Review of the strengths and difficulties questionnaire translated into languages spoken by children and adolescents of refugee background

The Strengths and Difficulties Questionnaire (SDQ), routinely used to screen for children's and adolescents' emotional and behavioural problems, has been translated into at least 80 languages. As children of refugee background are particularly vulnerable to mental health problems resulting from their refugee experiences, this review examines whether SDQs translated into languages spoken by major refugee groups are validated and culturally equivalent to the original SDQ and sensitive to change following interventions. No reviewed studies of translated SDQs reported on challenges in achieving conceptual and linguistic equivalence in translation. Factor analysis predominantly showed structural inequivalence with the original 5-factor model, suggesting translated SDQ subscales may measure different constructs. Predictive equivalence findings tended to show somewhat higher sensitivity for detecting disorder than the original SDQ's low sensitivity, and somewhat lower specificity. Outcome studies yielded equivocal results with refugee and immigrant groups. SDQ items do not detect the psychological sequelae of trauma; hence it is recommended that the SDQ be used with caution to screen refugee children, with a follow-up clinical interview for verification. Cross-cultural qualitative research is needed into parents' and adolescents' interpretation of translated SDQ items.