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Measurements
- Child Behaviour Checklist and Youth Self Report
The 112-item Child Behavior Checklist (CBCL) is a parent questionnaire designed for the assessment of behavioural problems in children aged between 6 and 17 years (22). Adequate reliability and validity of the CBCL were confirmed for the Dutch translation (23). The 113-item Youth Self Report (YSR) questionnaire is a self-report questionnaire designed for assessment of behavioural problems in adolescents aged between 11 and 18 years (24). The YSR is the youth self- report version of the CBCL and assesses the same constructs and reports the same symptom scales. Good validity and test-retest reliability of the YSR have been established and confirmed by the Dutch translation (25). For CBCL and YSR, Cronbach’s alpha were 0.90 for both internalizing scales, 0.94 and 0.90 respectively for the externalizing scale and 0.97 and 0.95 respectively for the total problem scale (26).
These questionnaires cover behavioural, emotional, and social problems that occurred in the past six months. The respondents were asked to rate the occurrence of problems on a 3-point scale: 0 = not true, 1 = somewhat or sometimes true, and 2 = very or often true. The following syndrome scales can be derived from both questionnaires: Anxious/Depressed, Withdrawn/ Depressed, Somatic Complaints, Social Problems, Thought Problems, Attention Problems, Rule-Breaking Behaviour, and Aggressive Behaviour. The first 3 syndromes are also scored on an Internalizing broadband scale while the last 2 syndromes are scored on an Externalizing broadband scale. For each questionnaire, a Total Problem Score is derived by summing all individual item scores. For all subscales, raw scores were converted to T-scores in all subscales with higher T-scores indicating more problematic behaviour using a reference value of the norm population which is standardized at 50 (27).For the syndrome scales, T-scores up to 65 indicate the normal range. Scores from 65 to 69 reflect the borderline range (93th–97th percentile) and indicate problems rated high enough to be of concern. Scores above 69 (above 97th percentile) reflect the clinical range and indicate problems of relevant deviance. For the Internalizing and Externalizing scale and the Total Problem scale, T-scores below 60 are in the normal range, T-scores of 60 to 63 (84th–90th percentile) are the borderline range, and T-scores above 63 (above 90th percentile) are in the clinical range.
Anthropometrics
Height was measured with an accuracy of 0.1 cm using an electronic stadiometer (KERN250D, De Grood Metaaltechniek, Nijmegen, the Netherlands). Body weight was measured (in underwear) within 0.1 kg with a calibrated electronic flat scale (SECA 861, Schinkel, Nieuwegein, the Netherlands). Weight and height were used to calculate BMI (weight in kilograms divided by the square of height in meters). For BMIsds, reference data of Dutch children collected in 1997 were used (www.growthanalyser.org; version 3.5). The BMIsds
Behaviour and social-emotional function
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