A script concordance test to implement 2024 HAS ADHD guidelines in primary care

The 2024 French Haute Autorité de santé (HAS) guidelines introduced the concept of an "ADHD-specialized physician" calling for competency-based models to support broader, evidence-based ADHD care for children and adolescents. However, no standardized assessment currently exists to evaluate the clinical reasoning required for this role.

This study describes the development and initial validation of a Script Concordance Test (SCT) designed to assess clinical reasoning in ADHD management, with potential applications as both a pedagogical and certification tool.

Following international standards for SCT design, the test was constructed using a structured blueprint aligned with HAS 2024 guidelines. A panel of 25 national experts completed the full version (72 items); after reviewing the items and excluding those with low consensus, 43 items were retained. Inter-rater agreement was analyzed using Kendall's coefficient of concordance (W=0.67). Qualitative validation was achieved through iterative expert consensus ensuring clarity, relevance, and representativeness.

The expert panel demonstrated substantial concordance (Kendall's W=0.67) consistent with previous SCT validation studies in psychiatry and pediatrics. Qualitative reviews confirmed the clarity, representativeness, and clinical relevance of the retained items.

This SCT provides a valid and adaptable method to assess higher-order clinical reasoning in ADHD care. By operationalizing the competencies implied in the HAS 2024 guidelines, it may support the emerging role of the "ADHD-specialized physician" and contribute to competency-based certification models similar to those used in other regulated medical practices.