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Citation: Sheel, H.; Suárez, L.; Marsh,
N.V. Screening Children in India:
Translation and Psychometric
Evaluation of the Parents’Evaluation of
Developmental Status and the Strength
and Difficulties Questionnaire. Pediatr.
Rep. 2023,15, 750–765. https://
doi.org/10.3390/pediatric15040067
Academic Editor: Maurizio Aricò
Received: 13 September 2023
Revised: 6 December 2023
Accepted: 8 December 2023
Published: 14 December 2023
Copyright: © 2023 by the authors.
Licensee MDPI, Basel, Switzerland.
This article is an open access article
distributed under the terms and
conditions of the Creative Commons
Attribution (CC BY) license (https://
creativecommons.org/licenses/by/
4.0/).
Article
Screening Children in India: Translation and Psychometric
Evaluation of the Parents’ Evaluation of Developmental Status
and the Strength and Difficulties Questionnaire
Hina Sheel 1,2, Lidia Suárez 1and Nigel V. Marsh 1 ,*
1School of Social and Health Sciences, James Cook University, Singapore 387380, Singapore;
hina.sheel@dmu.ac.uk (H.S.); lidia.suarez@jcu.edu.au (L.S.)
2School of Health and Life Sciences, De Montfort University, Academic City,
Dubai 294345, United Arab Emirates
*Correspondence: nigel.marsh@jcu.edu.au
Abstract:
Timely screening and surveillance of children for developmental delay and social–emotional
learning difficulties are essential in Low- and Middle-Income Countries like India. Screening mea-
sures like the Parents’ Evaluation of Developmental Status (PEDS) and Strength and Difficulties
Questionnaire (SDQ) are considered suitable for India due to their low cost, easy accessibility, and
no training requirement for administration. However, India lacks validated screening measures,
and the PEDS and SDQ have yet to be validated for children in India. The study aimed to translate
the PEDS and SDQ from English to Hindi and psychometrically evaluate the same measures on
children aged 4–8 years in India. The original PEDS and SDQ forms and their translations were pilot
tested on 55 participants and evaluated using data from 407 children with typical development (TD)
and 59 children with developmental disability (DD). Parents and teachers reported no meaningful
discrepancy between the original and translated (Hindi) questionnaires. Internal consistency for the
PEDS was acceptable, but unacceptable for most subscales on the SDQ, for both TD and DD samples.
Test–retest reliability was poor for the PEDS but adequate for the SDQ. Results from known-group
validity testing showed that the PEDS scores could be used to distinguish between the TD and DD
samples. The results from this study provide further support for the use of the PEDS and SDQ in
developing countries like India.
Keywords: PEDS; SDQ; translation; cross-validation; children; India
1. Introduction
Meeting developmental milestones is a crucial aspect for the growth of a healthy
child [
1
]. The Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition, Text Revision
(DSM-5-TR) classified DD as an Intellectual Developmental Disorder (IDD), characterized
by a lack of general mental capacities and adaptive functioning [
2
]. Individuals with
DD may struggle with social relationships when compared to neurotypical peers, and
they may read nonverbal and subtle social signs differently [
3
]. Evidence from global
health databases suggests that about 240 million children globally have developmental
disabilities, with the majority of these children being from Sub-Saharan Africa (69.9 million)
and South Asian countries (64.4 million children) [
4
]. In India, about 10% of children
have developmental delays resulting in disabilities, while nearly 6% of infants are born
with congenital disabilities [
5
]. Social–economic factors such as poverty, poor health,
lack of infrastructure, and limited developmental literacy are risk factors for the delayed
identification of children with impaired developmental, cognitive, and social–emotional
functioning [
6
]. Cities across India lack clinics and trained professionals to provide rigorous
diagnoses and interventions under one roof [
7
]. Furthermore, there is limited research
conducted on children from a specific population and a lack of comparative studies between
Pediatr. Rep. 2023,15, 750–765. https://doi.org/10.3390/pediatric15040067 https://www.mdpi.com/journal/pediatrrep
Pediatr. Rep. 2023,15 751
children with TD and DD in India [
7
,
8
]. Therefore, timely screening and surveillance of
children in Low- and Middle-Income Countries (LMIC) is essential [1].
Developmental screening seeks to identify impairments in specific areas by healthcare
professionals/doctors using a brief questionnaire [
9
]. Identifying which children may have
a learning disability and require early intervention is the initial step [
9
]. Measures devel-
oped in Western countries are frequently used when assessing children for Developmental
Disability (DD) and Social–Emotional Learning (SEL) in LMIC [
10
]. Specifically, measures
from the United States and the United Kingdom are increasingly used in cultures other
than those in which they were developed [
11
]. In theory, culture plays a vital role in the
child’s social, cognitive, and motor development [
10
]. However, there is no consensus
regarding the most effective screening tool for detecting delay and disability in children
from diverse cultural settings. There is a scarcity of validated measures available to identify
children with DD and SEL in LMIC [12].
The Parents’ Evaluation of Developmental Status (PEDS) and the Strength and Diffi-
culties Questionnaire (SDQ) are considered to be suitable for a LMIC country like India
because they are self-reporting, low cost, easily accessible, and do not require any training
for administration [
13
,
14
]. Glascoe [
15
] reported the PEDS to be accurate for children in
America with adequate sensitivity, specificity, interrater and test–retest reliability. In India,
the English version of the PEDS has yet to be validated. The SDQ was validated on British
children and had good internal consistency and predictive validity. However, the test–rest
reliability was relatively poor [16].
Parents are exclusively regarded as the primary source of obtaining developmental
and behavioral information about their children, and there is extensive literature to support
parent-completed screening tools [
13
,
17
]. However, recently, there has been a growing
appreciation for the teachers’ contribution to the screening and diagnostic process [
18
].
Evidence indicates that classroom teachers can reliably rate children’s learning effectiveness.
Teachers can differentiate between students at risk for anti-social behavior and typically de-
veloping students at an early age [
19
]. Some screening tools, like the SDQ, have equivalent
forms for both parents and teachers to complete.
Sheel et al. [
20
] conducted a scoping review of research from 1990–2020 to assess
whether the PEDS, PEDS:DM, and SDQ were widely utilized in India. The review found
that only a few studies have employed these screening tools. The PEDS:DM was not used,
and scant published literature existed on the use of the PEDS in India. Most of the literature
consisted of text and opinion-based evidence emphasizing the lack of screening in India
and the limited use of the PEDS to screen children for developmental delays. Furthermore,
only two studies briefly mentioned translation of the PEDS questionnaires [
12
,
21
]. The
review also found that the SDQ was administered to the Indian population and used as
a screening tool to compare mental health across age groups. The SDQ was found to
effectively differentiate groups of individuals concerning SEL and behavioral concerns.
Since India is a diverse country with many regional languages, the studies that used the
SDQ catered to various population types and translated the questionnaire to regional and
national languages.
In a recent study, Mukherjee et al. [
22
] validated the Hindi version of the PEDS and
PEDS:DM on children under two years old. The study concluded that the measures are
unsuitable for developmental screening due to their sub-optimal diagnostic accuracy. In
addition, for the past two years, several studies have used the SDQ on children in India
but have not investigated the psychometric properties of the measure [
23
–
28
]. However,
it appears that the PEDS and SDQ have yet to be used together to screen children for
developmental delay and SEL in India.
Understanding language is essential for all self-report instruments, where the re-
sponders answer many questions in oral and written format [
29
]. Thus, translating an
instrument to meet another country’s language and cultural needs is essential. Abdoola
et al. [
30
] reported that in LMIC countries, if screening tools like PEDS are not translated
and adapted, they may only sometimes be appropriate developmental surveillance tools
Pediatr. Rep. 2023,15 752
within these contexts due to cultural and linguistic differences. Rigorous translation and
cultural adaptation processes for self-report instruments have not been adopted for use in
DD, Autism Spectrum Disorder, and general populations [
31
,
32
]. Specifically, English and
translated Hindi versions of the PEDS and SDQ are yet to be psychometrically evaluated
for use with children in India [20].
Considering the need for active developmental and SEL screening and the lack of
validated measures available for LMICs like India, the present study aimed to first translate
the PEDS and SDQ from English to Hindi. Second, the study evaluated the psychometric
properties (reliability and validity) of the translated measures when used with parents and
teachers of children in India.
2. Measures
2.1. Parents’ Evaluation of Developmental Status (PEDS)
The PEDS [
33
] is a surveillance and screening tool for children aged 0–8 years. The tool
elicits and addresses parents’ concerns about development, behavior, and mental health.
The tool comprises one form with 10 questions across 10 categories (expressive language;
receptive language; and social–emotional, behavioral, fine motor, gross motor, self-help,
school, cognitive, and health issues). The questions in the PEDS elicit parents’ perspectives
of their child’s development and their answers are used to classify their child as high,
medium, or low risk. The response options are “yes”, “no”, and “a little”. The scoring
for the PEDS includes columns for each age range and identifies which concerns predict
problems and which do not. Furthermore, the form directs the investigator to one of five
evidence-based decisions regarding the results. Path A indicates two or more predictive
concerns, Path B includes one predictive concern, Path C includes nonpredictive concerns,
Path D includes parental difficulties in communication, and Path E includes no concerns.
The PEDS interpretation form contains an algorithm to decide whether to refer, screen
further, or observe the child, or counsel or reassure the parents on the results obtained [
33
].
Sheel et al. [
20
] reported that the PEDS was restandardized and revalidated in 2013 [
15
].
The interrater reliability was 0.95, and the test–retest reliability was 0.88 [
15
]. The PEDS
accurately and rapidly differentiates children with developmental delay with a sensitivity
of 86% and specificity of 74% [
34
]. The PEDS is considered one of the promising measures
for use across settings in LMIC [12].
2.2. Strengths and Difficulties Questionnaire (SDQ)
The SDQ was developed in the United Kingdom. This screening measure evaluates
mental health problems in children aged 2–17 years [
16
]. It comprises 25 questions under
five domains: (a) emotional symptoms, (b) conduct problems, (c) hyperactivity/inattention,
(d) peer-relation problems, and (e) prosocial behavior, and parents and teachers complete
it [
14
]. This screening tool includes a 3-point rating scale: not true,somewhat true, and
certainly true. The scoring for the SDQ comprises the total difficulty score, which is obtained
by summing the scores for four scales, excluding the prosocial scale. The total score
ranges from 0 to 40. The cut-off points for the SDQ scores are “normal”, “borderline”, and
“abnormal” [16].
Sheel at el. [
20
] reported that Kresten et al. [
35
] found the SDQ has sound psychometric
properties. The screening measure internal consistency is 0.73, and the test–retest reliability
is 0.62. The discriminative and convergent validity are 0.80, and 0.50, respectively, and the
specificity and sensitivity are above 70% [35].
3. Translation of PEDS and SDQ to Hindi
The current study utilized the guidelines recommended by Guillemin et al. [
36
]. These
guidelines recommend translation, back translation, committee meetings, expert review
of this translation and back translation, and pilot-testing interviews ensuring cultural
acceptability and face validity of the tool.
Pediatr. Rep. 2023,15 753
Expert and professional judgments are often used to assess measures’ content and
face validity. Face validity is the extent to which a measure appears to the user to reflect
what it is intended to measure [
37
]. Although face validity is not a true measure of validity,
it is essential for obtaining participant cooperation and engagement, so it is typically
considered during preliminary checks of questionnaires [
38
]. However, what experts may
consider suitable face validity may not be appropriate for service users [
39
]. Therefore,
to ensure face validity, it is vital to conduct pilot testing interviews with service users to
determine any discrepancies and difficulties between the original English and translated
Hindi questionnaires.
3.1. Translation
Guillemin et al. [
36
] stated that translations are of higher quality when undertaken
by at least two translators. Therefore, two independent translators conducted the forward
translation process. The PEDS and SDQ were translated into the target language, Hindi.
The translators were native to the target language and culture. They were aware of the
objective underlying the material to be adapted and the concepts involved, to provide more
restitution of the intended measurement [
36
]. To ensure quality, the two translators helped
identify discrepancies in translation interpretations [40].
3.2. Back Translation
Back translation helps to improve the quality of the final version of the instrument and
compromises one or multiple translators [
36
]. This method helps to highlight translation
errors that may have occurred in the forward translation and would impact the study’s
validity [
36
]. Two additional translators who were also native to the target language and
culture conducted the back translation for the two forms (PEDS and SDQ). Back translation
aimed to determine any discrepancy between the original and translated forms and help
improve the overall quality of the final version of the translated questionnaire. A similar
process was followed by Juneja et al. [
41
], where the authors translated and back-translated
the Ages and Stages Questionnaire to screen children with DD in India.
The forward-back translations used bilingual translators. The translators’ first lan-
guage was Hindi, they all completed a degree in English or Hindi and worked as language
translators of content and video scripts for Indian government schools and organizations.
3.3. Committee Meeting
Once the translation and back translations were completed, one of the authors (HS)
chaired a meeting with the four translators to proofread the translated questionnaires and
compare the preliminary translation with the original English questionnaires. There were
three questions in the PEDS and six questions in the SDQ that had discrepancies in the
forward–back translation process. During the meeting, the author and the translators
resolved the questions with more culturally appropriate words and phrases. Thus, the
panel (author and the translators) agreed on the screening measure translation quality.
3.4. Expert Review
Two experts in the field of DD and SEL, with experience in working with young
children, fluent in both English and Hindi languages, and registered with the Rehabilitation
Council of India (RCI), reviewed the original and final versions of the PEDS and SDQ in the
domains of target language and culture [
42
]. The experts reviewed the measures, agreed
with the translation, and found no discrepancy or difficulty between the English and Hindi
translation, ensuring face validity and cultural acceptability of the questionnaires. The
final version of the instrument ensured semantic, idiomatic, experiential, and conceptual
equivalences before pilot testing was conducted, which is essential as reported in Dubay
and Watson [29] and Guillemin et al. [36] studies.
Pediatr. Rep. 2023,15 754
3.5. Pilot Testing Interviews
Brooks et al. [
43
] defined pilot testing interviews as “an initial small-scale implemen-
tation that is used to prove the viability of the project idea” (p. 52). In the current study,
pilot testing interviews included evaluating whether respondents understood the meaning
of items, identified rarely used phrases in the local context, and determined disparity in
sentence structure between the original and translated forms [44].
The pilot study was approved by the Human Research Ethics Committee of James
Cook University (HREC number: H8285). The Participant Information Sheet, detailing the
study and the type of information required, was provided to participants through Qualtrics.
Qualtrics is a software tool that is used to conduct survey research and evaluations. The
platform is fast, easy to use, and can store large volumes of data at any given time [
45
].
Once the participants read the information and consented to participate in the study, they
were presented with the two measures (PEDS and SDQ (English and Hindi versions)). The
participants completed the questionnaires, and each participated in an online interview to
check their interpretation and understanding of the screening measures. The total time to
complete the form and answer the interview questions was 30 min.
3.5.1. Participants
A group of 55 participants were recruited to demonstrate their interpretation and
understanding of the original and translated questionnaires for the pilot test. Through
purposive sampling, 21 parents and 34 teachers of children aged 4–8 years were recruited
from various socioeconomic backgrounds in Chandigarh and the National Capital Region,
India. Inclusion criteria for participants were parents of children aged 4–8 years who were
citizens of India and could read, write, and speak at least at the Primary 6 level in either
English or Hindi. Inclusion criteria for teachers were teaching children aged 4–8 years who
were citizens of India and could read, write, and speak at least at the Primary 6 level in
either English or Hindi. Exclusion criterion was parents whose child was not currently
attending school. The demographic characteristics of the parent participants are presented
in Table 1.
Table 1. Demographic Characteristics of the Pilot Study Participants (Parents).
Demographic Characteristics n%
Parent
Mother 19 90
Father 2 10
Highest Educational Qualification
Certificate/Diploma 2 10
Undergraduate Degree 1 4
Postgraduate Degree 18 86
Yearly Household Income
<75,000 INR * 4 19
INR 0.75–1.5 lakhs 1 5
INR 1.6–3 lakhs 1 5
INR 3.1–5 lakhs 4 19
INR 5.1–10 lakhs 3 14
>10 lakhs 8 38
Note. *A lakh in Indian rupees is equivalent to one thousand US dollars.
For the parent report group, the children’s mean age was 5.9 years (SD = 1.44,
range = 4–8 years
), and the majority (n= 13, 62%) were female. Most of the children (n= 20,
95%) displayed Typical Development (TD). However, a few parents indicated that their
child displayed speech and hearing problems, low attention span, or behavioral issues
across the two screening measures.
A total of 34 teachers filled out the SDQ questionnaire regarding a specific child
they were teaching. The child reference group had a mean age of 6.29 years (SD = 1.29,
Pediatr. Rep. 2023,15 755
range = 4–8 years
), and the majority (n= 27, 79%) were male. Most of the children (n= 30,
88%) displayed TD. Only four children had DD, such as speech and hearing impairment
and mild to severe autism spectrum disorder.
3.5.2. Procedure
The sample size for the current study was adequate for a pilot study since studies
have concluded that data must be collected with purposive sampling until saturation is
reached [
46
,
47
]. Parents were recruited through schools and social media tools by sharing
links of the questionnaire with groups and requesting parents and teachers of children in
the age range of 4–8 years to fill the questionnaires and participate in an online interview
using Qualtrics.
The pilot study was conducted using Qualtrics, where participants filled out the
original and translated questionnaires and participated in an online structured interview.
Fully structured interviews require the questions, probes, and responses necessary to be
standardized where no practitioner-based inquiries are allowed [
48
]. In the Qualtrics
structured interviews, the researcher asked the following questions regarding the original
and translated questionnaire: Was there any difficulty in understanding the English and
Hindi questions? Did you find the questions upsetting and offensive? Did you find any
questions confusing to understand? And did you find any discrepancy between the original
English and translated Hindi questions presented to you? Participants responded with
either “Yes” or “No”. If they answered yes to any question, the researcher sought further
clarification on those specific questions.
3.5.3. Results
Parents’ and teachers’ responses were collated and summarized. Ninety-five percent
of the participants agreed that there was no discrepancy between the original English and
translated Hindi Questionnaire for PEDS and SDQ. However, two teachers were unclear
about the intent and context of the English SDQ questions like “Constantly fidgeting or
squirming” and “Gets on better with adults than with other children”. The researcher
(HS) took note of the queries and provided clarifications on those specific questions to the
participants through a telephone conversation. The questions were not altered when further
administered since the concerns were regarding the intent of the original questionnaire
(English) and not the translation quality of the questionnaire from English to Hindi.
4. Psychometric Evaluation of the Translated Measures
Once the forward–back translation of the screening measures was completed, which
found the PEDS and SDQ to have adequate face validity for the original and translated
version of the measures, the second part of the study aimed to psychometrically evaluate
the PEDS and SDQ to ensure the measures are suitable for use with Indian children. The
study aimed to explore both the reliability (internal consistency and test–retest) and validity
(known group validity) of the two measures.
Reliability is “the consistency of scores across instances of testing procedures” ([
49
], p. 34).
Internal consistency is the extent of agreement between different items within a test during
single administration. In contrast, test–retest reliability is the consistency of scores obtained
by administration of the same test on separate occasions [
49
]. Cronbach’s alpha of >0.70 for
internal consistency [
50
] and a Pearson correlation of >0.70 for test–retest reliability [
51
] are
considered acceptable for demonstrating reliability. For health status measures intended
for long-term use, the recommended test–retest interval is one to two weeks [52].
Validity refers “to the degree to which evidence and theory support the interpretation
of test scores for proposed use of tests” ([
49
], p. 11). Based on the results of pilot testing,
the current study assumed that the English and Hindi versions were equivalent. So, the
data collected for psychometric evaluation used either language version, as selected by
the participants.
Pediatr. Rep. 2023,15 756
4.1. Reliability: Internal Consistency
4.1.1. Research Setting
The study was conducted in India, which follows the British structure in the education
system with kindergarten for 4–6 years of age, primary school for grades 1–5 (children aged
6–11 years), and middle school for grades 6–8 (children aged 11–14 years [
53
]). The schools
were categorized as private, government, and primary schools run with the municipal
cooperation of the cities in which they exist [54].
Participants were recruited from private inclusive schools in rural and urban areas of
Chandigarh, Himachal Pradesh, Punjab, Haryana, and the National Capital Region, India.
Inclusive schools cater to children with TD and DD. Children were categorized as DD based
on their school records; clinicians assess children in government hospitals using standardized tests
and present their reports to the school for admission. Furthermore, all the states and union
territories are located in North India, where people are fluent in Hindi, English, and the
states’ regional languages [55].
4.1.2. Participants
For thistype of research, Bujang and Adnan [
56
] recommend a sample size of 300 children.
Considering a potential attrition rate of 20% [
57
], 720 (360 parents and 360 teachers) partici-
pants of children with TD and additional 240 participants (120 parents and 120 teachers) of
children with DD were required to be recruited for research.
For the current study, participants comprised a convenient sample of parents and
teachers of 466 children: 454 with TD and 61 with DD. Data for 47 children with TD and
2 with DD were excluded due to missing data and/or because the participants did not
meet the inclusion criteria. Therefore, the final sample consisted of parents and teachers of
407 children with TD and 59 children with DD. In addition, a 25-item SDQ (teacher form)
was completed by 138 teachers of the children with TD and DD. Parents were asked if
they could be contacted to participate in a follow-up study (either the test–retest study or
the known-group validity study). If they agreed, they provided their phone number and
email address.
The inclusion and exclusion criteria for the participants were the same as for the pilot
study. Demographic characteristics of the participants are presented in Table 2.
Table 2.
Demographic Characteristics of Participants (Parents) for the Psychometric Evaluation Studies.
Demographic
Characteristics
Reliability (Internal Consistency)
(n= 466)
Reliability (Test–Retest)
(n= 48)
Validity (Known Group)
(n= 38)
TD DD TD DD TD and DD
Gender of the Child
Males 259 (64%) 43 (73%) 27 (64%) 5 (83%) 22 (58%)
Females 148 (36%) 16 (27%) 15 (36%) 1 (17%) 16 (42%)
Parent
Mother 276 (68%) 41 (69%) 33 (79%) 3 (50%) 27 (71%)
Father 131 (32%) 18 (31%) 9 (21%) 3 (50%) 11 (29%)
Highest Educational Level
Middle school 14 (3%) 23 (39%) 3 (7%) 0 (0%) 7 (18%)
High school 35 (9%) 4 (8%) 1 (2%) 0 (0%) 1 (3%)
Diploma 21 (5%) 5 (8%) 1 (2%) 0 (0%) 2 (5%)
Undergraduate degree 118 (29%) 15 (25%) 12 (30%) 5 (83%) 12 (31%)
Postgraduate degree 219 (54%) 12 (20%) 25 (59%) 1 (17%) 16 (42%)
Yearly household income
<75 k 67 (16%) 28 (47%) 7 (17%) 1 (17%) 11 (29%)
75 k–1.5 Lac 55 (14%) 6 (10%) 5 (12%) 0 (0%) 8 (21%)
1.6–3 Lac 42 (10%) 9 (15%) 2 (5%) 1 (17%) 7 (18%)
3.1–5 Lac 90 (22%) 4 (8%) 9 (21%) 0 (0%) 4 (10%)
5.1–10 Lac 88 (22%) 11 (19%) 10 (24%) 4 (66%) 4 (66%)
>10.1 Lac 65 (16%) 1 (1%) 9 (21%) 0 (0%) 2 (5%)
Note. TD = Typical Development, DD = Developmental Disability.
Pediatr. Rep. 2023,15 757
4.1.3. Procedure
The study received approval from the Human Research Ethics Committee (H8285)
to administer the screening questionnaires to parents and teachers of children aged 4 to
8 years. Data collection was conducted online using Qualtrics from all-inclusive schools
in India.
4.1.4. Results
Cronbach’s alpha [
58
] was used to determine the internal consistency for the PEDS,
and the five subscales and Total Difficulties score of the SDQ [
15
,
16
]. Reliability was
considered acceptable if >0.70 [50].
The PEDS internal consistency was acceptable (0.83 for parents of children with TD
and 0.73 for parents of children with DD). The internal consistency reliability for most of
the SDQ subscales, specifically Peer Problem for parents and teachers of children with TD
and DD, was below standard (Table 3).
Table 3. Internal Consistency of the SDQ with Parents and Teachers of Children with TD and DD.
SDQ Subscales TD DD
Parent Teacher Parent Teacher
Total Difficulties 0.63 0.78 0.75 0.76
Emotional Symptoms 0.61 0.82 0.56 0.57
Conduct Problem 0.49 0.56 0.61 0.63
Hyperactivity 0.53 0.71 0.62 0.62
Peer Problem 0.30 0.40 * *
Prosocial Behavior 0.61 0.78 0.63 0.63
Note. * represents a negative internal consistency tabulated using Cronbach’s Alpha.
4.2. Reliability: Test–Retest
4.2.1. Participants
To determine the sample size for test–retest reliability with an interval of 2 weeks across
all questionnaires [
52
], a power analysis was conducted using G*power to test correlation,
a medium effect size of (d = 0.3) and an alpha of 0.05. Based on the assumptions, the
minimum sample size required was 84 [59].
A test–retest procedure evaluated the consistency of scores for the two questionnaires
(PEDS and SDQ). In the current study, 368 parents of the children with TD and DD provided
consent to be contacted for the retest, which involved completing the measures online again
after two weeks. However, only 48 parents (42 parents of children with TD and 6 parents of
children with DD) completed the questionnaires for the retest. Demographic characteristics
of these participants are presented in Table 2.
4.2.2. Results
Test–retest reliability was calculated using Pearson Product Moment correlation to
estimate the level of agreement between the test and the retest [
16
,
60
–
63
]. Generally,
reliability is considered acceptable if >0.70 [
51
]. More detailed guidelines recommend that
<0.40 is considered poor, 0.40 to 0.59 is fair, 0.60 to 0.74 is good, and >0.74 is excellent [64].
Table 4provides the test–retest reliability of the PEDS and the subscales of the parent
report on the SDQ. The retest occurred two weeks after the initial test. Results for the SDQ
subscales were variable, with fair to good reliability for emotional symptoms, hyperactivity,
prosocial behavior, and the total difficulty scale. Test–retest reliability for the two groups
on the PEDS was poor.
Pediatr. Rep. 2023,15 758
Table 4. Test–Retest Reliability for PEDS and Parent report SDQ.
Measure
Test–Retest Correlation
TD DD
PEDS 0.45 * −0.29
SDQ Subscales
Total Difficulties 0.73 * 0.81 *
Emotional Symptoms 0.72 * 0.89 *
Conduct Problem 0.52 * 0.57
Hyperactivity 0.64 * 0.80
Peer Problem 0.52 * 0.45
Prosocial Behavior 0.66 * 0.63
Note. * p< 0.01.
4.3. Validity: Construct-Related
4.3.1. Participants
Thirty-eight participants from the urban population were recruited to test known-
group validity. The first group comprised 24 TD participants from the higher and lower
PEDS quartile, and the second group comprised 14 participants with DD. Groups were
formed using a random number generator but were matched on gender and age. Demo-
graphic characteristics of the participants are presented in Table 2.
4.3.2. Procedure
A sample of children with TD and DD were assessed using established diagnos-
tic measures to establish known groups. Face-to-face assessment was conducted on the
school premises or in a place convenient to the participants. Children were administered
the original English language Kaufman Brief Intelligence Test—Second edition (KBIT-II;
ref. [
65
]), and parents and teachers of the children were interviewed to complete the par-
ent/caregiver and teacher forms of the Vineland Adaptive Behavior Scale—Third edition
(VABS-3; ref. [
66
]). The KBIT-II and VABS-3 results were used to validate group member-
ship, TD or DD. Parents were present during the KBIT-II assessment of their child.
4.3.3. Results
To confirm group membership, three t-tests were conducted to examine the differences
between the two groups (TD and DD) on each of the three criterion measures: the KBIT-II,
VABS-3 parent form, and VABS-3 teacher form. Chi-square analysis was used to assess the
construct validity of PEDS in distinguishing between the known groups (TD and DD).
On the KBIT-II, the difference between the TD group (mean = 99.54, SD = 15.34,
range = 68–130) and the DD group (mean = 83.86, SD = 14.84, range = 67–109) was statis-
tically significant (t(36) = 3.07, p= 0.004). The results from the clinical assessment found
that, on average, the TD group scored higher than the DD group on the measure of general
intelligence.
On the VABS-3 parent form, the difference between the TD group (mean = 109.04,
SD = 14.31, range = 87–134) and the DD group (mean = 92.43, SD = 12.62, range = 72–113)
was statistically significant (t(36) = 3.59, p= 0.001). Parents reported that children with TD
displayed more adaptive behavior than children with DD on the VABS-3 parent form.
On the VABS-3 teacher form, the difference between the TD group (mean = 110.17,
SD = 13.21, range = 89–136) and the DD group (mean = 93.07, SD = 13.21, range = 72–117)
was statistically significant (t(36) = 3.94, p= < 0.001). Teachers reported that children with
TD displayed more adaptive behavior than children with DD on the VABS-3 teacher form.
The results from the KBIT-II and VABS-III comparisons supported the difference
between the two groups. To assess the construct validity of the PEDS, a chi-square analysis
was conducted on groups by PEDS outcome X
2
(4, n= 38) = 21.14, p= < 0.001. The known
Pediatr. Rep. 2023,15 759
groups were rated as significantly different on the PEDS by their parents, with parents of
children with TD reporting less concerns than parents of children with DD on PEDS. This
provides support for the construct validity of the PEDS in distinguishing between children
with TD and DD.
5. Discussion
This report described the translation and psychometric examination of the PEDS and
SDQ when used to assess children with TD and DD in India. The forward–back translation
procedure with the PEDS and SDQ was effective as no discrepancies were found between
the original and translated Hindi version of the questionnaires.
Epstein et al.’s [
67
] study concluded that the forward–backward translation method
aids in reducing discrepancies between the original and source document resulting in more
satisfactory results. Rigorous translation provides an equivalence between the two versions
of the questionnaires, ensuring that any differences detected result from the differences
between the groups and not from contrasts inherent in the measurement tool used to gather
the data [
68
]. All participants in the translation and pilot study agreed that there were no
discrepancies or difficulties in the PEDS and SDQ English and Hindi language forms. This
outcome gave us confidence for establishing the cultural acceptability of the questionnaires.
Therefore, the results from the current study support DuBay and Watson’s [
29
] argument
of the necessity for a rigorous approach to translation and validation of screening measures
where cultural differences exist.
Psychometric evaluation of the measures indicated that the internal consistency for
PEDS was acceptable. However, the internal consistency for both parent report and teacher
report SDQ for children with either TD or DD was less than recommended by established
guidelines in most SDQ domains. Specifically, the Peer Problem scale for parents and
teachers of children with TD and DD was well below the recommended level. The test–
retest reliability was poor for PEDS and generally adequate for the parent report SDQ. The
use of the KBIT-II and VABS-3 (parent and teacher forms) provided objective assessment of
group membership for the examination of the validity of the PEDS.
In the current study, the PEDS had a robust internal consistency, similar to the findings
from studies conducted within community samples in LMICs, such as Tehran [
15
,
69
].
However, the test–retest reliability for the PEDS with TD children was poor. This contrasts
with results reported by Glascoe’s [
15
] study and research conducted in LMIC countries,
like Tehran [
69
], and with translated Dutch [
70
] and Mandarin [
71
] versions of the PEDS,
all of which have reported acceptable test–retest reliability.
One possible reason for the poor test–retest reliability found in the current study
is that it is likely that after the initial PEDS administration, most parents realized their
children could perform tasks they had not thought they would be able to [
72
]. In support of
this explanation, findings in the current study showed that parents’ concerns significantly
diminished following the initial screening. Further, the lack of routine screening results
in low developmental literacy in parents in LMICs compared to those in high-income
countries. Therefore, the initial PEDS administration could have acted as training for
parents in what to observe in their children, resulting in different responses being given on
the second administration of the PEDS. As the PEDS was not administered in an interview
format, parents were not able to describe and review their concerns with the interviewer.
Therefore, it is plausible that they would have reflected on the PEDS items after the first
administration, hence reporting less concerns in the retest [73].
The test–retest reliability for parents of children with DD was negative. However, with
a small sample size of only six participants, these findings cannot be considered meaningful,
leading to inaccurate results [51].
Glascoe [
33
] evaluated the concurrent validity of the PEDS with the Kaufman As-
sessment Battery for Children and the Vineland Adaptive Behavior Scale. The results
indicated a moderate to high correlation between the PEDS domains and the diagnostic
measures. The measures used in the current study, the KBIT-II and VABS-3, have been
Pediatr. Rep. 2023,15 760
found to differentiate between children with TD and DD [
74
] and were used here to provide
validation of group membership. The results from the PEDS could distinguish between
the known groups of children with TD and DD, providing evidence for the concurrent
validity of PEDS scores. These current results are like those reported in a South African
study, where most parents of children at risk of DD had higher concerns than parents of
their age-equivalent peers on the developmental milestones of behavior, school, cognitive
development, and health [75].
On the SDQ, the internal consistency found in the current study was very similar
to findings from other LMIC, such as the Democratic Republic of the Congo (parent and
teacher; community sample; [
76
]), Vietnam (parent; clinical and community samples; [
77
])
and South Africa (caregivers; community sample; [
78
]), and High-Income Countries, such
as Australia (parent; community sample; [
79
]), Germany (parent; community sample; [
80
]),
Sweden (parent; clinical and community samples; [
81
]), Netherlands (parent; community
samples; [
82
]; parent and teacher; community samples; [
83
]), New Zealand (parent and
teacher; community samples; [
84
]), and the United Kingdom (parent; community sam-
ples; [
85
]; parent, community; [
86
]). However, even higher internal consistency reliability
has been reported in Turkey (parent; community sample; [
87
]) and Germany (parent and
teachers; community sample; [88]).
In the current study, only six (25%) of the internal consistency correlations where
above the cut-off of 0.70. The results for the peer problem subscale were particularly poor.
Multiple factors could contribute to the wide range of the results obtained. First, Van
Widenfelt et al.’s [
83
] study found that low internal consistency for the peer problems
subscale could be due to one or two items not fitting with the remaining scale and parents
and teachers partially reporting existing problems, probably due to being only partly aware
or willing to report concerns on this subscale. Second, the SDQ consists of only five items
per subscale [
82
,
83
], and studies have reported that the low internal consistency of the
SDQ subscales could be attributed to the negative items in the five items of each subscale
contributing to measurement error [
89
]. Third, items in the peer problem subscale are
strongly linked with ASD, which includes social and communication impairments, whereas
the current study consisted of children with no disability and a range of developmental
disabilities [
82
,
90
]. Lastly, for the DD sample, the highest educational qualification for 39%
of the parents was middle school, which may have limited their ability to understand and
interpret the questions.
The current findings for test–retest reliability are similar to those reported in Aus-
tralia [
91
] and Japan [
61
], where the authors also provided a 2-week test–retest period. In
contrast, in the original study, Goodman [
16
] provided a test–retest period of four to six
months and reported moderate correlation coefficients. However, Goodman mentioned
that the period he used for test–retest should not be considered suitable as it was too long.
It is unclear what the most suitable test–retest interval for assessing the reliability of
the SDQ is. Polit [
52
] and Streiner et al. ([
92
], p. 172) recommended a two- to three-week
gap for obtaining accurate reliability. In contrast, Muris et al. [
82
] used a period of 2 months
and reported high reliability on the parent report SDQ. Studies carried out in Finland [
93
]
and Australia [
79
] found similar test–retest reliability coefficients as the current study, even
though the retest periods were 12 weeks and 12 months, respectively.
Systematic reviews of the SDQ’s psychometric properties have reported low test–retest
reliability [
35
]. Specifically, test–retest reliability is generally low for the parent report group
compared to that of the teacher report over time [
94
]. Overall, there is not a large body
of research findings on the SDQ’s test–retest reliability, and more research needs to be
conducted to explore the SDQ’s psychometric properties across cultures.
6. Limitations and Future Recommendations
Despite the rigorous translation process and the large sample recruited for the first
administration of the measures, the sample sizes were small for test–retest (n= 48) and
known-group (n= 38) validity testing. Furthermore, the study consisted of only children
Pediatr. Rep. 2023,15 761
aged 4–8 years and from a few states in North India; this is not a national representation
of India, which has 28 states and multiple languages. Furthermore, since the data were
s collected during the COVID-19 pandemic, caution is recommended in generalizing the
results for a non-pandemic environment where physical attendance at school is the norm.
Future studies could conduct face-to-face pilot testing interviews for a more detailed
evaluation of the screening tools [
95
]. Moreover, India is multilinguistic, so the question-
naires may need to be adapted to regional languages to cater for a specific population.
Studies have shown that parents of children from low-socioeconomic backgrounds, who
often speak their native languages, can better report on their children when interviewed in
that native language [96].
Despite this limitation, this study is the first attempt to validate the PEDS and SDQ
using parents and teachers of children with TD and DD in India. This study included
children from rural and urban North India, making the results generalizable beyond the
usual urban-based studies. Furthermore, PEDS and SDQ were translated into Hindi,
allowing schools and clinics use of the tool for screening.
7. Conclusions
In summary, by following a rigorous translation and pilot testing procedure, this study
demonstrated the face validity and cultural accessibility of the PEDS and SDQ for the
Indian population. These positive results also raise the possibility of these measures being
suitable for use in other LMICs. While the findings for reliability were mixed, there was
evidence for the construct validity of the PEDS. The issues negatively impacting some of
the SDQ reliability coefficients were most likely a function of the nature of the items and
the lack of parental awareness of developmental phases in childhood.
It is vital to consider the critical construct and language issues when adapting measures
standardized for Western cultures for use in the Asian context [
1
]. However, this study
demonstrates that these issues are not insurmountable. The results also suggest that the
assessment process can be a way of educating parents on best practices to promote their
child’s development. The assessment process can be expanded to include information
about vigilant monitoring and childrearing, as well as provide parent training sessions [
33
].
Author Contributions:
H.S. wrote the manuscript under the supervision of L.S. and N.V.M.; H.S.
and N.V.M. conducted the data analysis. All authors have read and agreed to the published version
of the manuscript.
Funding: The APC is funded by James Cook University, Singapore (HDRCF202313).
Institutional Review Board Statement:
The study was conducted and approved by the Human Re-
search Ethics Committee of James Cook University, Australia (protocol code H8285 and
21 January 2021
).
Informed Consent Statement:
Informed consent was obtained from all subjects involved in the study.
Data Availability Statement:
The data are available at https://research.jcu.edu.au/data/default/
rdmp/home (accessed on 12 December 2023)—https://research.jcu.edu.au/data/published/b19b5
43076d211ed9b9a51fb9846a249/ (accessed on 12 December 2023).
Conflicts of Interest: The authors do not have any conflict of interest to disclose.
References
1.
Kiing, J.S.; Low, P.S.; Chan, Y.H.; Neihart, M. Interpreting Parents’ concerns about their Children’s development with the parents
evaluation of developmental status: Culture matters. J. Dev. Behav. Pediatr. 2012,33, 179–183. [CrossRef]
2.
American Psychiatric Association. Diagnostic and Statistical Manual of Mental Disorders (DSM-5-TR), 5th ed.; American Psychiatric
Association Publishing: Washington, DC, USA, 2022.
3.
Ryan-Enright, T.; O’Connor, R.; Bramham, J.; Taylor, L.K. A systematic review of autistic children’s prosocial behaviour. Res.
Autism Spectr. Disord. 2022,98, 102023. [CrossRef]
4.
Olusanya, B.O.; Smythe, T.; Ogbo, F.A.; Nair, M.K.C.; Scher, M.; Davis, A.C. Global prevalence of developmental disabilities in
children and adolescents: A systematic umbrella review. Front. Public Health 2023,11, 1122009. [CrossRef] [PubMed]
5.
Shekhawat, D.S.; Gupta, T.; Singh, P.; Sharma, P.; Singh, K. Monitoring tools for early identification of children with developmental
delay in India: An update. Child Neuropsychol. 2022,28, 814–830. [CrossRef] [PubMed]
Pediatr. Rep. 2023,15 762
6.
Kvestad, I.; Taneja, S.; Kumar, T.; Bhandari, N.; Strand, T.A.; Hysing, M. The assessment of developmental status using the Ages
and Stages questionnaire-3 in nutritional research in north Indian young children. Nutr. J. 2013,12, 50. [CrossRef] [PubMed]
7.
Mukherjee, S.B.; Mukherjee, S.; Ghosh, S.; Singh, A. Providing services for Indian children with developmental delay and
disabilities in the community: Rashtriya Bal Suraksha Karyakram. Indian Pediatr. 2021,58, 73–79. [CrossRef]
8.
Mukherjee, S.B.; Aneja, S.; Krishnamurthy, V.; Srinivasan, R. Incorporating developmental screening and surveillance of young
children in office practice. Indian Pediatr. 2014,51, 627–635. [CrossRef] [PubMed]
9.
Faruk, T.; King, C.; Muhit, M.; Islam, M.K.; Jahan, I.; ul Baset, K.; Badawi, N.; Khandaker, G. Screening tools for early identification
of children with developmental delay in low- and middle-income countries: A systematic review. BMJ Open
2020
,10, e038182.
[CrossRef]
10.
Gladstone, M.J.; Lancaster, G.A.; Jones, A.P.; Maleta, K.; Mtitimila, E.; Ashorn, P.; Smyth, R.L. Can Western developmental
screening tools be modified for use in a rural Malawian setting? Arch. Dis. Child. 2008,93, 23–29. [CrossRef]
11.
Soto, S.; Linas, K.; Jacobstein, D.; Biel, M.; Migdal, T.; Anthony, B.J. A review of cultural adaptations of screening tools for autism
spectrum disorders. Autism 2015,19, 646–661. [CrossRef]
12.
Marlow, M.; Servili, C.; Tomlinson, M. A review of screening tools for the identification of autism spectrum disorders and
developmental delay in infants and young children: Recommendations for use in low- and middle-income countries. Autism Res.
2019,12, 176–199. [CrossRef]
13.
Glascoe, F.P. Parents’ concerns about children’s development: Prescreening technique or screening test? Pediatrics
1997
,99,
522–528. [CrossRef] [PubMed]
14.
Goodman, R. The Strengths and Difficulties Questionnaire: A Research Note. J. Child Psychol. Psychiatry
1997
,38, 581–586.
[CrossRef] [PubMed]
15.
Glascoe, F.P. Summary of PEDS Research from Page Glascoe, PhD Collaboratingwith Parents, 2nd ed.; PEDStest.com LLC: Nolensville,
TN, USA, 2013; Available online: https://pedstest.com/static/research/summaryOfPedsResearchByGlascoe.html (accessed on
24 April 2023).
16.
Goodman, R. Psychometric Properties of the Strengths and Difficulties Questionnaire. J. Am. Acad. Child Adolesc. Psychiatry
2001
,
40, 1337–1345. [CrossRef] [PubMed]
17.
Squires, J.; Bricker, D.; Potter, L. Revision of a parent-completed developmental screening tool: Ages and Stages Questionnaires.
J. Pediatr. Psychol. 1997,22, 313–328. [CrossRef] [PubMed]
18.
Schanding, G.T.; Nowell, K.P.; Goin-Kochel, R.P. Utility of the social communication questionnaire-current and social responsive-
ness scale as teacher-report screening tools for autism spectrum disorders. J. Autism Dev. Disord.
2012
,42, 1705–1716. [CrossRef]
[PubMed]
19.
Dwyer, S.B.; Nicholson, J.M.; Battistutta, D. Parent and teacher identification of children at risk of developing internalizing or
externalizing mental health problems: A comparison of screening methods. Prev. Sci. 2006,7, 343–357. [CrossRef] [PubMed]
20.
Sheel, H.; Suárez, L.; Marsh, N.V. Parents’ Evaluation of Developmental Status and Strength and Difficulties Questionnaire as
Screening Measures for Children in India: A Scoping Review. Pediatr Rep. 2023,15, 175–196. [CrossRef]
21.
Poon, J.K.; Larosa, A.C.; Pai, G.S. Developmental delay: Timely identification and assessment. Indian Pediatr.
2010
,47, 415–422.
[CrossRef]
22.
Mukherjee, S.B.; Verma, S.; Sharma, S.; Aneja, S. Diagnostic Accuracy of Parents’ Evaluation of Developmental Status (PEDS),
PEDS Developmental Milestones, and PEDS Combined in Indian Children Aged Less than 2 Years. Indian J. Pediatr.
2022
,89,
459–465. [CrossRef]
23.
Halli, P.; Khandeparkar, P.; Kanougiya, S.; Pereira, B. An exploratory study of the prevalence of mental health symptoms among
girls living in 5 childcare institutions in Goa and Mumbai. Clin. Epidemiol. Glob. Health 2021,9, 179–183. [CrossRef]
24.
Kallapiran, K.; Jayanthini, V. Emotional problems in children of mothers who had depression: A cross-sectional study. Indian J.
Psychol. Med. 2021,43, 410–415. [CrossRef]
25.
Mahanta, P.; Das Thakuria, K.; Goswami, P.; Kalita, C.; Knower, R.; Rajbangshi, M.C.; Majumder, P. Evaluation of physical and
mental health status of orphan children living in orphanages in Sonitpur district of Assam: A cross-sectional study. BMC Pediatr.
2022,22, 722. [CrossRef]
26.
Malhi, P.; Annam, A.; Singhi, P. Screening children with epilepsy for behavioral problems: Utility of the strength and the
difficulties questionnaire. Ann. Indian Acad. Neurol. 2022,25, 143. [CrossRef] [PubMed]
27.
Nambiar, P.P.; Jangam, K.V.; Jose, A.; Seshadri, S.P. Predictors of behavioral and emotional issues in children involved in custody
disputes: A cross sectional study in urban Bengaluru. Asian J. Psychiatry 2022,67, 102930. [CrossRef]
28.
Venkat, S.L.B.; Ananthakrishnan, K.R. Psychosocial impact of the COVID-19 lockdown in school-aged children and adolescents
in Karaikal-A longitudinal study. Indian J. Soc. Psychiatry 2021,37, 77–81. [CrossRef]
29.
DuBay, M.; Watson, L.R. Translation and cultural adaptation of parent-report developmental assessments: Improving rigor in
methodology. Res. Autism Spectr. Disord. 2019,62, 55–65. [CrossRef]
30.
Abdoola, S.; Swanepoel, D.W.; Van der Linde, J. A scoping review on the use of the parents evaluation of developmental status
and PEDS: Developmental milestones screening tools. J. Early Interv. 2023,45, 203–226. [CrossRef]
31.
Kondolot, M.; Özmert, E.N.; Öztop, D.B.; Mazıcıo˘glu, M.M.; Gümü¸s, H.; Elmalı, F. The modified checklist for autism in Turkish
toddlers: A different cultural adaptation sample. Res. Autism Spectr. Disord. 2016,21, 121–127. [CrossRef]
Pediatr. Rep. 2023,15 763
32.
Windham, G.C.; Smith, K.S.; Rosen, N.; Anderson, M.C.; Grether, J.K.; Coolman, R.B.; Harris, S. Autism and developmental
screening in a public, primary care setting primarily serving Hispanics: Challenges and results. J. Autism Dev. Disord.
2014
,44,
1621–1632. [CrossRef]
33.
Glascoe, F.P. The Value of “Parents” Evaluations of Developmental Status’ in Detecting and Addressing Children’s Developmental
and Behavioral Problems. Diagnostique 1998,23, 185–203. [CrossRef]
34.
Kiing, J.S.H.; Neihart, M.; Chan, Y. Teachers’ role in identifying young children at risk for developmental delay and disabilities:
Usefulness of the Parents Evaluation of Developmental Status tool. Child Care Health Dev.
2019
,45, 637–643. [CrossRef] [PubMed]
35.
Kersten, P.; Czuba, K.; McPherson, K.; Dudley, M.; Elder, H.; Tauroa, R.; Vandal, A. A systematic review of evidence for the
psychometric properties of the Strengths and Difficulties Questionnaire. Int. J. Behav. Dev. 2016,40, 64–75. [CrossRef]
36.
Guillemin, F.; Bombardier, C.; Beaton, D. Cross-cultural adaptation of health-related quality of life measures: Literature review
and proposed guidelines. J. Clin. Epidemiol. 1993,46, 1417–1432. [CrossRef] [PubMed]
37.
Hardesty, D.M.; Bearden, W.O. The use of expert judges in scale development: Implications for improving face validity of
measures of unobservable constructs. J. Bus. Res. 2004,57, 98–107. [CrossRef]
38.
Goorts, K.; Vanovenberghe, C.; Lambreghts, C.; Bruneel, E.; Rusu, D.; Du Bois, M.; Vandenbroeck, S.; Godderis, L. Assessment of
long-term sickness absence: Content and face validity of a new questionnaire based on qualitative data from nominal groups.
BMC Med. Res. Methodol. 2019,19, 205. [CrossRef] [PubMed]
39.
Connell, J.; Carlton, J.; Grundy, A.; Taylor Buck, E.; Keetharuth, A.D.; Ricketts, T.; Barkham, M.; Robotham, D.; Rose, D.; Brazier, J.
The importance of content and face validity in instrument development: Lessons learnt from service users when developing the
Recovering Quality of Life measure (ReQoL). Qual. Life Res. 2018,27, 1893–1902. [CrossRef]
40.
Beaton, D.E.; Bombardier, C.; Guillemin, F.; Ferraz, M.B. Guidelines for the process of cross-cultural adaptation of self-report
measures. Spine 2000,25, 3186–3191. [CrossRef]
41.
Juneja, M.; Mohanty, M.; Jain, R.; Ramji, S. Ages and stages questionnaire as a screening tool for developmental delay in Indian
children. Indian Pediatr. 2012,49, 457–461. [CrossRef]
42.
Sousa, V.D.; Rojjanasrirat, W. Translation, adaptation and validation of instruments or scales for use in cross-cultural health care
research: A clear and user-friendly guideline. J. Eval. Clin. Pract. 2011,17, 268–274. [CrossRef]
43.
Brooks, J.; Reed, D.M.; Savage, B. Taking off with a pilot: The importance of testing research instruments. In Proceedings of
the 15th European Conference on Research Methodology for Business and Management Studies, Kingston, UK, 9–10 June 2016;
pp. 51–59.
44. Mehrotra, S. Cognitive interviewing: An overview and an illustration. J. Indian Acad. Appl. Psychol. 2007,33, 81–84.
45.
Boas, T.C.; Christenson, D.P.; Glick, D.M. Recruiting large online samples in the United States and India: Facebook, mechanical
turk, and qualtrics. Political Sci. Res. Methods 2020,8, 232–250. [CrossRef]
46.
Carlsen, B.; Glenton, C. What about N? A methodological study of sample-size reporting in focus group studies. BMC Med. Res.
Methodol. 2011,11, 26. [CrossRef] [PubMed]
47.
Guest, G.; Bunce, A.; Johnson, L. How Many Interviews Are Enough?: An Experiment with Data Saturation and Variability. Field
Methods 2006,18, 59–82. [CrossRef]
48.
Rogers, R. Structured interviews and dissimulation. In Clinical Assessment of Malingering and Deception; The Guilford Press: New
York, NY, USA, 1997; pp. 301–327.
49.
American Educational Research Association; American Psychological Association; National Council on Measurement in Edu-
cation. Standards for Educational and Psychological Testing; American Educational Research Association: Washington DC, USA,
2014.
50. Nunnally, J.C. Psychometric Theory, 2nd ed.; McGraw-Hill: New York, NY, USA, 1978.
51.
Paiva, C.E.; Barroso, E.M.; Carneseca, E.C.; de Pádua Souza, C.; Dos Santos, F.T.; Mendoza López, R.V.; Ribeiro Paiva, S.B. A
critical analysis of test-retest reliability in instrument validation studies of cancer patients under palliative care: A systematic
review. BMC Med. Res. Methodol. 2014,14, 8. [CrossRef] [PubMed]
52.
Polit, D.F. Getting serious about test–retest reliability: A critique of retest research and some recommendations. Qual. Life Res.
2014,23, 1713–1720. [CrossRef] [PubMed]
53.
Cheney, G.R.; Ruzzi, B.B.; Muralidharan, K. A Profile of the Indian Education System. Prepared for the New Commission on
the Skills of the American Workforce. 2005. Available online: http://schoolofeducators.com/wp-content/uploads/2008/12/
eduction1.pdf (accessed on 24 April 2023).
54.
Misty, V.R. Fastering readiness for primary grades: Innovative action programs with municipal schools in India. In Preventing
School Failure: The Relationship between Preschool and Primary Education, Proceedings of the Workshop on Preschool Research, Bogota,
Colombia, 26–29 May 1981; The International Development Research Centre: Ottawa, Canada, 1981.
55.
Gupta, B.K.; Roshan, M. The Proficiency and Familiarity of English in Indian Context. Int. J. Engl. Lang. Stud.
2020
,2, 25–32.
[CrossRef]
56.
Bujang, M.A.; Adnan, T.H. Requirements for Minimum Sample Size for Sensitivity and Specificity Analysis. J. Clin. Diagn. Res.
2016,10, YE01–YE06. [CrossRef]
57.
Heo, M. Impact of Subject Attrition on Sample Size Determinations for Longitudinal Cluster Randomized Clinical Trials.
J. Biopharm. Stat. 2014,24, 507–522. [CrossRef]
58. Cronbach, L.J. Coefficient alpha and the internal structure of tests. Psychometrika 1951,16, 297–334. [CrossRef]
Pediatr. Rep. 2023,15 764
59.
Matheson, G.J. We need to talk about reliability: Making better use of test-retest studies for study design and interpretation. PeerJ
2019,7, e6918. [CrossRef]
60.
Baviskar, S.; Diop-Christensen, A.; Ebsen, F.C.; From, K.J.; Mackrill, T. Structural validity and reliability of the Danish self-report
Strengths and Difficulties Questionnaire among male and female students in vocational education and training. J. Child Adolesc.
Ment. Health 2020,32, 87–98. [CrossRef]
61.
Doi, Y.; Ishihara, K.; Uchiyama, M. Reliability of the Strengths and Difficulties Questionnaire in Japanese Preschool Children
Aged 4-6 Years. J. Epidemiol. 2014,24, 514–518. [CrossRef] [PubMed]
62.
Du, Y.; Kou, J.; Coghill, D. The validity, reliability and normative scores of the parent, teacher and self report versions of the
Strengths and Difficulties Questionnaire in China. Child Adolesc. Psychiatry Ment. Health 2008,2, 8. [CrossRef] [PubMed]
63.
Yao, S.; Zhang, C.; Zhu, X.; Jing, X.; McWhinnie, C.M.; Abela, J.R.Z. Measuring Adolescent Psychopathology: Psychometric
Properties of the Self-Report Strengths and Difficulties Questionnaire in a Sample of Chinese Adolescents. J. Adolesc. Health
2009
,
45, 55–62. [CrossRef]
64.
Cicchetti, D.V. Guidelines, Criteria, and Rules of Thumb for Evaluating Normed and Standardized Assessment Instruments in
Psychology. Psychol. Assess. 1994,6, 284–290. [CrossRef]
65.
Kaufman, A.S. Kaufman Brief Intelligence Test–Second Edition (KBIT-2); American Guidance Services: Circle Pines, MN, USA, 2004.
66. Sparrow, S.S.; Cicchetti, D.V.; Saulnier, C.A. Vineland adaptive behavior scales, (Vineland-3); Pearson: San Antonio, TX, USA, 2004.
67.
Epstein, J.; Santo, R.M.; Guillemin, F. A review of guidelines for cross-cultural adaptation of questionnaires could not bring out a
consensus. J. Clin. Epidemiol. 2015,68, 435–441. [CrossRef] [PubMed]
68.
Eremenco, S.L.; Cella, D.; Arnold, B.J. A comprehensive method for the translation and cross-cultural validation of health status
questionnaires. Eval. Health Prof. 2005,28, 212–232. [CrossRef] [PubMed]
69.
Vameghi, R.; Sajedi, F.; Shahshahani, S.; Biglarian, A. Validity and reliability determination of parents evaluation of developmental
status (peds) in 4–60 months old children in Tehran. Iran. Rehabil. J. 2015,13, 62–67.
70.
Doove, B.; Feron, J.; Feron, F.; van Os, J.; Kker, M. Validation of short instruments assessing parental and caregivers’ perceptions
on child health and development for personalized prevention. Clin. Child Psychol. Psychiatry 2019,24, 608–630. [CrossRef]
71.
Toh, T.H.; Lim, B.C.; Bujang, M.A.B.; Haniff, J.; Wong, S.C.; Abdullah, M.R. Mandarin parents’ evaluation of developmental status
in the detection of delays. Pediatr. Int. 2017,59, 861–868. [CrossRef] [PubMed]
72.
Charafeddine, L.; Sinno, D.; Ammous, F.; Yassin, W.; Al-Shaar, L.; Mikati, M.A. Ages and Stages Questionnaires: Adaptation to an
Arabic speaking population and cultural sensitivity. Eur. J. Paediatr. Neurol. 2013,17, 471–478. [CrossRef] [PubMed]
73.
Ng, W.; Reynolds, D.L.; Kennedy, E.; Feightner, K.; Holowaty, P.; Wade, K.; Fleiszer, P.; Northrup, D.; VGlascoe, F.P. Measuring the
Prevalence of Children at Risk Using Parents’ Evaluation of Developmental Status in a Telephone Survey. Child Indic. Res.
2010
,3,
167–181. [CrossRef]
74.
Duan, S.; Lee, M.; Wolf, J.; Naples, A.J.; McPartland, J.C. Higher depressive symptoms predict lower social adaptive functioning
in children and adolescents with ASD. J. Clin. Child Adolesc. Psychol. 2022,51, 203–210. [CrossRef] [PubMed]
75.
Maleka, B.K.; Van Der Linde, J.; Swanepoel, D.W.; Glascoe, F.P. Prioritized surveillance of young at-risk South African children:
An evaluation of the PEDS tools referral and response characteristics. J. Health Care Poor Underserved
2019
,30, 668–679. [CrossRef]
76.
Kashala, E.; Elgen, I.; Sommerfelt, K.; Tylleskar, T. Teacher ratings of mental health among school children in Kinshasa, Democratic
Republic of Congo. Eur. Child Adolesc. Psychiatry 2005,14, 208–215. [CrossRef]
77.
Dang, H.-M.; Nguyen, H.; Weiss, B. Incremental validity of the Child Behavior Checklist (CBCL) and the Strengths and Difficulties
Questionnaire (SDQ) in Vietnam. Asian J. Psychiatry 2007,29, 96–100. [CrossRef]
78.
Mellins, C.A.; Xu, Q.; Nestadt, D.F.; Knox, J.; Kauchali, S.; Arpadi, S.; Kvalsvig, J.; Shrout, P.E.; Davidson, L.L. Screening for
Mental Health Among Young South African Children: The Use of the Strengths and Difficulties Questionnaire (SDQ). Glob. Soc.
Welf. 2018,5, 29–38. [CrossRef]
79.
Hawes, D.J.; Dadds, M.R. Australian data and psychometric properties of the Strengths and Difficulties Questionnaire. Aust. N. Z.
J. Psychiatry 2004,38, 644–651. [CrossRef]
80.
Rothenberger, A.; Becker, A.; Erhart, M.; Wille, N.; Ravens-Sieberer, U. Psychometric properties of the parent strengths and
difficulties questionnaire in the general population of German children and adolescents: Results of the BELLA study. Eur. Child
Adolesc. Psychiatry 2008,17, 99–105. [CrossRef]
81.
Malmberg, M.; Rydell, A.; Smedje, H. Validity of the Swedish version of the Strengths and Difficulties Questionnaire (SDQ-Swe).
Nord. J. Psychiatry 2003,57, 357–363. [CrossRef]
82.
Muris, P.; Meesters, C.; van den Berg, F. The Strengths and Difficulties Questionnaire (SDQ): Further evidence for its reliability
and validity in a community sample of Dutch children and adolescents. Eur. Child Adolesc. Psychiatry 2003,12, 1–8. [CrossRef]
83.
Van Widenfelt, B.M.; Goedhart, A.W.; Treffers, P.D.; Goodman, R. Dutch version of the Strengths and Difficulties Questionnaire
(SDQ). Eur. Child Adolesc. Psychiatry 2003,12, 281–289. [CrossRef] [PubMed]
84.
Kersten, P.; Vandal, A.C.; Elder, H.; McPherson, K.M. Strengths and Difficulties Questionnaire: Internal validity and reliability for
New Zealand preschoolers. BMJ Open 2018,8, e021551. [CrossRef] [PubMed]
85.
Edmunds, S.; Garratt, A.; Haines, L.; Blair, M. Child Health Assessment at School Entry (CHASE) project: Evaluation in 10
London primary schools. Child Care Health Dev. 2005,31, 143–154. [CrossRef] [PubMed]
86.
Toseeb, U.; Oginni, O.; Rowe, R.; Patalay, P. Measurement invariance of the strengths and difficulties questionnaire across
socioeconomic status and ethnicity from ages 3 to 17 years: A population cohort study. PLoS ONE
2022
,17, e0278385. [CrossRef]
Pediatr. Rep. 2023,15 765
87.
Dursun, O.B.; Ö˘gütlü, H.; Esın, ˙
I.S. Psychometric Properties of Turkish Version of the Strength and Difficulties Questionnaire for
Age 2–4. Noro Psikiyatr. Ars. 2020,57, 44–49. [CrossRef] [PubMed]
88.
Becker, A.; Woerner, W.; Hasselhorn, M.; Banaschewski, T.; Rothenberger, A. Validation of the parent and teacher SDQ in a clinical
sample. Eur. Child Adolesc. Psychiatry 2004,13, II11–II16. [CrossRef]
89.
Palmieri, P.A.; Smith, G.C. Examining the structural validity of the Strengths and Difficulties Questionnaire (SDQ) in a US sample
of custodial grandmothers. Psychol. Assess. 2007,19, 189. [CrossRef]
90.
Russell, G.; Rodgers, L.R.; Ford, T. The strengths and difficulties questionnaire as a predictor of parent-reported diagnosis of
autism spectrum disorder and attention deficit hyperactivity disorder. PLoS ONE 2013,8, e80247. [CrossRef]
91.
Mellor, D. Furthering the Use of the Strengths and Difficulties Questionnaire: Reliability with Younger Child Respondents.
Psychol. Assess. 2004,16, 396–401. [CrossRef]
92.
Streiner, D.L.; Norman, G.R.; Cairney, J. Reliability. In Health Measurement Scales; Oxford University Press: New York, NY, USA,
2014. [CrossRef]
93.
Borg, A.-M.; Kaukonen, P.; Salmelin, R.; Joukamaa, M.; Tamminen, T. Reliability of the Strengths and Difficulties Questionnaire
among Finnish 4–9-year-old children. Nord. J. Psychiatry 2012,66, 403–413. [CrossRef] [PubMed]
94.
Stone, L.L.; Janssens, J.M.; Vermulst, A.A.; Van Der Maten, M.; Engels, R.C.; Otten, R. The Strengths and Difficulties Questionnaire:
Psychometric properties of the parent and teacher version in children aged 4–7. BMC Psychol. 2015,3, 4. [CrossRef] [PubMed]
95.
Queirós, A.; Faria, D.; Almeida, F. Strengths and limitations of qualitative and quantitative research methods. Eur. J. Educ. Stud.
2017,3, 369–387. [CrossRef]
96.
Tsimpli, I.M.; Vogelzang, M.; Balasubramanian, A.; Marinis, T.; Alladi, S.; Reddy, A.; Panda, M. Linguistic diversity, multilingual-
ism, and cognitive skills: A study of disadvantaged children in India. Languages 2020,5, 10. [CrossRef]
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