Evaluating ADHD screening tools: A comparative analysis of accuracy, cost, and complexity

Area of Science:

• Psychiatry
• Clinical Psychology
• Neuroscience

Background:

• Rising Attention-Deficit/Hyperactivity Disorder (ADHD) diagnoses necessitate validated screening tools.
• Existing ADHD screening tools vary widely in accuracy, cost, and length.
• Comparative data on ADHD screening tool performance is essential for clinical decision-making.

Purpose of the Study:

• To provide a comparative inventory of ADHD screening tools for clinicians.
• To evaluate the balanced accuracy, item count, cost, and reporter type of ADHD screening instruments.
• To examine predictive values of ADHD screening tools at realistic prevalence rates.

Main Methods:

• Systematic literature searches of MEDLINE, PsycINFO, and EMBASE databases (Jan 2021-July 2025).
• Characterization of screening instruments for children, adolescents, and adults by reporter type.
• Statistical modeling of balanced accuracy using mixed-effects beta regression, including cost, item count, and reporter type as predictors.

Main Results:

• Analysis of 74 assessments covering 40 unique ADHD screening tools.
• Mean balanced accuracy was 76%, with self-report tools showing higher performance than teacher reports.
• No significant association between cost and balanced accuracy; item count showed a slight, non-significant positive trend.

Conclusions:

• ADHD screening tools demonstrate fair to good accuracy, with brief and lower-cost options performing effectively.
• Reporter type differences were partially explained by age, suggesting age-appropriateness is key.
• Low positive predictive values (PPV) but high negative predictive values (NPV) indicate positive screens require further assessment, while negative screens can reliably rule out ADHD.