Discriminative utility and limitations of the strengths and difficulties questionnaire for ADHD in a referred clinical pediatric sample

Abstract

Background and objectives

Attention-deficit/hyperactivity disorder (ADHD) is a prevalent neurodevelopmental disorder. However, access to diagnosis and treatment remains limited, requiring improved screening strategies. This study evaluates the discriminative utility of the Strengths and Difficulties Questionnaire (SDQ) for ADHD diagnosis in a clinical sample and explores group differences and the contribution of different informants.

Methods

We conducted a retrospective analysis of 496 children aged 6–16 referred to a mental health clinic; 358 (72.2 %) received a clinical ADHD diagnosis. Baseline SDQ-Parent (SDQ-P) and SDQ-Teacher (SDQ-T) ratings were analyzed. Logistic regression and receiver operating characteristic (ROC) curve analyses were used to assess the diagnostic performance of SDQ subscales against clinical ADHD diagnoses.

Results

ADHD diagnoses were more frequent in males (65.6 %) and in younger children (mean age = 9.53 ± 2.59). Hyperactivity/Inattention showed the highest discrimination (AUC = 0.806 for SDQ-P; 0.883 for SDQ-T). Sensitivity was high but specificity low (.21 (95 % CI [.09, .43]) for SDQ-P; .30 (95 % CI [.07, .65]) for SDQ-T), limiting differential diagnosis. Teacher ratings outperformed parent ratings (higher AUC and specificity), underscoring informant complementarity.

Conclusion

The SDQ—especially Hyperactivity/Inattention—offers useful screening discrimination in referred youth, with teacher ratings outperforming parent ratings; however, low specificity limits differential diagnosis, so confirmation requires structured clinical interviews using multiple informants.

Future work should test calibrated subscale thresholds and local norms to boost discrimination and clarify context effects on SDQ ratings.