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Child's difficulties put burden on adult or family

Codes and Frequencies

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For sample children age 4 to 17 whose parents said they had difficulties with emotions, concentration, behavior, or being able to get along with other people (EMODIFF), and whose difficulties had lasted 1 month or longer (DIFMOS), DIFBURDEN reports responses to the follow-up question, "Do the difficulties put a burden on you or the family as a whole?" Interviewers handed respondents a flashcard listing acceptable responses: "Not at all," "A little," "A medium amount," "A great deal."

As discussed in more detail below, DIFBURDEN was part of the Strengths and Difficulties Questionnaire Extended (SDQ-EX) which, according to the 2001 and 2003-2004 Field Representative's Manuals, was included "to monitor emotional and behavioral problems in children and the impact that these problems have on children's lives." More specifically, in these years, DIFBURDEN was part of a section of the SDQ-EX which the NHIS Survey Descriptions for 2001 forward describe as "extended questions that provide information on the duration of a child's problem and the impact that problem has on the child and his/her family."

Strengths and Difficulties Questionnaire Extended

DIFBURDEN is part of a set of 33 questions from the Strengths and Difficulties Questionnaire Extended (SDQ-EX) developed by Dr. Robert Goodman, Institute of Psychiatry, London, England.


As the Appendix on SDQ in the 2001 and 2003-2004 Codebook of the NHIS public use files explains:

The parent respondent version of the SDQ was added as a mental health supplement for children ages 4-17 as part of a collaborative agreement between NCHS and the National Institute of Mental Health (NIMH). The first part of the SDQ consists of 25 scale items . . . These items can be divided into five subscales measuring the following psychological attributes or dimensions:
  • emotional symptoms;
  • conduct problems;
  • hyperactive behavior;
  • peer relationships;
  • prosocial behavior.

DIFBURDEN was an element in the second part of the SDQ, which the same source describes as follows:

The second part of the SDQ, the extended questions . . . obtains additional information about the duration and impact of symptoms, which can be useful for determining psychiatric caseness.

More information on the SDQ-EX is available at This source describes the second section of the SDQ-EX, which includes DIFBURDEN, as the "Impact Supplement."

Calculating a Score for the SDQ-EX Impact Supplement

Because DIFBURDEN addresses the impact of the child's difficulties on others, DIFBURDEN is not included when calculating an "impact score" for the child's difficulties.


In the 2001 and 2003-2004 NHIS, if parents said (in EMODIFF) that the child had minor, definite, or severe difficulties with emotions, concentration, behavior, or getting along with others, they were asked how long the difficulties had been present (DIFMOS). If the reported duration of these difficulties was one month or longer, interviewers asked further follow-up questions that were the basis of the following variables:

  • Difficulties upset or distress child (DIFUPSET)
  • Child's difficulties interfere with home life (DIFHOME)
  • Child's difficulties interfere with friendships (DIFFRIEND)
  • Child's difficulties interfere with classroom learning (DIFLEARN)
  • Child's difficulties interfere with leisure activities (DIFLEISURE)

DIFUPSET was based on the question, "Do the difficulties upset or distress your child?" The remaining four variables were based on query, "Do the difficulties interfere with your child's everyday life in the following areas: Home life? Friendships? Classroom learning? Leisure activities?"

These aforementioned elements of the SDQ-EX Impact Supplement all address the effect of children's difficulties (with emotions, concentration, behavior, or getting along with others) on children themselves. By contrast, DIFBURDEN addresses the effect of children's difficulties on their parents or other family members.

The Scoring Guide at the website provides guidance on how responses for the aforementioned variables--other than DIFBURDEN--"can be summed to generate an impact score that ranges from 0 to 10 for the parent-completed version." Variable descriptions for these other variables address how IPUMS NHIS values for these other variables can be combined into a score useful for evaluate the effect of the child's difficulties on the child himself or herself.


This variable is completely comparable over time.


  • 2001; 2003; 2004: Sample children age 4 to 17 who have difficulty with emotions, concentration, behavior, or getting along with others, and had this difficulty for 1+ months.


  • 2001, 2003-2004