Parental perceptions and sociodemographic predictors of emotional and behavioral difficulties among children and adolescents in Makkah City: a cross-sectional study

Background Emotional and behavioral difficulties among children and adolescents are increasingly recognized worldwide, with significant implications for development, academic performance, and social well-being. In Saudi Arabia, nearly 40% of youth are estimated to experience such challenges, yet parental recognition is often hindered by cultural stigma and limited awareness. Understanding how parents perceive and report these difficulties is critical for early identification and mental health promotion. Objectives To assess Saudi parents’ perceptions and reports of emotional and behavioral difficulties among children and adolescents in Makkah City, examine how sociodemographic factors influence these difficulties, and identify independent predictors. Methods A cross-sectional study was conducted among 434 Saudi parents of children aged 6–18 years, recruited from eight stratified randomly selected schools across Makkah. Data were collected using an online, parent-completed questionnaire that included sociodemographic information and items derived from the validated Arabic version of the Strengths and Difficulties Questionnaire–Parent Version (SDQ-P). Emotional and behavioral difficulties were assessed and categorized according to the SDQ Total Difficulties Score (TDS). Statistical analyses included nonparametric Mann–Whitney test and Kruskal–Wallis tests for bivariate associations and multiple linear regression modeling to identify independent sociodemographic predictors. Results The median age of the children was 12 years, with 59% being female. Based on parent-reported TDS, 51.8% of children were within the normal range, 20.7% were borderline, and 27.4% were in the abnormal range. Elevated difficulties were particularly noted in emotional symptoms (26.5%) and conduct problems (27.4%). Bivariate analysis showed that male sex, older age, lower parental education, unemployed fathers, maternal employment, larger family size, separated or widowed parents, and lower household income were significantly associated with higher TDS ( p < 0.05). Multivariate analysis confirmed several of these as independent predictors, with maternal employment (B = 4.437, p < 0.001), low household income (B = 3.761, p < 0.001), and lower parental education (B = 2.801, p = 0.011 for mothers; B = 2.316, p = 0.015 for fathers) showing the strongest associations. Conclusion A substantial proportion of children in Makkah exhibit emotional and behavioral difficulties as reported by their parents using the SDQ-P. These difficulties are significantly influenced by sociodemographic factors, particularly parental education, employment status, and household income. Targeted awareness programs, early school-based screening, and culturally sensitive, family-focused interventions are essential to support child emotional and behavioral health in this setting.