Congruent Validity of the Strengths and Difficulties Questionnaire to Screen for Comorbidities in Children With ADHD

ADHD Comorbid With Major Depression on Parents and Teachers Perceptions

Objective: Examine the Strengths and Difficulties Questionnaire (SDQ) responses of parents and teachers for children with ADHD comorbid with major depressive disorder (MDD), with an emphasis on determining how well the respondent groups' responses correlate, and how well the results obtained perform as predictors of clinical diagnosis. Method: The SDQ was completed by parents and teachers of (n = 215 participants, 7-12 years old) in ADHD, MDD, ADHD + MDD, and healthy control groups. Agreement between parent and teacher SDQs and their concordance with Diagnostic and Statistical Manual of Mental Disorders (4th ed.; DSM-IV) diagnoses were assessed. Receiver operating characteristic (ROC) and Kappa concordance analyses were used to compare the groups with the health control group. Results: The comorbid group presented greater impairments than the ADHD, MDD, and control groups (p < .001). Conclusion: The presence of psychiatric comorbidity causes greater impairment for school children with ADHD. The SDQ has good sensitivity for detecting these children and correlates well with DSM diagnosis.

A Systematic Review of Some Reliability and Validity Issues regarding the Strengths and Difficulties Questionnaire Focusing on Its Use in Out-of-Home Care

PURPOSE

A systematic review was conducted to analyze the inter-rater reliability, cross-informant consistency, test-retest reliability, and temporal stability of the Strengths and Difficulties Questionnaire (SDQ), and its ability to discriminate.

METHOD

We searched three databases for articles about the SDQ (parent, teacher, and self-report version), used samples of children up to age 18 and reported inter-rater reliability, cross-informant reliability, test-retest reliability, temporal stability, specificity, sensitivity, positive predictive value (PPV), and negative predictive value (NPV).

RESULTS

Focusing on the TDS, inter-rater, and cross-informant reliability showed acceptable values, but respondent types (e.g., mothers and fathers) are not interchangeable. Test-retest reliability and temporal stability were also acceptable, and not excessively high. Specificity and NPV were acceptable but not sensitivity and PPV.

DISCUSSION AND CONCLUSION

Greater transparency is needed about who the respondent is when the term "parents" is used. The SDQ is an important supplement to service-as-usual assessments by social care professionals.

The Strengths and Difficulties Questionnaire Predicts Concurrent Mental Health Difficulties in a Transdiagnostic Sample of Struggling Learners

Children and adolescents with developmental problems are at increased risk of experiencing mental health problems. The Strengths and Difficulties Questionnaire (SDQ) is widely used as a screener for detecting mental health difficulties in these populations, but its use thus far has been restricted to groups of children with diagnosed disorders (e.g., ADHD). Transdiagnostic approaches, which focus on symptoms and soften or remove the boundaries between traditional categorical disorders, are increasingly adopted in research and practice. The aim of this study was to assess the potential of the SDQ to detect concurrent mental health problems in a transdiagnostic sample of children. The sample were referred by health and educational professionals for difficulties related to learning (N = 389). Some had one diagnosis, others had multiple, but many had no diagnoses. Parent-rated SDQ scores were significantly positively correlated with parent ratings of mental health difficulties on the Revised Child Anxiety and Depression Scale (RCADS). Ratings on the SDQ Emotion subscale significantly predicted the likelihood of having concurrent clinical anxiety and depression scores. Ratings on the Hyperactivity subscale predicted concurrent anxiety levels. These findings suggest the SDQ could be a valuable screening tool for identifying existing mental health difficulties in children recognized as struggling, as it can be in typically developing children and those with specific diagnoses.

Anxiety modulates the relation between attention-deficit/hyperactivity disorder severity and working memory-related brain activity

OBJECTIVES

Individuals with attention-deficit/hyperactivity disorder (ADHD) often have heightened levels of anxiety, which has been associated with worse performance on working memory tasks. Knowledge of the neural pathways underlying the combined presence of ADHD and anxiety may aid in a better understanding of their co-occurrence. Therefore, we investigated how anxiety modulates the effect of ADHD severity on neural activity during a visuospatial working memory (VSWM) task.

METHODS

Neuroimaging data were available for 371 adolescents and young adults participating in the multicentre cohort study NeuroIMAGE (average age 17.1 years). We analysed the effects of ADHD severity, anxiety severity and their interaction on-task accuracy, and on neural activity associated with working memory (VSWM trials minus baseline), and memory load (high memory load trials minus low load trials).

RESULTS

Anxiety significantly modulated the relation between ADHD severity and neural activity in the cerebellum for the working memory contrast, and bilaterally in the striatum and thalamus for the memory load contrast.

CONCLUSIONS

We found that ADHD with co-occurring anxiety is associated with lowered neural activity during a VSWM task in regions important for information gating. This fits well with previous theorising on ADHD with co-occurring anxiety, and illustrates the neurobiological heterogeneity of ADHD.

No Medication for My Child! A Naturalistic Study on the Treatment Preferences for and Effects of Cogmed Working Memory Training Versus Psychostimulant Medication in Clinically Referred Youth with ADHD

In this naturalistic clinical study, we explored the applicability and clinical effectiveness of Cogmed WMT, pharmacotherapy, and their combination for clinically referred children and adolescents with attention-deficit/hyperactivity disorder (ADHD). Ninety youth with ADHD (ages 6-16 years) and their parents were offered the possibility to choose one of the three interventions. The motives for choosing various interventions were quite different. Medication was chosen because this treatment was expected to be most effective, but also because the Cogmed WMT program was regarded as too taxing. The choice for Cogmed WMT was mainly negatively motivated: participants tended to be strongly against the use of medication, found it a too rigorous step, or feared side effects and addiction problems. The choice for the combination treatment was strongly positively motivated: parents and youth indicated that they wanted to receive the best possible intervention and part of them also had high expectations of Cogmed WMT. In terms of clinical effectiveness, pharmacotherapy with stimulant medication and the combination treatment produced larger reductions in ADHD symptomatology than Cogmed WMT. Further, results indicated that Cogmed WMT selectively enhanced working memory performance. Finally, after conducting Cogmed WMT, youths and parents were more 'open' to accept pharmacotherapy as intervention, probably because the training increased greater insight in and awareness of the problematic features of ADHD.

The diagnosis of attention-deficit/hyperactivity disorder in Australian children: Current paediatric practice and parent perspective

AIMS

In a sample of newly diagnosed children with attention-deficit/hyperactivity disorder (ADHD), the aims were to examine (1) paediatrician assessment and management practices; (2) previous assessments and interventions; (3) correspondence between parent-report and paediatrician identification of comorbidities; and (4) parent agreement with diagnosis of ADHD.

DESIGN

cross-sectional, multi-site practice audit with questionnaires completed by paediatricians and parents at the point of ADHD diagnosis.

SETTING

private/public paediatric practices in Western Australia and Victoria, Australia.

MAIN OUTCOME MEASURES

paediatricians: elements of assessment and management were indicated on a study-designed data form. Parents: ADHD symptoms and comorbidities were measured using the Conners 3 ADHD Index and Strengths and Difficulties Questionnaire, respectively. Sleep problems, previous assessments and interventions, and agreement with ADHD diagnosis were measured by questionnaire.

RESULTS

Twenty-four paediatricians participated, providing data on 137 patients (77% men, mean age 8.1 years). Parent and teacher questionnaires were used in 88% and 85% of assessments, respectively. Medication was prescribed in 75% of cases. Comorbidities were commonly diagnosed (70%); however, the proportion of patients identified by paediatricians with internalising problems (18%), externalising problems (15%) and sleep problems (4%) was less than by parent report (51%, 66% and 39%). One in seven parents did not agree with the diagnosis of ADHD.

CONCLUSIONS

Australian paediatric practice in relation to ADHD assessment is generally consistent with best practice guidelines; however, improvements are needed in relation to the routine use of questionnaires and the identification of comorbidities. A proportion of parents do not agree with the diagnosis of ADHD made by their paediatrician.