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Months child's difficulties present

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), DIFMOS reports answers to the follow-up question, "How long have these difficulties been present?" Responses were grouped into the following categories: "Less than a month," "1-5 months," "6-12 months," "over 12 months."

As discussed in more detail below, DIFMOS 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, DIFMOS 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."

If the duration of these difficulties, as reported in DIFMOS, was 1 month or greater (i.e., IPUMS NHIS codes 2, 3, or 4), then interviewers asked a series of follow-up questions.


These follow-up questions asked how much these difficulties upset or distressed the child (DIFUPSET, whether they interfered with the child's everyday life (DIFHOME, DIFFRIEND, DIFLEARN, DIFLEISURE), and whether they burdened the child's family (DIFBURDEN).

Strengths and Difficulties Questionnaire Extended

DIFMOS 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.

DIFMOS 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 DIFMOS, as the "Impact Supplement."

Calculating a Score for the SDQ-EX Impact Supplement 

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?"

The Scoring Guide at the website provides guidance on how responses for these five variables "can be summed to generate an impact score that ranges from 0 to 10 for the parent-completed version." Under these guidelines, the responses "not at all" and "a little" are given a score of 0; a response of "a medium amount" is given a score of 1; and a response of "a great deal" is given a score of 2. For each of these variables, a score of 0 implies the least impact from the child's difficulty, and a score of 2 implies the greatest impact from the child's difficulty. If the scores for these five variables are summed, the total ranges from 0 to 10, with 0 implying the least impact from the child's difficulties and 10 implying the greatest impact from the child's difficulties.

If parents responded "no" to the opening question about whether the child had difficulties with emotions, concentration, behavior, or getting along with others (EMODIFF), none of these five questions were asked. In such cases, when parents "are not asked to complete the questions on resultant distress or impairment," the Scoring Guide states, "the impact score is automatically scored zero." The same is true when, in DIFMOS, parents reported difficulty in these areas that lasted less than 1 month (and thereby avoided these follow-up questions on "resultant distress or impairment").

The five variables that can be summed to create a total "impact score" receive codes in IHIS that facilitate this scoring process. Responses that should receive a score of 0 in the scoring process--namely, "not at all" or "a little"--receive a code of 0 in the first digit. In addition, sample children with no reported difficulties (in EMODIFF) or with difficulties lasting "less than one month" (code 1 in DIFMOS) also receive a code of 0 in the first digit in these five variables. (The three different categories, "No difficulty for greater than or equal to 1 month," "not at all," and "a little" can still be distinguished from each other by the respective values of 0, 1, and 2 in the second digit.) The response "a medium amount," which should receive a score of 1, receives a code of 1 in the first digit (and a code of 0 in the second digit). The response "a great deal," which should receive a score of 2, receives a code of 2 in the first digit (and a code of 0 in the second digit). Cases which should be excluded from this summing of scores--that is, not in universe cases consisting of persons other than sample children age 4-17, and cases with a response of "unknown"--all receive a code of 9 in the first digit (with the second digit distinguishing between those not in the variable universe and unknowns.)

Put succinctly, to calculate an "impact score" for the child's difficulties, researchers should 1) exclude cases beginning with a code of 9; 2) group together other categories that share a common first digit; 3) sum the scores across the five variables, using only the first digit of the codes for each variable. The result will range from 0 to 10.

The Scoring Guide at provides the following guideline for interpreting these results:

Although the impact scores can be used as continuous variables, it is sometimes convenient to classify them as normal, borderline, or abnormal: a total impact score of 2 or more is abnormal; a score of 1 is borderline; and a score of 0 is normal.

Individual Elements of the SDQ-EX Impact Supplement 

Some researchers may prefer to use only some of the "impact" variables (DIFUPSET, DIFHOME, DIFFRIEND, DIFLEARN, and DIFLEISURE) discussed in the previous section, or to avoid combining their values in a single "impact score." The same is true for EMODIFF (which reports whether the child had difficulties with emotions, concentration, behavior, or getting along with others) and DIFMOS (which reports the duration of such difficulties, if present). DIFBURDEN (which reports parents' answers to the question, "Do the difficulties put a burden on you or the family as a whole?") focuses on the effect of difficulties on family members other than the child. DIFBURDEN is thus excluded from the calculation of an "impact score" for the child, described in the previous section.

In the abbreviated version of the SDQ, which was part of the NHIS in 2002 and 2005-2006, EMODIFF was the only element of the "impact supplement" from the SDQ-EX included in the survey.


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.


  • 2001, 2003-2004