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

• Erica Fongaro ^[1] ; Arnaud Carlier ^[1] ; Alexandra Vauclare ^[1] ; Judith Brisot-Dubois ^[1] ; Damien Huzard ^[2] ; Hervé Caci ^[3] ; Hala Kerbage ^[4] ; Diane Purper-Ouakil ^[5]
  1. [1] Centre Hospitalier Universitaire de Montpellier, Saint Eloi Hospital, Montpellier, France
  2. [2] Neuronautix, Place Sean Mc Bride, Montpellier, France
  3. [3] Hôpitaux Pédiatrique de Nice, CHU Lenval, 57, avenue de la Californie, 06200 Nice, France
  4. [4] Centre Hospitalier Universitaire de Montpellier, Saint Eloi Hospital, Montpellier, France Université Paris-Saclay, UVSQ, Inserm, CESP, 94807 Villejuif, France
  5. [5] Centre Hospitalier Universitaire de Montpellier, Saint Eloi Hospital, Montpellier, France b Université Paris-Saclay, UVSQ, Inserm, CESP, 94807 Villejuif, France

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• Localización: European journal of psychiatry, ISSN 0213-6163, Vol. 40, Nº 1, 2026
• Idioma: inglés
• DOI: 10.1016/j.ejpsy.2025.100333
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  • 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.