Received: 2 February 2018 | Revised: 8 September 2018 | Accepted: 10 September 2018

DOI: 10.1111/jcap.12211

ORIGINAL ARTICLE

Emotional and behavioral problems among Jordanian

adolescents: Prevalence and associations with academic
achievement

Maysoun Atoum1 | Mahmoud Alhussami2 | Ahmad Rayan3

1
Department of Community and Mental
Health Nursing, Faculty of Nursing, The Abstract
Hashemite University, Zarga, Jordan Background: Mental health concerns are important for adolescent’s general
2
Department of Community Health Nursing,
wellbeing and they can be associated with their ability to function effectively in
School of Nursing, The University of Jordan,
Amman, Jordan various aspects of their daily life.
3
Department of Nursing, Faculty of Nursing, Aim: The purpose of this study was to identify emotional and behavioral disorders
Zarqa University, Zarqa, Jordan
(EBD) among Jordanian adolescents and their association with academic outcomes.
Correspondence Methods: A descriptive correlational design was used. A total of 810 adolescents
Ahmad Rayan, PhD, Psychiatric and Mental
Health Nursing, Faculty of Nursing, Zarqa participated in the study and completed the demographic survey and the Strengths
University, PO Box 132222, Zarqa 13132, and Difficulties Questionnaire (SDQ). The grade point average (GPA) was used as an
Jordan.
Email: [email protected]; indicator of the academic achievement. The GPA was correlated with the SDQ scores
[email protected] to identify the relationship between the EBD and academic achievement.
Results: About 11.7% of the participants had psychological and behavioral problems.
The most commonly reported problems were emotional symptoms (14.2%), conduct
problems (12.5%), and hyperactivity (7.5%). There was a significant difference in
psychological and behavioral problems according to the participants’ gender. There
was a significant negative relationship between the SDQ scores and the GPA.
Conclusion: There is a need to identify adolescents at risk of emotional and
behavioral difficulties and refer them to appropriate care and support, which in turn
would improve their academic achievement.

KEYWORDS
academic achievement, adolescents, emotional and behavioral problems, Jordan

1 | INTRODUCTION may disturb class with inappropriate behaviors including fighting,

physical violence, and abusive language.
In the recent decades, psychological and behavioral problems have The unmet mental health needs of adolescents have been
increased especially among adolescents (Merikangas et al., 2011). documented in the literature (Burns & Rapee, 2016; Jensen et al.,
Worldwide, 20% of children and adolescents suffer from a disabling 2011). A study conducted by Green et al. (2013) reported that only
mental illness (Kessler et al., 2005). Mental health concerns are a 36.2% of adolescents with mental health difficulties had received
major component of the adolescent’s general wellbeing, which are treatment, whereas half of the adolescents with severe mental
intimately bound up with their physical health and can cause life‐long disorders had never received any mental health treatment for their
health problems. Likewise, adolescents who have psychological and symptoms. Mental health treatment during adolescence has the
behavioral problems may be identified as emotionally disturbed in potential to reduce the severity of future mental illness (Kieling et al.,
schools. Adolescents with psychological and behavioral problems 2011; Patton et al., 2014).
J Child Adolesc Psychiatr Nurs. 2018;1–9. wileyonlinelibrary.com/journal/jcap © 2018 Wiley Periodicals, Inc. | 1
2 | ATOUM ET AL.

Schools are increasingly playing an important role in addressing adolescents were safeguarded. The informed consent of the parents
the mental disorders (Bruns et al., 2016). Greater use of integrated or legal guardians was obtained before the data collection.
mental health services in schools could considerably improve the
mental, emotional, behavioral, and academic outcomes for adoles-
2.2 | Sample and settings
cents by improving the effectiveness, efficiency, and contextual
suitability of education sector services (Stephan, Mulloy, & Brey, A two‐stage cluster sampling technique was used to select the study
2011). Indeed, mental health is necessary for optimal academic sample. First, the researchers randomly selected two schools from a
success (Stevenson, 2010). list of all government schools in Amman, the capital of Jordan. Then,
Psychiatric and mental health nurses can play a vital role in the within each selected school, the researchers selected the adolescents
referral of adolescents exhibiting psychological and behavioral (ages 14, 15, and 16 years) and invited them to complete the study.
problems and developing special intervention programs to meet Eligibility criteria included: (a) being an adolescent in a secondary
their needs (Walker & Brigham, 2017). Knopf, Park, and Mulye governmental school; (b) having no sensory or physical impairment
(2008) reported that the demands for adolescent’s mental health (e.g., diabetes mellitus, epilepsy, etc.) that would affect a student’s
services exceed the available resources within the school system. ability to learn and concentrate, and therefore, negatively influence
Therefore, a universal screening has been suggested as a method of student’s academic performance; and (c) availability of parents to
identifying mental health difficulties early and providing specific provide a written informed consent.
intervention according to the student’s needs (Dowdy, Ritchey, &
Kamphaus, 2010).
2.3 | Instruments
Identifying the prevalence of psychological and behavioral
problems is important to develop effective interventions to address Two measures were used to collect data including the demographic
the needs of adolescents. Green et al. (2013) found that screening survey and the Strengths and Difficulties Questionnaire (SDQ; Good-
and early identification of psychological and behavioral problems by man, 2001). The demographic survey was used to collect data regarding
school’s efforts were associated with the rate of mental health the basic demographic characteristics of the students, such as their age
service utilization among students. To date, very few data are and gender. The grade point average (GPA) was used as an indicator of
available on the prevalence of psychological and behavioral problems the academic achievement. To estimate emotional and behavioral
among adolescents in Jordan. Therefore, there is a need to problems for adolescents, the SDQ was used. The SDQ is a valuable
investigate the psychological and behavioral problems among screening tool for detecting emotional and behavioral problems for
Jordanian adolescents, at the very least, to have baseline data adolescents. It was, developed reflecting the Diagnostic and Statistical
regarding the extent of the problem. Manual of Mental Disorders‐IV diagnostic criteria (He, Burstein,
The purpose of this study was to identify emotional and behavioral Schmitz, & Merikangas, 2013; Levitt, Saka, Hunter romanelli, &
disorders (EBD) among Jordanian adolescents and their association with Hoagwood, 2007; Mieloo et al., 2014). Previous studies indicated that
academic outcomes. The results of this study could provide a direction the internal consistency reliability and test–retest stability of the SDQ
for health policy‐makers related to integrating mental health services are satisfactory (Borg, Kaukonen, Salmelin, Joukamaa, & Tamminen,
within the school setting. Such integration could be helpful for 2012; Muris, Meesters, & van den Berg, 2003). In addition, the SDQ has
adolescents who are at risk of emotional and behavioral problems in been found to be a valid measure for emotional and behavioral
the governmental schools. It could be helpful in early identification and problems (Mieloo et al., 2014). The five‐factor instrument was
prevention of mental health problems rather than focusing solely on the developed to screen emotional and behavioral difficulties in children
treatment of mental disorders (Dowdy et al., 2010). Moreover, and adolescents aged 3–17 years. The SDQ has three versions for
considering the recent events in the Middle East Region, Jordan is parents, teachers, and adolescents, respectively.
experiencing a rise in Syrian refugees studying in the government The SDQ contains 25 items in five subscales including emotional,
schools. Thus, there is also a need to understand how school mental conduct problems, hyperactivity/inattention, peer relationship pro-
health services contribute to refugee health status within the school blems, and prosocial behavior (Rimal & Pokharel, 2013). For the
settings (El‐Khatib, Scales, Vearey, & Forsberg, 2013). purpose of this study, the Arabic self‐rated version of the SDQ (A‐SDQ)
was used. The Arabic version of the scale is valid and reliable (Alyahri &
Goodman, 2006; Emam, Hilal, Kazem, & Alkharousi, 2016) and used
2 | METHODS
frequently in the previous research (El‐Keshky & Emam, 2015; Emam,
Kazem, & Al‐Zubaidy, 2016; Thabet, Stretch, & Vostanis, 2000).
2.1 | Study design
A cross‐sectional design was used. Ethical approval for the study
2.4 | Internal consistency reliability for the SDQ in
protocol was obtained from the University of Jordan Institutional
the current study
Review Board committee. In addition, the approval was obtained
from the Ministry of Education to conduct the study at the selected Cronbach’s α reliability was used to estimate the internal consistency
schools before data collection. Privacy and confidentiality of the reliability of SDQ, which was found to be 0.85. Regarding SDQ, the
ATOUM ET AL. | 3

T A B L E 1 The demographic characteristics scores and the GPA according to the gender of the participants. One‐
way analysis of variance (ANOVA) was used to compare the SDQ
Gender Age (years) Frequency Percent
scores and the GPA according to the three age categories of the
Male (n = 374, 46.2%) 14 94 25.1
participants. Pearson’s correlation coefficients were calculated to
15 150 40.1
measure the correlation between the GPA and total SDQ scores.
16 130 34.8
Results were considered statistically significant when p < 0.05.
Female (n = 436, 53.8%) 14 125 28.7
15 128 29.3
16 183 42
3 | RESULTS

3.1 | Demographic characteristics

Cronbach’s α reliability was 0.79 for the emotional symptoms A total of 810 adolescents completed the study. The male students
subscale, 0.79 for the hyperactivity‐inattention subscale, 0.79 for were 374 (46.2%), while the female students were 436 (53.8%). The
peer problems subscale, 0.84 for conduct problems subscale, and mean age of the participant was 15.12 years (SD = 0.80), ranging
0.89 for prosocial behavior subscale. These outcomes indicate good between 14 and 16 years. Most students were 16 years old (n = 313,
to very good internal consistency reliability for the SDQ total score 38.6%), followed by the 15 years old (n = 278, 34.3%), and 219
and its subscales. students (26.0%) were 14 years old. The distribution of the students
as per age and gender are presented in Table 1.

2.5 | Data collection procedures

3.2 | Distribution of the SDQ scores
After obtaining the ethical approval, the school principals of selected
schools were contacted about their students’ participation in the Descriptive statistics were used to describe the total score of SDQ
study. Then, information sessions were provided for teachers and the SDQ subscales to identify the major EBD (emotional health,
regarding the purpose of the study and the procedure of data conduct problems, hyperactivity, peer relationship problems, SDQ,
collection. Data were collected from July 2017 through November and prosocial behavior) among adolescents at the governmental
2017 using the self‐reported questionnaires. Data collection was schools. As presented in Table 2, the mean scores of adolescents in
performed in the classrooms at the adolescent’s schools, guided by the total difficulties score (SDQ) and its subscales for the entire
the first author. Each adolescent completed the self‐report form of sample are within the normal values.
the SDQ and the demographic data (i.e., gender and age) were also Additional analysis was conducted to describe the frequencies
obtained from the participants. The time required for completing and percentages of the adolescents who are categorized as normal or
the SDQ was about 10–15 min. One thousand questionnaires were without challenges, at borderline, and abnormal with challenges
distributed, but 810 were completed and returned by the partici- (Table 3). Overall, adolescent’s perception of their strengths and
pants. difficulties in life indicated that 95 (11.7%) of the participants were
categorized as “abnormal.” Regarding the SDQ subscales, the most
commonly reported abnormal findings were related to the emotional
2.6 | Data analysis
symptoms subscale (n = 115, 14.2%), followed by the conduct
All statistical analyses were carried out using the SPSS Software problems subscale (n = 101, 12.5%), and the hyperactivity‐inattention
version 21.0 (IBM Corp, 2010). Descriptive statistics were used to subscale (n = 61, 7.5%). The least commonly reported abnormal
describe the demographic variables, SDQ scores, and the GPA of the findings were related to the prosocial behavior subscale (n = 34,
students. Independent sample t tests were used to compare the SDQ 4.2%) and the peer problems subscale (n = 46, 5.7%).

T A B L E 2 Descriptive statistics of total and subscale of strength and difficulties among adolescents (N = 810)

Interpretation

Variables Mean SD Min Max Normal Borderline Abnormal

SDQ 12.8 5.3 1 31 0–15 16–19 20–40
Emotion 3.77 2.4 0 19 0–5 6 7–10
Conduct 2.4 1.7 0 8 0–3 4 5–10
Hyperactivity 4.0 1.9 0 9 0–5 6 7–10
Peer 2.7 1.6 0 9 0–3 4–5 6–10
Proscial 8.0 1.8 0 10 6–10 5 0–4

Note. SDQ: Strengths and Difficulties Questionnaire.

4 | ATOUM ET AL.

T A B L E 3 Frequency and percent of the adolescents who are regarding the emotional symptoms subscale (p < 0.001) and the
categorized as normal, at borderline, and abnormal (N = 810) hyperactivity‐inattention subscale (p = 0.001) than male participants.
Variables Normal, Borderline, Abnormal, Male participants were found to have a significantly higher percent of
n (%) n (%) n (%) abnormal values regarding the conduct problems subscale (p = 0.001)
SDQ 581 (71.7) 134 (16.5) 95 (11.7) and the peer problems subscale (p = 0.001) than female participants.
Emotion 625 (77.2) 70 (8.6) 115 (14.2) Although male participants had higher percent of abnormal values

Conduct 612 (75.6) 97 (12) 101 (12.5)

regarding the prosocial behavior subscale than female participants, this
difference was not significant (p = 0.36).
Hyperactivity 644 (79.5) 105 (13) 61 (7.5)
Peer 581 (71.7) 183 (22.6) 46 (5.7)
Prosocial 737 (91) 39 (4.8) 34 (4.2) 3.3 | Differences in SDQ and GPA according to the
Note. SDQ: Strengths and Difficulties Questionnaire. gender of participants
Independent t test was used to examine differences between male and
female adolescents in the mean scores of SDQ and its subscales
In addition, the results indicated that the percent of normal
(Table 5). The results showed that female adolescents had higher mean
values on the SDQ total score and its subscales ranged between
scores than male adolescents in SDQ (mean SDQ for females = 13.23,
71.7% and 79.5%, except for the prosocial behavior subscale that was
SD = 5.46 and mean SDQ for males = 12.24, SD = 5.02; t = −2.65,
found to have a higher percent of normal values (91%) than all other
p = 0.008). In addition, female participants had significantly higher
subscales. It is noteworthy that 22.6% of the participants had scores
scores on emotional (t = −7.87, p < 0.001), Hyperactivity (t = −3.005,
at the “borderline” regarding peer problems subscale.
p = 0.003), and prosocial subscales (t = −3.16, p = 0.002) than male
Table 4 presents the frequencies and percentages of the adoles-
participants. In contrast, male participants had significantly higher
cents who are categorized as normal, at borderline, and abnormal
scores on peer problems subscale (t = 4.99, p < 0.001) than female
according to their gender (Table 4). The most commonly reported
participants. No significant differences were found in conduct subscale
abnormal finding among female participants was related to the
between males and females. With respect to the differences in GPA,
emotional symptoms subscale (n = 90, 20.6%), while the least commonly
the results indicated no significant differences in the GPA between
reported abnormal finding among female participants was related to the
female (M = 76.66, SD = 13.567) and male students (M = 75.95,
peer problems subscale (n = 15, 3.4%). The most commonly reported
SD = 11.269, t = −0.816, p = 0.420).
abnormal finding among male participants was related to the conduct
problems subscale (n = 59, 15.8%), while the least commonly reported
abnormal finding among male participants was related to the prosocial
3.4 | Differences in SDQ and GPA according to the
behavior subscale (n = 17, 4.5%). The results of χ2 indicated that female
age of the participants
participants (n = 63, 14.4) were found to have a significantly higher
percent of abnormal values regarding the total difficulties score (SDQ) The results of one‐way ANOVA indicated no significant difference in
than male participants (n = 32, 8.6%; p = 0.03). In addition, female the mean of GPA between the three age groups (14, 15, and 16
participants were found to have a higher percent of abnormal values years). The same outcome was reported for the SDQ score and its

T A B L E 4 Frequency and percent of the adolescents who are categorized as normal, at borderline, and abnormal based on their
gender (N = 810)

Variable Category Normal, n (%) Borderline, n (%) Abnormal, n (%) p

SDQ Male 276 (73.8) 66 (17.6) 32 (8.6) 0.032
Female 305 (70) 68 (15.6) 63 (14.4)
SDQ: Emotion Male 322 (86.1) 27 (7.2) 25 (6.7) <0.001
Female 303 (69.5) 43 (9.9) 90 (20.6)
SDQ: Conduct Male 277 (74.1) 38 (10.2) 59 (15.8) 0.017
Female 335 (76.8) 59 (13.5) 42 (9.6)
SDQ: Hyperactivity Male 316 (84.5) 43 (11.5) 15 (4) 0.001
Female 328 (75.2) 62 (14.2) 46 (10.6)
SDQ: Peer Male 248 (66.3) 95 (25.4) 31 (8.3) 0.001
Female 333 (76.4) 88 (20.2) 15 (3.4)
SDQ: Proscial Male 335 (89.6) 22 (5.9) 17 (4.5) 0.360
Female 402 (92.2) 17 (3.9) 17 (3.9)

Note. SDQ: Strengths and Difficulties Questionnaire.

ATOUM ET AL. | 5

T A B L E 5 Differences in Strengths and Difficulties Questionnaire Halawa, and El Din (2015) assessed the prevalence of emotional and
(SDQ) and grade point average (GPA) according to the gender of the behavioral problems among Egyptian adolescents and found that
participants 15.7% of the participants had abnormal scores regarding emotional
Gender n Mean SD t p and behavioral problems. However, consistent with the results of the
current study, the study of Mowafy et al. (2015) found that the most
Emotion Male 374 3.09 2.095 −7.87 <0.001
Female 436 4.35 2.458 commonly reported abnormal score was related to the emotional
problems and the least commonly reported abnormal findings were
Conduct Male 374 2.41 1.810 0.898 0.370
Female 436 2.30 1.613 related to the peer problems. Furthermore, a study was conducted by

Hyperactivity Male 374 3.73 1.742 −3.005 0.003 Eapen, Al‐Gazali, Bin‐Othman, and Abou‐Saleh (1998) in the UAE to
Female 436 4.12 1.936 examine the prevalence of psychiatric problems in a sample of 3278
Peer Male 374 3.01 1.618 4.99 <0.001 adolescents and it was found that 23.9% of the participants had
Female 436 2.46 1.546 psychiatric problems.
Proscial Male 374 7.81 1.817 −3.16 0.002 In comparison with the non‐Arab countries, the prevalence of
Female 436 8.21 1.746 psychological problems among adolescents differs from the results of
GPA Male 374 75.95 11.269 −0.816 0.420 the current study. For example, a study conducted by Mohammadi
Female 436 76.66 13.567 et al. (2013) who used the SDQ to assess the prevalence of
SDQ total Male 374 12.24 5.017 −2.65 0.008 psychological problems among adolescents in Iran with a sample of
Female 436 13.23 5.460 5171 participants aged 12–17 years. The results showed that the
highest prevalent psychological problem was related to conduct
problems (24%) and the lowest prevalence was reported for social
problems (5.76%). Another study conducted by Gomez and Suhaimi
subscales as no difference was found in SDQ score and its subscales (2013) to assess the rates of emotional and behavioral problems of a
according to the age of the participants (Table 6). sample of 1407 Malaysian school‐aged children using the SDQ found
that about 5% of the participants were at the abnormal level and
10% are at the borderline level. Furthermore, a study was conducted
3.5 | The relationship between scores of the SDQ
by Faizi, Azmi, Ahmad, and Shah (2016) in the 13–15 years’ age group
and the academic achievement
Table 7 presents the correlations between the academic achievement
and the SDQ and its subscales. The results indicated a significant T A B L E 6 Differences in Strengths and Difficulties Questionnaire
negative relationship between the SDQ total score and the GPA (SDQ) and grade point average (GPA) according to the age of the
(r = −0.23, p < 0.01). In addition, four subscales of SDQ were participants
negatively correlated with the GPA; emotional problems (r = −0.16, Age
p<0.01), peer relationship problems (r = −0.19, p < 0.01), hyperactivity (years) n Mean SD F p
problems (r = −0.17, p < 0.01), and in conduct problems (r = −0.13, GPA 14 219 75.38 12.599
p < 0.01). These results indicate that higher scores on SDQ and its 15 278 77.62 12.008 2.329 0.098
subscales (except for prosocial subscale) were associated with lower 16 313 75.85 12.942
academic achievement as measured by GPA. However, the magni- SDQ: Emotion 14 219 3.95 2.189
tude of these correlations was small. 15 278 3.60 2.369 1.351 0.260
16 313 3.80 2.513
SDQ: Conduct 14 219 2.33 1.671
15 278 2.44 1.793 0.574 0.564
4 | D IS C U S S IO N 16 313 2.29 1.655
SDQ: 14 219 3.92 1.842
The purpose of this study was to identify EBD among Jordanian Hyperactivity 15 278 3.85 1.797 0.701 0.497
adolescents and their association with academic achievement. 16 313 4.03 1.923
Research regarding emotional and behavioral problems in commu- SDQ: Peer 14 219 2.72 1.668
nity‐based samples is necessary to develop psychiatric and mental 15 278 2.87 1.549 2.462 0.086
health services for adolescents who are living in the community 16 313 2.58 1.596

(Davidson, Grigorenko, Boivin, Rapa, & Stein, 2015). SDQ 14 219 12.92 5.119
15 278 12.76 5.288 0.121 0.886
Overall, 95 (11.7%) of the participants in the current study had
16 313 12.70 5.398
scores indicating emotional and behavioral problems. This outcome
SDQ: Prosocial 14 219 8.26 1.664
indicates that the participants in the current study have a relatively
15 278 7.77 1.906 0.794 0.452
lower percent of abnormal SDQ scores than those in other Arab 16 313 8.08 1.743
countries. For example, a study conducted by Mowafy, Ahmed,
6 | ATOUM ET AL.

T A B L E 7 The relationship of the Strengths and Difficulties Questionnaire (SDQ) total score and its subscales with the grade point
average (GPA)

GPA Emotion Conduct Hyperactivity Peer Proscial SDQ total

GPA 1
Emotion −0.160** 1
Conduct −0.126** 0.347** 1
Hyperactivity −0.168 **
0.431 **
0.336** 1
Peer −0.185 **
0.285 **
0.274 **
0.141** 1
Prosocial −0.013 −0.093 **
−0.340 **
−0.127** −0.223** 1

**p < .01.

employing SDQ with a sample of 1456 students in India. The results example, a study conducted by Ortuño‐Sierra, Fonseca‐Pedrero,
indicated that the prevalence of psychological problems was found to Paino, Sastre i Riba, and Muñiz (2015) using the SDQ to screen
be 9.75%. The prevalence of conduct, emotional, peer, prosocial mental health problems with a sample of 1474 Spanish adolescents
problems, and hyperactivity was 5.56%, 5.42%, 4.40%, 4.26%, and with a mean age of 15.92 years found that female participants had
3.78%, respectively. In comparison with the current study, the study higher mean score in emotional problems than male participants. In
of Faizi et al. (2016) reported a lower prevalence of conduct addition, a study conducted by Yao et al. (2009) used the self‐report
problems, emotional problems, and hyperactivity among the adoles- SDQ in a sample of Chinese adolescents and found that girls had
cents from India than those from Jordan. higher scores on the emotional symptoms subscale than the boys,
In addition, in the United States, a study conducted on 1420 whereas boys had higher scores on conduct and peer problems
adolescents found that the prevalence of emotional and behavioral subscales than the girls.
problems was 13.3% (Costello, Mustillo, Erkanli, Keeler, & Angold, The results of one‐way ANOVA indicated no significant difference in
2003). In Taiwan, a study conducted with adolescents found that the the mean of the SDQ score and its subscales according to the age of the
prevalence of emotional and behavioral problems was 14.8–22.7%; the participants (14, 15, and 16 years). The same outcome was reported by
hyperactivity problems was the most frequent problem (Gau, Chong, Mohammadi et al. (2013) who found no difference in psychological
Chen, & Cheng, 2005). Thus, there is significant variations in SDQ scores problems according to the age of the participants 12–14‐ and
by region, but the results are difficult to interpret and compare. 15–17‐year‐old adolescents). On contrary, a study of Yao et al. (2009)
found that adolescents in age groups of 15 and 18 years had higher
scores on the prosocial and hyperactivity behavior subscales than the
4.1 | Differences in SDQ scores according to the adolescents between the ages of 11 and 14 years. The adolescents of
gender and age of the participants 15 and 18 years had lower scores on the peer problems subscale than
The results of the current study showed that female adolescents had did adolescents between the ages of 11 and 14 years.
higher mean scores than male adolescents in SDQ. In addition, female In the current study, there was no difference in the GPA
participants had significantly higher scores on emotional, hyperac- according to the age and gender of the participants. This outcome
tivity, and prosocial subscales than male participants. In contrast, was somewhat supported by the previous literature. Although the
male participants had significantly higher scores on peer problems research found a difference in GPA scores according to the age and
subscale than female participants. The outcome regarding the gender of the adolescents, the effect sizes for these differences were
differences in emotional symptoms subscale between female and small (Jabor, Machtmes, Kungu, Buntat, & Nordin, 2011). Kupczynski,
male participants was extensively supported in the literature. For Brown, Holland, and Uriegas (2014) found no significant difference in
example, a study conducted by Emam et al. (2016) used the Arabic academic achievement according to the gender of the student.
self‐report version of the SDQ to assess the emotional and Furthermore, Jennifer (2011) found that the age and gender of the
behavioral problems in a sample of 816 middle school students in student did not have an impact on the academic achievement. Reisi
Oman. The results indicated a significant difference in emotional and et al. (2017) conducted a cross‐sectional study on 1100 adolescents
behavioral problems according to the gender of the participant, as in Iran and found that academic achievement was significantly
female participants had more emotional symptoms than male correlated with gender and age of the student.
participants, whereas male participants had more conduct and peer The current study indicated a significant negative relationship
problems than female participants. between the SDQ total score and the GPA. In addition, all of the four
This outcome is also consistent with the study of Mohammadi subscales of SDQ were negatively correlated with the GPA. These
et al. (2013) who found that emotional problems were significantly results indicate that increases in emotional problems, peer relation-
higher among female participants compared with male participants. ship problems, hyperactivity problems, and conduct problems were
The same outcome was reported in the western literature. For associated with lower academic achievement as measured by GPA
ATOUM ET AL. | 7

among the adolescents who completed the current study. These care and support, which in turn would improve their academic
outcomes were supported by the previous literature. Previous achievement (Verhaak, van Dijk, Walstock, & Zwaanswijk, 2015). In
research established links between academic successes and students’ the United Sates, for example, some schools have adopted screening
emotional and behavioral functions (Bruhn et al., 2014; Hill, procedures for adolescents’ emotional and behavioral problems and
Ohmstede, & Mims, 2012). Mattison (2015) conducted a study with established partnership and collaboration with various mental health
adolescents who had emotional and behavioral problems (i.e., services to develop and implement specific school‐based strategies
attention‐deficit/hyperactivity disorder, conducts disorder, and focused on the needs of these students (Bruns et al., 2016). Future
learning disability) and found a significant relationship between research may want to conduct longitudinal studies employing specific
these emotional and behavioral problems and academic achievement interventions that show changes in one area, such as academic
scores. In fact, mental health is necessary for optimal academic achievements, following changes in the emotional, social, and behavioral
success (Stevenson, 2010). In addition, academic achievement is functioning of the adolescents (Valdez, Lambert, & Ialongo, 2011).
significantly increased when behavioral problems among adolescents
are managed (Mattison & Blader, 2013). Adolescents with emotional
and behavioral problems might not only have an inability to learn, but 4.2 | Limitations
also they might have difficulty to establish satisfactory social The outcomes of the current study should be interpreted taking into
relationships with their family members, peers, and other colleagues
considerations the following limitations. The age of the participants who
in the school. It is noteworthy, however, that the magnitude of the completed this study ranges between 14 and 16 years, which may not
correlations between the SDQ subscales and the academic achieve-
reflect psychological and behavioral problems in all adolescents.
ment were small, indicating that the Jordanian adolescents’ mental Another limitation of the current study was collecting data from two
health difficulties may not have a strong influence on the Jordanian large schools that may not represent all adolescents in Jordan.
adolescents’ academic achievement and may not be a big problem for Collecting data employing a self‐administered questionnaire is another
the Jordanian adolescents’ performance at school. However, school study limitation, as it might not provide in‐depth information regarding
administrators should not underestimate the influence of adoles-
the academic difficulties experienced by Jordanian adolescents who
cents’ mental health and behavioral difficulties on various aspects of suffer from psychological and behavioral problems.
adolescents’ lives.
Considering the outcomes of the current study, there is a need to
integrate mental health services into schools setting to improve the
5 | CO NCL USION
mental, emotional, behavioral, and academic outcomes for adoles-
cents (Bruns et al., 2016; Stephan et al., 2011). While this is the first
In the current study, the prevalence of adolescents’ psychological
study to investigate adolescents’ psychological and behavioral
and behavioral problems as measured by the SDQ in a Jordanian
problems in Jordan, these problems were previously reported in
sample was 11.7%. There was a small negative relationship
other countries worldwide. In addition, the SDQ, which was used in
between the SDQ scores and the GPA. This is the first report
the current study as a screening tool, was previously used in many
from Jordan to assess adolescents’ psychological and behavioral
countries, cultures, and languages. Therefore, it is imperative that the
problems. However, the study outcomes were consistent with
psychological and behavioral problems among adolescents are
various previous studies, indicating that the psychological and
prevalent worldwide and they are not central to one country or
behavioral problems among adolescents are prevalent worldwide
culture. Considering this, there is a need for global efforts to develop
and they are not central to one country or culture. Therefore,
standardized policies for early identification and screening of
there is a need for global efforts to develop standardized policies
psychological and behavioral problems among adolescents at schools.
worldwide taking into consideration the academic challenges and
In addition, adolescents who demonstrate emotional and beha-
other difficulties faced by adolescents with psychological and
vioral problems should be referred to effective interventions, taking
behavioral problems. Schools should not only adopt screening
into consideration the academic and other challenges they face. In
procedures for adolescents’ emotional and behavioral problems
fact, screening and identification of psychological and behavioral
but also establish effective partnerships with mental health
problems among adolescents at schools without providing effective
services to respond to the needs of these adolescents.
interventions might label them and create a stigma that undermines
their academic success (Sayal et al., 2010). Thus, policy‐makers need
to enforce specific policies that link screening efforts of psychological
CON F LI CTS OF I NTERE ST
and behavioral problems among adolescents to effective mental
health services that are matched to their needs. The authors declare that there are no conflicts of interest.
To date, many schools have not adopted universal screening
procedures in the identification of adolescents at risk for emotional
ORCI D
and behavioral difficulties. There is a need to identify adolescents at risk
for emotional and behavioral difficulties and refer them to appropriate Ahmad Rayan http://orcid.org/0000-0002-8377-2297
8 | ATOUM ET AL.

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