
tured parent interviews. Table III shows the correla-
tions between these interview measures and the
equivalent SDQ and CBCL scores, e.g., between the
interview measure of internalizing symptoms and
either the SDQ Emotional score or the CBCL Inter-
nalizing score. For internalizing symptoms and exter-
nalizing problems, the interview-questionnaire
correlations were comparable for the two question-
naires. For inattention-hyperactivity, however, the in-
terview rating correlated significantly more highly
with the SDQ score than with the CBCL score; con-
straining the two correlations to be equal led to a
significant worsening of the structural equation
model (x2 = 6.14, 1 df, p < .02). When considering
the magnitude of some of the correlations, it is worth
remembering that, in a clinical sample, symptom
scores are bunched toward the upper end of the
range, resulting in lower correlations than would be
found in a more heterogenous sample. However, this
effect will have applied equally to interview-SDQ and
interview-CBCL correlations.
22 Goodman and Scott

Table II. Correlations of Equivalent SDQ and CBCL Scales" Table IV. Intercorrelations of Different Scales from the
Problem scales SDQ-CBCL correlations Same Questionnairea

Total .87 Correlations of the two scores

Externalizing/Conduct .84 Problem scales For SDQ For CBCL
Inattention/Hyperactivity .71
Internalizing/Emotional .74 Externalizing-Inattention .65 .72
Social/Peer .59 Externalizing-internalizing .37" .63
"SDQ = Strength and Difficulties Questionnaire; CBCL = Child Inattention-Internalizing .35" .63
Behavior Checklist. All correlations significant at p < .001.
a
SDQ = Strengths and Difficulties Questionnaire; CBCL =
Child Behavior Checklist.
b
Significantly lower for SDQ than CBCL, p < .001.

Table III. Correlations of Questionnaires and Interview Scalesa

Correlations between interview
measure and:
Problem scales SDQ
Externalizing/Conduct .64
Inattention/Hyperactivity .43"
Internalizing/Emotional .53
a
SDQ = Strengths and Difficulties Questionnaire; CBCL = Child
Behavior Checklist.
b
Significantly greater SDQ-interview correlation than CBCL-inter-
view correlation, p < .02.
Cross-Domain Correlations for Each Questionnaire
The three main domains of psychopathology
tapped by each questionnaire are externalizing prob-
lems, inattention-hyperactivity, and internalizing
symptoms. Table IV shows how scores for these three
domains correlated with one another, considering
each questionnaire separately. The externalizing-in-
attention correlations were comparable whether ob-
tained from the SDQ or CBCL; a structural equation
model that constrained the two to be equal did not
fit significantly worse than an unconstrained model
(X2 = 2.52, 1 df, p = .11). By contrast, the external-
izing-internalizing and inattention-internalizing cor-
relations were significantly higher with the CBCL
than with the SDQ (f = 18.43, 1 df, p < .001 for
externalizing-internalizing; x2 = 18.54, 1 df, p < .001
for inattention-internalizing).
For the children in the psychiatric sample, it was
possible to compare cross-domain correlations for
the questionnaire and interview measures. The exter-
nalizing-internalizing correlation was .05 for the in-
terview, .02 for the SDQ, and .52 for the CBCL
(CBCL correlation but not SDQ correlation signifi-
cantly different from the interview correlation; %2 =
10.51, 1 df, p < .002). The inattention-internalizing
correlation was .13 for the interview, .05 for the
SDQ, and .42 for the CBCL (representing a trend
CBCL for the CBCL correlation but not the SDQ correla-
.52
tion to differ from the interview correlation; j} =
.15 2.75, 1 df,p < .1).
.44
Questionnaire Preference
Of the 71 mothers from the low-risk sample, 64
expressed a preference for one or other question-
naire: 41 preferred the SDQ and 23 preferred the
CBCL—a significant difference (sign test, z = 2.25,
p < .025). Mothers from the high-risk sample were
not asked which questionnaire they preferred.
DISCUSSION
As hypothesized, scores derived from the in-
formant-rated Strengths and Difficulties Question-
naire (Goodman, 1997) and the Child Behavior
Checklist (Achenbach, 1991a) correlated highly with
one another, and the two questionnaires were equally
able to discriminate between children drawn from
high-risk and low-risk samples. This equivalence is
striking since the SDQ is only around a fifth of the
length of the CBCL.
Other things being equal, shorter scales are nor-
mally less reliable than longer scales, thereby attenu-
ating validity too (Streiner & Norman, 1989). In this
instance, though, the brevity of the SDQ did not reduce
its criterion validity, as judged against a standardized
semistructured interview: The interview-based ratings
correlated more highly with the SDQ than with the
CBCL scores, with this difference being statistically
significant for inattention-hyperactivity. Why should
the 5-item SDQ Inattention-Hyperactivity scale have
Comparison of SDQ and CBCL
greater criterion validity than the corresponding 11-
item CBCL scale? One possible explanation is that
the SDQ scale has greater content validity since item
selection was guided by DSM-IV and ICD-10 diag-
nostic criteria for ADHD (APA, 1994) and hyperki-
nesis (World Health Organization, 1993). Drawing on
a large body of empirical studies, both classifications
emphasize that the core symptoms domains are in-
attention, hyperactivity, and impulsiveness. All five
SDQ items are drawn from these three domains,
whereas many of the CBCL items tap different symp-
tom domains: immaturity, confusion, nervousness,
twitching, poor school work, and clumsiness. Increas-
ing scale length by including items that are concep-
tually marginal may only serve to undermine validity.
The correlation between the Internalizing and
Externalizing scales was significantly lower for the
SDQ than for the CBCL. This was not because all
interscale correlations were attenuated for the
shorter questionnaire: The externalizing-inattention
correlation was almost equally high for the SDQ and
CBCL. Two alternative explanations are plausible.
On the one hand, the lower SDQ internalizing-ex-
ternalizing correlation may reflect the SDQ scales
being less contaminated by one another than the
comparable scales from the CBCL. Alternatively, the
higher CBCL internalizing-externalizing correlation
may be a more accurate reflection of real comorbid-
ity. While there is no doubt that comorbidity exists
(Caron & Rutter, 1991), the question is whether this
comorbidity is underestimated by the SDQ or over-
estimated by the CBCL. The present findings are
more suggestive of the latter since, when interview-
based correlations were low, SDQ correlations were
also low, whereas CBCL correlations remained high.
These findings require confirmation on larger and
more representative samples, but they do support the
notion that the CBCLs Internalizing and Externaliz-
ing scales are indeed more contaminated by one an-
other than are the comparable SDQ scales.
Parents of the low-risk sample were significantly
more likely to prefer the SDQ to the CBCL, perhaps
because of the SDQ's brevity and greater emphasis
on strengths. The preference of parents whose chil-
dren are at high psychiatric risk has yet to be estab-
lished; perhaps they welcome the opportunity
provided by the CBCL to report on a broader range
of psychopathology.
The results of this study are necessarily prelimi-
nary, being based on a comparison of two relatively
small samples of young children at high and low risk
23
of psychiatric disorders. It will obviously be impor-
tant to attempt to replicate these findings on a
broader age range, using larger samples, including
community samples and diverse clinical samples.
Such studies could also compare the informant-rated
SDQ completed by teachers with the Teacher Report
Form (TRF; Achenbach, 1991b), and the self-report
SDQ (Goodman et al., 1998) with the Youth Self-
Report (YSR; Achenbach, 1991c).
Pending such larger-scale studies, the current
findings suggest that the SDQ and CBCL are com-
parable in many ways. Consequently, either question-
naire would be suitable for many purposes. In some
respects, however, the two questionnaires have differ-
ent strengths. The SDQ's brevity and its acceptability
to the parents of low-risk children may make it a par-
ticularly suitable screening measure for community
studies where response rates are liable to be under-
mined by long or negatively slanted questionnaires.
The SDQ may also provide a more useful measure
of inattention and hyperactivity. On the other hand,
the CBCL covers a broader range of problems, par-
ticularly suiting it for studies or clinical assessments
that require coverage of rare as well as common
forms of childhood psychopathology. Both question-
naires have their value but serve somewhat different
purposes.
ACKNOWLEDGMENTS
We are very grateful to all participating parents;
to Hilary Richards, Quentin Spender, Pippa Hoad,
Julia Featherstone, Jenny Price, Rosemarie Berry,
Moira Doolan, and Deborah Fulford for their assis-
tance in data collection and coding; and to all the
staff of the clinics that took part in the study: the
Department of Paediatric Dentistry of King's Dental
Institute; the Children's Department of the Maudsley
Hospital; the Child and Family Psychiatry Clinic,
Croydon; and the Child and Family Service for Men-
tal Health, Chichester. Data on the psychiatric sam-
ple were obtained in the course of a study funded
by the National Health Service Research and Devel-
opment Executive.
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