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The predictive validity of the Strengths and Difficulties Questionnaire for child attention-deficit/hyperactivity disorder


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.

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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.

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Correspondence to Kristin Romvig Overgaard.

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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.

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Overgaard, K.R., Madsen, K.B., Oerbeck, B. et al. The predictive validity of the Strengths and Difficulties Questionnaire for child attention-deficit/hyperactivity disorder. Eur Child Adolesc Psychiatry 28, 625–633 (2019).

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  • ADHD
  • SDQ
  • Cohort study
  • Patient registries