Screening for the attention deficit hyperactivity disorder phenotype using the strength and difficulties...

Area of Science:

• Child and Adolescent Psychiatry
• Mental Health Screening
• Developmental Psychology

Background:

• The Strengths and Difficulties Questionnaire (SDQ) is a widely used child mental health screening tool.
• Previous research suggests the SDQ may be a useful screener for the Attention-Deficit/Hyperactivity Disorder (ADHD) phenotype.
• The DSM-IV criteria provide a standardized framework for diagnosing ADHD subtypes.

Purpose of the Study:

• To evaluate the screening properties of the SDQ hyperactivity-inattention subscale for the DSM-IV ADHD phenotype in a large population-based sample.
• To compare the diagnostic accuracy of the SDQ subscale using parent and teacher reports.
• To assess the SDQ's ability to identify different ADHD subtypes.

Main Methods:

• A cross-sectional study involving 6,233 children aged 7-9 years in Bergen, Norway.
• Parents and teachers completed questionnaires including the SDQ and the 18-item SNAP-IV ADHD symptom list.
• Receiver Operating Characteristic (ROC) analyses were used to determine the screening performance, with DSM-IV ADHD phenotype based on both informants as the gold standard.

Main Results:

• The SDQ hyperactivity-inattention subscale demonstrated strong screening performance, with an Area Under the Curve (AUC) of 0.91 for parent reports and 0.95 for teacher reports.
• The SDQ predictive algorithm correctly identified 74% of children with the ADHD combined subtype.
• Sensitivity was lower for the ADHD inattentive (22%) and ADHD hyperactive subtypes, indicating limitations in detecting these presentations.

Conclusions:

• The 5-item SDQ hyperactivity-inattention subscale serves as a concise and effective screening tool for the ADHD combined subtype.
• While useful for general ADHD screening, clinicians should be aware of its lower sensitivity for the inattentive and hyperactive subtypes.
• The SDQ offers a practical alternative to longer ADHD symptom checklists, particularly when teacher ratings are available.