Child reports reveal distinct clues to self-injury in preadolescents

One in four preadolescents in a Tianjin community sample reported self-injurious behaviour during the previous six months, and their own accounts were more closely associated with that behaviour than parents’ reports for emotional distress, hyperactivity and peer difficulties. The school-based cross-sectional study included 1,923 parent-child pairs with a mean age of 11.01 years. Among them, 484 children, or 25.2%, endorsed at least one intentional self-injury behaviour and were classified operationally as having non-suicidal self-injury, or NSSI. Emotional symptoms, hyperactivity and peer interaction problems had statistically significantly stronger associations with NSSI when reported by children than by parents, indicating that the two informants captured partly different aspects of the children’s experiences.

The finding does not mean that parent questionnaires are unreliable or that children’s reports should replace them. Instead, the analysis indicates that asking a child directly may reveal internal and peer-related difficulties that are less visible outside school, while parents may be better positioned to notice conduct problems occurring at home. When child reports were added after parent reports, the statistical model improved substantially more than when parent reports were added after child reports. The combined model explained 21.0% of the variance in NSSI status, but neither informant alone approached definitive predictive accuracy. These results support a complementary, multi-informant approach rather than a contest over which perspective is universally superior.

Researchers collected paired questionnaires in December 2021 from students in grades four through six at eight primary schools in Dongli District, Tianjin. Children completed self-report forms in class with trained teachers and research assistants available for clarification and to preserve privacy, while parents completed questionnaires at home and returned them in sealed envelopes. Children provided assent and parents gave written consent. The investigators excluded incomplete or invalid questionnaires and cases missing either the child or parent Strengths and Difficulties Questionnaire, reducing the initial group of 4,206 students to 1,923 matched parent-child dyads. A complete-case sensitivity analysis produced results consistent with the primary analysis. Because the sampling was by convenience and the participating schools were in one district, the findings describe this particular sample rather than all children in Tianjin or China.

NSSI was measured with the 16-item short version of the Deliberate Self-Harm Inventory, which asks about intentional self-injury during the preceding six months. Each item ranges from never to three or more times, and endorsement of at least one behaviour placed a child in the NSSI group. The most common reported method was carving words, pictures, designs or other marks into the skin, reported by 65.5% of the NSSI group. Cutting the wrist, arms or another body area was reported by 33.9%, and scratching severely enough to cause scarring or bleeding by 30.4%. Biting until the skin broke was reported by 21.7%, while 3.1% reported self-harm that led to hospitalisation or medical treatment. The researchers note that suicidal intent was not assessed separately, so the classification was operational rather than a clinical confirmation that every episode occurred without suicidal intent.

Emotional and behavioural characteristics were assessed with child and parent versions of the Strengths and Difficulties Questionnaire, or SDQ. Its five subscales cover emotional symptoms, conduct problems, hyperactivity and inattention, peer interaction problems and prosocial behaviour. In unadjusted comparisons, children in the NSSI group had higher scores on all four problem subscales in both informants’ reports and lower prosocial-behaviour scores. These group differences do not show that any feature preceded or caused the self-injury, because the survey measured children and behaviours at the same time. The SDQ is a screening instrument rather than a diagnostic assessment, and the study did not test whether its categories corresponded to diagnosed psychiatric disorders.

Multivariable logistic regression, adjusted for age and gender, produced a more nuanced pattern after all five SDQ subscales were entered simultaneously. With standardised scores, each one-standard-deviation increase in parent-reported emotional symptoms was associated with 1.26 times the odds of NSSI, compared with 1.66 for child-reported emotional symptoms. The corresponding odds ratios were 1.25 for parent-reported hyperactivity and 1.39 for child-reported hyperactivity. Child-reported peer interaction problems were associated with NSSI, with an odds ratio of 1.24, whereas parent-reported peer interaction problems were not significant after adjustment. Parent-reported conduct problems were also associated with NSSI, with an odds ratio of 1.18, whereas child-reported conduct problems and prosocial behaviour were not significant after adjustment. These are associations in odds, not changes in an individual child’s probability caused by a symptom score, and the study cannot establish which problems preceded the behaviour.

Formal joint models were then used to compare coefficients for the same SDQ subscale when both child and parent reports were included simultaneously. Wald tests indicated that the associations were statistically significantly larger for child-reported emotional symptoms, hyperactivity and peer interaction problems, with false-discovery-rate-adjusted p-values below 0.001 in each case. The investigators did not find significant differences for conduct problems or prosocial behaviour. Parent-reported peer interaction problems differed between the NSSI and non-NSSI groups in simple comparisons but were no longer significant after adjustment, apparently because their variation overlapped with the other SDQ subscales included in the model. The results therefore describe differences in measured statistical associations; they do not prove that one informant is inherently more accurate, nor do they establish a mechanism for the differences.

Child reports also improved discrimination between children classified with and without NSSI. The child-report model produced an area under the receiver operating characteristic curve, or AUC, of 0.753 with a 95% confidence interval of 0.732 to 0.779, indicating moderate discrimination. The parent-report model yielded an AUC of 0.659, with a 95% confidence interval of 0.638 to 0.694. The difference was statistically significant in a DeLong test for correlated curves, with Z equal to -7.75 and p below 0.001. Nevertheless, an AUC of 0.753 should not be presented as high accuracy or as proof that child reports are more truthful. The models were evaluated in the same cross-sectional sample, with no independent screening validation, so their performance cannot automatically be transferred to another school, region or clinical setting.

Several limitations constrain the interpretation and likely contributed to the apparently stronger child-report results. NSSI and the child SDQ came from the same respondent, creating possible shared-method variance: a child who reports both emotional distress and self-injury may therefore show a stronger association than a parent’s report can reproduce. The DSHI-s was developed for adolescents, and the self-report SDQ is officially recommended for children aged 11 and above, although previous research has reported acceptable psychometric properties in children as young as 8 to 10. Additional validation is therefore needed for these instruments among Chinese children aged 9 to 12. The study also did not independently verify self-injury through clinical interview or another informant, and the functions of the behaviour, such as emotion regulation or social signalling, were not assessed.

The design also prevents conclusions about temporal sequence, causation, prevalence across all Chinese children or the reasons children self-injure. The models adjusted only for age and gender, leaving possible influences such as socioeconomic conditions, parental mental health, academic stress, peer victimisation and parenting style unmeasured. More than half of the initially enrolled students were excluded because complete matched data were unavailable, which may also have introduced selection effects. The study’s clearest conclusion is that, in this particular sample of 9- to 12-year-olds, child and parent questionnaires supplied overlapping but non-identical information: children contributed particularly strong signals about internal distress, hyperactivity and peer problems linked to concurrent self-reported self-injury, while parents contributed additional information that was modest but measurable when added after child reports. Any use of these findings in screening would require further validation rather than treating either report as a standalone diagnostic test.

Subject of Research: Comparison of child and parent reports of emotional and behavioural correlates of self-reported non-suicidal self-injury among preadolescents in Tianjin

Article Title: Emotional and behavioural problems and non-suicidal self-injury in preadolescent children: complementary insights from child and parent reports

Article References: Yang, T., Li, M., Yu, H., Hou, X., Yan, G., Li, B., Ma, H., Sun, L., Yin, H., & Xu, G. (2026). Emotional and behavioural problems and non-suicidal self-injury in preadolescent children: complementary insights from child and parent reports. Frontiers in Psychiatry, 17, Article 1973448. https://doi.org/10.3389/fpsyt.2026.1973448

Image Credits: AI Generated

DOI: 10.3389/fpsyt.2026.1973448

Keywords: preadolescents, self-injury, child self-report, parent report, emotional symptoms, hyperactivity, peer problems, school-based survey, Tianjin, mental health, Emotional, behavioural