The predictive validity of the Strengths and Difficulties Questionnaire for child attention-deficit/hyperactivity disorder
- 142 Downloads
We need accurate screening measures for attention-deficit/hyperactivity disorder (ADHD) to ensure that children with the disorder are referred for assessment without raising concern for children with normal behaviour. The Strengths and Difficulties Questionnaire (SDQ) provides hyperactivity–inattention (HI), conduct, emotional and peer problem subscales and impact scores that may be used for screening. The aim of the study was to investigate the predictive validity of the Danish version of the parent SDQ HI subscale at the child age of 7 years for subsequent clinically diagnosed ADHD (age 8–15 years). Participants were part of the Danish National Birth Cohort (N = 51,096), and children with ADHD were identified through the Danish National Health registries (n = 943). Receiver operating characteristic analysis showed that the screening accuracy for the HI scores was good (area under the curve = .84). With Cox multivariate regression analysis, we found that SDQ HI subscale scores ≥ 7 with impact gave a nearly 14-fold [hazard ratio (HR) = 13.59] increased risk for ADHD, while conduct and emotional problems indicated low risk (HRs of 1.62 and 1.67, respectively). For the HI subscale to be a sensitive measure for ADHD, a low cutoff (4) was needed, but gave many false screening positives (PPV = .02). Although the diagnostic accuracy of the parent version of the SDQ HI subscale for predicting ADHD was good, our results question the feasibility of screening the general child population for ADHD with only the parent SDQ HI subscale.
KeywordsADHD SDQ Cohort study Patient registries
The Danish National Research Foundation established the Danish Epidemiology Science Centre, which initiated and created the Danish National Birth Cohort. The cohort is also a result of a major grant from the Danish National Research Foundation. Additional support for the Danish National Birth Cohort was obtained from the Pharmacy Foundation, the Egmont Foundation, the March of Dimes Birth Defects Foundation, the Augustinus Foundation, and the Health Foundation.
Compliance with ethical standards
Conflict of interest
The authors declare no potential conflicts of interest with respect to the research, authorship, and/or publication of this article. Professor emeritus Svein Friis has received an honorarium as a data consultant for RAND Corporation for a project sponsored by the Janssen-Cilag pharmaceutical company.
- 9.Chorozoglou M, Smith E, Koerting J, Thompson MJ, Sayal K, Sonuga-Barke EJ (2015) Preschool hyperactivity is associated with long-term economic burden: evidence from a longitudinal health economic analysis of costs incurred across childhood, adolescence and young adulthood. J Child Psychol Psychiatry 56(9):966–975. https://doi.org/10.1111/jcpp.12437 CrossRefPubMedPubMedCentralGoogle Scholar
- 11.Dalsgaard S, Leckman JF, Mortensen PB, Nielsen HS, Simonsen M (2015) Effect of drugs on the risk of injuries in children with attention deficit hyperactivity disorder: a prospective cohort study. Lancet Psychiatry 2(8):702–709. https://doi.org/10.1016/s2215-0366(15)00271-0 CrossRefPubMedGoogle Scholar
- 15.Carballo JJ, Rodriguez-Blanco L, Garcia-Nieto R, Baca-Garcia E (2014) Screening for the ADHD phenotype using the Strengths and Difficulties Questionnaire in a clinical sample of newly referred children and adolescents. J Atten Disord. https://doi.org/10.1177/1087054714561858 CrossRefPubMedGoogle Scholar
- 16.Stone LL, Otten R, Engels RC, Vermulst AA, Janssens JM (2010) Psychometric properties of the parent and teacher versions of the strengths and difficulties questionnaire for 4- to 12-year-olds: a review. Clin Child Fam Psychol Rev 13(3):254–274. https://doi.org/10.1007/s10567-010-0071-2 CrossRefPubMedPubMedCentralGoogle Scholar
- 22.Dopfner M, Breuer D, Wille N, Erhart M, Ravens-Sieberer U, BELLA Study Group (2008) How often do children meet ICD-10/DSM-IV criteria of attention deficit-/hyperactivity disorder and hyperkinetic disorder? Parent-based prevalence rates in a national sample—results of the BELLA study. Eur Child Adolesc Psychiatry 17(Suppl 1):59–70. https://doi.org/10.1007/s00787-008-1007-y CrossRefPubMedGoogle Scholar
- 25.Rimvall MK, Elberling H, Rask CU, Helenius D, Skovgaard AM, Jeppesen P (2014) Predicting ADHD in school age when using the Strengths and Difficulties Questionnaire in preschool age: a longitudinal general population study, CCC2000. Eur Child Adolesc Psychiatry 23(11):1051–1060. https://doi.org/10.1007/s00787-014-0546-7 CrossRefPubMedGoogle Scholar
- 30.World Health Organization (WHO) (1990) International classification of diseases and related health problems (ICD-10), 10th edn. WHO, GenevaGoogle Scholar
- 32.Niclasen J, Teasdale TW, Andersen AM, Skovgaard AM, Elberling H, Obel C (2012) Psychometric properties of the Danish Strength and Difficulties Questionnaire: the SDQ assessed for more than 70,000 raters in four different cohorts. PLoS One 7(2):e32025. https://doi.org/10.1371/journal.pone.0032025 CrossRefPubMedPubMedCentralGoogle Scholar
- 33.Niclasen J, Skovgaard AM, Andersen AM, Somhovd MJ, Obel C (2013) A confirmatory approach to examining the factor structure of the Strengths and Difficulties Questionnaire (SDQ): a large scale cohort study. J Abnorm Child Psychol 41(3):355–365. https://doi.org/10.1007/s10802-012-9683-y CrossRefPubMedGoogle Scholar
- 38.Youngstrom E, Meyers O, Youngstrom JK, Calabrese JR, Findling RL (2006) Comparing the effects of sampling designs on the diagnostic accuracy of eight promising screening algorithms for pediatric bipolar disorder. Biol Psychiatry 60(9):1013–1019. https://doi.org/10.1016/j.biopsych.2006.06.023 CrossRefPubMedGoogle Scholar