Development and Validation of Screening for Mental Health Needs of Korean Students with Developmental Disabilities(SM-KSDD)

Background and Purpose: Developmental disabilities are common and reported in 1 in 6 children in the United States. The number of children with developmental disabilities (autism, ADHD, and other developmental delays) has been increased in Korea as well. However, due to cultural conservatism which has been influenced by Confucianism in Eastern Asian society, Koreans tend to hide some mental illnesses and developmental disabilities of their children. Moreover, many children with both disabilities and mental health needs are even not easily diagnosed so that they are more likely to lose the chances to be clinically treated in a right time. In fact, it is important to note that some of the children with developmental disabilities are suffering various types of mental health problems such as emotional, social or behavioral disorders. Therefore, many stakeholders such as children’s parents and teachers, and psychiatrist have expressed the needs of the screening tool for mental health needs of children with developmental disabilities. The purposes of this study are to develop the SM-KSDD and determine whether it is reliable and valid measure.

Methods: The survey instrument developed was guided a thorough review of the literature and a series of feedbacks via FGIs(focus group interviews) from different groups (parents, teachers, psychiatrist). A cross-sectional study of children and adolescents aged 7-20 years was utilized. The data were collected throughout 40 schools from deferent educational levels (elementary, middle, and high schools) across the nation. The sample included a total of 1,374 which represent male (n=882, 64.2%), and autism (n=413, 29.8%), intellectual disabilities (n=900, 65.0 %). EFA(exploratory factor analysis) and CFA(confirmatory factor analysis) were utilized to assess the psychometric properties of the developed scale. Descriptive statistics and EFA were analyzed by SPSS 18.0 and CFA was done by Mplus 7.2. FIML(full information maximum likelihood) was employed to handle missing data .

Results: EFA was used to identify the underlying factors for a set of variables. The EFA yielded a four-factor solution, with 10 items on the first factor (ADHD related behaviors), six items on the second factor(internalizing behaviors), 4 items on the third factor(psychiatric symptomatic behaviors), and 4 items on the fourth factor(aggressive behaviors). Each sub-scale retained a series of good internal consistency reliabilities with Cronbach’s alphas as follows: .86, .78, .76, and .78 respectively. Then, the CFA results indicated an overall acceptable fit of the model. The final model for the four factors showed fit indices with χ²(245) = 1680.9, p< 0.001, CFI = 0.89, TLI = 0.87, RMSEA = 0.065 (90% CI: 0.062-0.068), SRMR = 0.060.   

Conclusion and Implications: The findings from this study suggest that the SM-KSDD represents a viable measurement tool for screening the mental health need for children with developmental disabilities (autism or intellectual disabilities, etc.). So far, no other scale has been developed and attempted to measure the mental health need aspects for children with developmental disability. The SM-KSDD may provide a more option for teachers and psychiatrists who are seeking a screening tool for children with mental health needs in shools and communities.