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3. Questionnaires for ADHD Diagnosis

3. Questionnaires for ADHD Diagnosis

Last updated:

Author: Ulrich Brennecke
Review: Waldemar Zdero, M.A. in Psychology (August 2024)

Questionnaires are completed by people with ADHD themselves and by significant others (parents, teachers, friends).

Questionnaires are highly subjective and carry the risk that the respondent’s personal opinion about ADHD may itself influence how the questions are answered. It sometimes happens that parents fundamentally reject an ADHD diagnosis, especially when it comes to their own child. Similarly, subjective beliefs held by people with ADHD (perhaps that they “want” a diagnosis in the hope of finding a solution to their suffering, or perhaps because they reject a diagnosis due to their fundamental rejection of ADHD or to avoid stigmatization) or shifts in evaluation criteria resulting from intense prior preoccupation with the topic can distort the results (bias).

For example, in tests involving elimination diets for ADHD, the results of parent questionnaires are consistently far more positive than the results of objective tests.1 Since this occurs even in double-blind studies, there is a significant bias on the part of parents to report the subjectively desired outcome (that ADHD can be treated with a diet rather than with medications that are viewed critically).
It is also possible, however, that the parents were already enthusiastic about the slight improvements that an elimination diet can bring about—or the placebo effect it may have on the affected child—and were unaware of the much better results that could be achieved through medication or therapy, or at least were unaware of them at the time of the evaluation.

Most online self-tests available for free on the Internet provide a rough initial assessment. However, prior exposure to such tests can skew the results of subsequent tests (bias).
However, due to the dramatic shortage of resources for diagnosing ADHD and a lack of knowledge on the part of many doctors and psychologists—which cannot be dismissed out of hand—the benefits outweigh the disadvantages for people with ADHD
can decide for themselves whether a diagnostic test is appropriate for them, given the clear risk of bias.

We have developed our own—quite comprehensive—online self-assessment test, which showed a correlation of about 93% with existing ADHD diagnoses and about 96% with the CAARS-L. Nevertheless, like any online self-assessment, it is only an indicator and can in no way replace a medical diagnosis. There is also a third-party assessment component available. For both tests, evaluations are available that can be presented to the diagnostician, allowing them to understand in detail how the assessment was arrived at. This provides an additional perspective on the symptoms.
Online ADHD Tests

ADHD RS-IV: ADHD Rating Scale-IV
ASRS 1.1: ADHD Self-Report Scale
ASRS-A 1.1. Adolescent ADHD Self-Report Scale
ASRS-A-S 1.1: Parent-Adolescent ADHD Self-Report Scale
BADDS: Brown Attention-Deficit Disorder Scale
CAARS: Conners’ Adult ADHD Rating Scales
CASQ: Conners’ Abbreviated Symptom Questionnaire
CBCL: Child Behavior Checklist
CBCL-AP scale: Child Behavior Checklist—Attention Problems
CPRS: Conners’ Parent Rating Scales
CPT: Continuous Performance Test
CTRS: Conners’ Teacher Rating Scales
DISC-5: Diagnostic Interview Schedule for Children
DIVA 2.0: Diagnostic Interview for ADHD in Adults, Version 2
DIVA 5: Diagnostic Interview for ADHD in Adults, Version 5
PAPA: Preschool Age Psychiatric Assessment
PICS: Parent Interview on Child Symptoms
QbCheck: Online Assessment by Qbtech
SNAP-IV: Swanson, Nolan, and Pelham Rating Scale-IV
SR-WRAADDS: Wender-Reimherr Adult Attention Deficit Disorder Scale
SWAN-DE-SB: Strengths and Weaknesses of ADHD Symptoms and Normal Behavior Scale, German Version, Self-Assessment Questionnaire
WURS: Wender Utah Rating Scales
WURS-K: Wender Utah Rating Scales (Abbreviated Version)

1. Self-Assessment Questionnaires for Diagnosis

Name of the instrument/test ; Test type ; Sensitivity (%) ; Specificity (%) ; Target population/Special features
AASS-5, Adult ADHD Symptom Scale for DSM-5, 21 questions, self-report questionnaire, DSM-5, derived from ASRS-6 Cut-off unknown to us; Van Wijk, 20202 95.1% 93.8%
ADHD-SB 22 questions, n = 88, Rösler et al., 20043 Cut-off 10: 88%; Cut-off 15: 77%; Cut-off 18: 65% Cut-off 10: 67%; Cut-off 15: 75%; Cut-off 18: 92%
BAARS-IV, Barkley Adult ADHD Rating Scale versus Diagnostic Interview for ADHD in Adults 2.0 (DIVA-2) in a sample of n = 390 male prison inmates in England4 37.9% 96.3%
BADDS (Brown Attention-Deficit Disorder Scale), Brazilian Portuguese translation, for comorbid SUD5 questionnaire 72% 88%
CAARS (Conners Adult ADHD Rating Scale) Questionnaire, adults, Van Voorhees et al., 20116 65% (Conners Index) 61% (Conners Index)
CAARS for comorbid substance use disorders Questionnaire, Dakwar et al., 20127 80% Adults; Questionnaire
CAARS on cannabis addiction 26 questions, DSM-IV, n = 99, Notzon et al., 20208 80% 91%
SWAN-AD Scale of Strengths and Weaknesses of ADHD Symptoms and Normal Behavior Scale (SWAN-DE-SB), German version questionnaire, cutoff 2.61, n = 405, Blume et al., 20259 93.3% 90.9% ADHD in adults; values at optimal cutoff
SWAN-HI Scale of Strengths and Weaknesses of ADHD Symptoms and Normal Behavior Scale (SWAN-DE-SB), German version questionnaire, cutoff 2.72, n = 405, Blume et al., 20259 95.6% 100% ADHD in adults; scores at the optimal cutoff
SWAN-TOT Scale of Strengths and Weaknesses of ADHD Symptoms and Normal Behavior Scale (SWAN-DE-SB), German version Cut-off 2.64, n = 405, Blume et al., 20259 95.6% 100% ADHD in adults; values at optimal cutoff
Wender-Reimherr Adult Attention Deficit Disorder Scale (SR-WRAADDS) Questionnaire, Marchant et al., 201510 97% (ADHD vs. non-affected individuals); 87% (ADHD vs. depression or anxiety)

Self-assessment questionnaires:11

  • BADD: Brown Attention Deficit Disorders Scale, a 40-item self-report questionnaire for assessing cognitive ADHD symptoms
    Emotional dysregulation (including in ADHD) can be assessed using the

  • Children with Difficulties (QCD)12

  • Conners’ Scales of Attention and Behavior for Adults – Self-Report (CAARS-S)

  • Cologne ADHD Test for Adults (KATE)

    • Workbook containing various tests and instructions for grading
    • ASRS 1.1.
  • Reactivity, Intensity, Polarity, and Stability Questionnaire (RIPoSt-40)13

  • Wender-Reimherr Self-Assessment (WR-SB)

  • Wender-Reimherr Adult Attention Deficit Disorder Scale (SR-WRAADDS)

  • Youth Self-Report, YSR/11-18 (Questionnaire for Adolescents)14

  • INDT-ADHD15

    • Indian ADHD Questionnaire with 18 items for ADHD in children, featuring a 4-factor structure
    • ADHD vs. non-affected individuals: sensitivity 87.7%, specificity 97.2%, positive predictive value 98.0%, negative predictive value 83.3%
    • ADHD vs. other neurodevelopmental disorders: sensitivity 87.7%, specificity 42.9%, positive predictive value 58.1%, negative predictive value 79.4%
    • Convergent validity with Conner’s Parents Rating Scale: r = 0.73
  • ADHD RS-IV (short form), 6 items: AUC 98% at a cutoff of 616

  • Quick Delay Questionnaire (QDQ); a self-report questionnaire for assessing delay-related behaviors in adults17

Adolescents with ADHD demonstrated gender-specific abilities to assess their own symptoms:18
Boys tended to underestimate their symptoms, while girls assessed themselves realistically.
Parents tend to underestimate the symptoms in girls.

A meta-analysis of 9 ADHD questionnaires found that only 37% assessed identical symptoms or behaviors.19 Most questionnaires for children were completed by parents, while most questionnaires for adults were self-administered.
With regard to questionnaires, a study revealed significant discrepancies in the assessments made by parents, teachers, and people with ADHD; these discrepancies concerned all existing symptoms—with the exception of emotional dysregulation—but even more so the frequency with which they occurred.20
In self-assessment questionnaires, response biases and unintentional misjudgments can influence the results.
Participants who were asked to report their daily physical activity showed significant discrepancies compared to the actigraphy measurements, even though they were aware that they were being monitored by actigraphy.21
Children with ADHD perform worse on tests with a slow event rate, while their results on exciting, challenging tasks were comparable to those of people without ADHD.22 23 This is consistent with the finding that test results for people with ADHD change when rewards are promised.24 This, too, suggests that it is not the ability to concentrate or the capacity for inhibition that is impaired per se, but rather that insufficient activation by “normally interesting” stimuli is the real key.

  • Behavioral symptoms were assessed in 28% to 81% of the questionnaire items
  • Cognitive symptoms were addressed in 9% to 44% of the questions
  • Emotional symptoms were mentioned in between 0% and 24% of the questions
  • Physical symptoms were assessed in only 3 of the 9 instruments

2. Third-Party Assessment Questionnaires for Diagnosis

Name of the instrument/test ; Test type ; Sensitivity (%) ; Specificity (%) ; Target group/Special features
CTRS/CPRS (Conners’ Teacher/Parent Rating Scales)25 Questionnaire 83.5% 35.7% Children; high sensitivity, low specificity
CTRS-R (Conners Teacher Rating Scale-Revised) (meta-analysis, k = 11)26 Questionnaire 72% 84% Children and adolescents; questionnaire for teachers
CBCL-AP Scale (Child Behavior Checklist-Attention Problem)(meta-analysis, k = 14)26 Questionnaire 77% 73% Children and adolescents
CRS-R (Conners Parent Rating Scale-Revised) (meta-analysis, k = 11)26 Questionnaire 75% 85% Children and adolescents; questionnaire for parents
DISC-5 (Diagnostic Interview Schedule for Children) Parent and Teacher Reports 27 Interview 94.7% 64.2% Combined Parent and Teacher Reports
DISC-5 (Diagnostic Interview Schedule for Children)27 Interview 80.8% (parents), 82.8% (adolescents) 71.6% (parents), 65% (adolescents) Children; parent report. DRAWBACK: The German version is NOT SUFFICIENT FOR PRESCRIBING STIMULANTS, as it has not yet been validated in German
Kiddie Schedule for Affective Disorders and Schizophrenia (Present Lifetime Version)28 Questionnaire 86% 80% Questionnaires for parents and teachers; false-positive rate 20%, false-negative rate 14%
PAPA (Preschool Age Psychiatric Assessment), a structured diagnostic interview for parents of preschool children, Persian version for DSM-5, Hassanzadeh et al., 202129 92% at a cutoff of 21.5 0.1% at a cutoff of 21.5 PPV: 95.83%, NPV: 98.91%, overall diagnostic accuracy = 98.67%
PICS (Parent Interview for Child Symptoms) with Teacher Telephone Interview (TTI)25 semi-structured interview 91.8% 70.7% children
SNAP-IV (Teacher-Teacher Interview, 2-stage)28 Interview 83 to 86% 80 to 97% Children; combination of teacher questionnaires and teacher interviews
SWAN-AD Scale of the Strengths and Weaknesses of ADHD Symptoms and Normal Behavior Scale (SWAN-DE-SB), German version, cutoff 2.619 Questionnaire 93.3% 90.9% ADHD in adults; values at optimal cutoff
SWAN-HI Scale of the Strengths and Weaknesses of ADHD Symptoms and Normal Behavior Scale (SWAN-DE-SB), German version, cutoff 2.729 Questionnaire 91.2% 90.9% ADHD in adults; scores at the optimal cutoff
SWAN-TOT Scale of the Strengths and Weaknesses of ADHD Symptoms and Normal Behavior Scale (SWAN-DE-SB), German version, cutoff 2.649 Questionnaire 95.6% 100% ADHD in adults; scores at the optimal cutoff
Wender-Reimherr Adult Attention Deficit Disorder Scale (SR-WRAADDS)10 Questionnaire 97% (ADHD vs. non-affected individuals); 87% (ADHD vs. depression or anxiety)
  • Achenbach System of Empirically Based Assessment (ASEBA)30

    • Children ages 5 to 10
      • AUC of 74% for the caregiver questionnaire
    • Youth ages 11 to 18
      • AUC of 73% for the caregiver questionnaire
      • AUC of 61% for the teacher questionnaire
  • Attention Deficit Disorders Evaluation Scale (ADDES)

    • Parent questionnaire with 46 items
    • Sensitivity below 70%, even at a low cutoff31
  • ADHD/ODDEFB: ADHD/ODD Parent Questionnaire32

  • Assessment Form for Parents, Teachers, and Educators (FBB-HKS)33

  • CAARS Parent ADHD Index

    • Sensitivity: 94% (cut-off: greater than 53); 43% (cut-off: greater than 60); 86% to 100% (optimized cut-off)34
    • Specificity: 54% (cut-off: greater than 53); 78% (cut-off: greater than 60); 34% to 80% (optimized cut-off)34
    • AUC: 78% (cut-off: greater than 8); 61% to 94% (optimized cut-off)34
  • CAARS Young Adult ADHD Index

    • Sensitivity: 57% (cut-off: greater than 56); 36% (cut-off: greater than 60); 23% to 81% (optimized cut-off)34
    • Specificity: 81% (cut-off: greater than 56); 90% (cut-off: greater than 60); 63% to 92% (optimized cut-off)34
    • AUC: 70% (cut-off: greater than 8); 51% to 90% (optimized cut-off)34
  • CHAOS Scale

    • Rating Scale for Core Symptoms of ADHD and Disruptive Behavior Disorders
    • 22 items
    • is filled out by parents and teachers
  • Child Behavior Checklist, CBCL/1.5–5

    • Parent questionnaire on the behavior of preschool children between the ages of 1.5 and 53536
  • Child Behavior Checklist, CBCL/6-18

    • Parent questionnaire on the behavior of children and adolescents ages 4 to 183736
  • Child and Adolescent Behavior Inventory (CABI)

    • Parent questionnaire with 75 questions
    • The CABI is more accurate than the CBCL for ADHD and anxiety, while the CBCL is more accurate for conduct disorder (CD) and oppositional defiant disorder (ODD)38
  • Childhood Executive Function Inventory (CHEXI)39

    • Questionnaire for Parents and Teachers
    • Parent ratings on the Inhibition subscale: Sensitivity 03%, Specificity 93%
  • Conners Scales of Attention and Behavior – Observer Assessment (CAARS-O) 40

  • Conners’ Abbreviated Symptom Questionnaire (ASQ)

    • Parent questionnaire with 10 items
    • Sensitivity below 70%, even at a low cutoff31
  • Expression and Emotion Scale for Children (EESC)

    • Questionnaire for Parents of Children with ADHD
    • Sensitivity 75%, specificity 67%, accuracy 71%, Cronbach’s α = 0.76; Pearson correlation r = 0.91; inter-rater reliability (ICC) = 0.66 for the Portuguese version41
  • Parent ABC Hyperactivity Subscale

    • Sensitivity: 91% (cut-off: greater than 3); 79% to 98% (optimized cut-off)34
    • Specificity: 42% (cut-off: greater than 3); 22% to 68% (optimized cut-off)34
    • AUC: 66% (cut-off: greater than 8); 47% to 86% (optimized cut-off)34
  • Parent SDQ ADHD subscale

    • Sensitivity: 60% (cut-off: greater than 6); 45% (cut-off: greater than 7); 41% to 88% (optimized cut-off)34
    • Specificity: 93% (cut-off: greater than 6); 97% (cut-off: greater than 7); 85% to 98% (optimized cut-off)34
    • AUC:
      • 79% (cut-off: greater than 8); 66% to 92% (optimized cut-off)34
      • 67% overall rate for all psychiatric problems in children at 39 months42
      • 61% on the “Internalization” subscale for internalizing problems in children at 39 months42
      • 77% on the “Externalization” subscale for ADHD and other externalizing disorders in children at 39 months42
  • Parent/Teacher Questionnaires (Conner)43

  • Parent Rating of Evening and Morning Behavior Scale, Revised (PREMB-R)44

  • Quantitative Behavior Test (QbTest)4546

    • To be completed by a diagnostician or a parent
    • 70% accuracy in adults aged 55 to 79
    • When combined with self-reported severity of ADHD symptoms, 91% accuracy
  • SDQ ADHD Hyperactivity-Inattention Subscale

    • AUC of 74% for ADHD-C and ADHD-HI47
    • 22% for ADHD-I
  • Teacher Rating Form (TRF 6–18)3736

  • Vanderbilt ADHD Diagnostic Parent Rating Scale

  • Weiss Functional Impairment Rating Scale - Parent Form (WFIRS-P)

    • Children and adolescents with ADHD vs. non-ADHD controls
    • AUC of 98% for the total WFIRS-P score at a cutoff of 0.4548
    • AUC ranging from 73% to 97% for the subscales48
    • Sensitivity of 88% for the total WFIRS-P score at a cutoff of 0.4548
    • Specificity of 96% for the total WFIRS-P score at a cutoff of 0.4548
    • Sensitivity of 92% for the “Family” subscale at a cutoff of 0.4248
    • Specificity of 96% for the “Family” subscale at a cutoff of 0.4248
    • Low sensitivity of the “Self-Concept” and “Life Skills” subscales48
    • AUC: 91% for the total WFIRS-P score at a cutoff of 0.6549
    • Sensitivity: 83% for the total WFIRS-P score at a cutoff of 0.6549
    • Specificity: 85% for the total WFIRS-P score at a cutoff of 0.6549
    • DeLong test: no significant differences in AUCs between men and women or between the 5- to 12-year-old and 13- to 19-year-old age groups49
  • Young Adult SDQ ADHD Subscale

    • Sensitivity: 28% (cut-off: greater than 8); 31% (cut-off: greater than 6); 4% to 54% (optimized cut-off)34
    • Specificity: 100% (cut-off: greater than 8); 88% (cut-off: greater than 6); 100% to 100% (optimized cut-off)34
    • AUC: 65% (cut-off: greater than 8); 44% to 87% (optimized cut-off)34

Combinations:

  • SNAP-IV (18 items) and SDQ ADHD—hyperactivity-inattention subscale (teacher version) (5 items): AUC 95%47
  • SNAP-IV (18 items) and SDQ ADHD—hyperactivity-inattention subscale (parent version) (5 items): AUC 91%47

3. Questionnaires for the Retrospective Assessment of ADHD in Childhood

For adults, ICD-10, ICD-11, DSM-IV, and DSM-5 require that symptoms (not a full-blown diagnosis) have begun—that is, the presence of several (not all those required for a diagnosis) ADHD symptoms—by age 6 (ICD-10, DSM-IV) or by age 11 (ICD-11, DSM-5). This criterion is strongly questioned by Barkley (in our view, rightly so), since ADHD is a neurodevelopmental disorder and the brain continues to develop until the age of 23 to 25. Consequently, ICD-11 (like the clinical diagnostic criteria of ICD-10) does not have a “strict” age limit, but instead gives the clinician the discretion to make the diagnosis even if the age limit has not been reached.

To identify symptoms in childhood, tools such as the WURS (50; free, ages 6–10) or the WURS-K (fee required, part of the HASE, ages 8–10) can be used.
With a diagnostic accuracy of 86%, the WURS-K shows a 10% lower diagnostic accuracy for ADHD in childhood than the WURS.51

The WURS-K is likely to systematically lead to diagnostic problems, since women and girls in particular—as well as men with the predominantly inattentive subtype of ADHD-I—often score just below the cutoff, despite otherwise clear ADHD symptoms.51
The WR-SB self-assessment questionnaire is also designed not to identify the predominantly inattentive presentation of ADHD-I.51
Even if the score falls just slightly short of the required threshold, the automated evaluation using the Hogrefe Test System will conclude that the ADHD criteria have not been met.

Name of the instrument/test ; Test type ; Sensitivity (%) ; Specificity (%) ; Target population/Special features
WURS questionnaire, English version ; questionnaire, 4 questions, cutoff 5, n = 69, Bakare et al. 202052 82.6% to 100% 0% to 14.3% retrospective presence of ADHD in childhood among adults; PPV: 66.7% to 90.9%; NPV: 12.5% to 33.3%
WURS-8, English version questionnaire, 8 questions, n = 1,014, Das et al. 201653 Cut-off 8: 86% Cut-off 8: 65% retrospective presence of ADHD in childhood among adults
WURS-25 Questionnaire for adults regarding the retrospective presence of ADHD in childhood, 25 questions
WURS-25 Cut-off 4654 (???), n = 485, Reimherr et al. 202155 62% 86% PPV: 73%; NPV: 79%
89% (ADHD vs. non-affected individuals); 49% (ADHD vs. depression or anxiety) Self-assessment questionnaire for adults; values determined using optimal cut-off adjustment within the group
WURS-25, English version n = 251, Ward et al., 199350 Cut-off 36: 96%; Cut-off 46: 86% Cut-off 36: 96%; Cut-off 46: 99%
WURS-25, English version n = 1,014, Das et al. 201653 Cut-off 20: 86% Cut-off 20: 63% Retrospective presence of ADHD in childhood among adults
WURS-25, Swedish version Cut-off 39, n = 121, Kouros et al. 201856 88% 70% PPV: 59%; NPV: 92%, AUC 87%
WURS-25, factor version n = 485, Reimherr et al. 202155 74% 88% PPV: 79%; NPV: 85%
WURS-25, Norwegian version n = 1,554, Brevik et al. 202057 Cut-off 21: 98%, Cut-off 26: 97%, Cut-off 29: 95%, Cut-off 35: 90%, Cut-off 36: 89%, Cut-off 42: 80%, Cut-off 46: 75%, Cut-off 56: 55% Cut-off 21: 71%, Cut-off 26: 80%, Cut-off 29: 83%, Cut-off 35: 88%, Cut-off 36: 89%, Cut-off 42: 93%, Cut-off 46: 95%, Cut-off 56: 98% , Cut-off 35: AUC 95.6%
WURS-25 for PTSD58 Questionnaire 27.7% 90.3% Retrospective presence of ADHD in childhood among adults
WURS-25 for cannabis dependence Cut-off 36, n = 99, Notzon et al., 20208 88% 75% Adults
WURS-25 + ASRS 18 combined n = 1,554, Brevik et al. 202057 Cut-off scores of 35 for both WURS-25 and ASRS: AUC 96.4%
WURS-45 n = 485, Reimherr et al. 202155 80% 90% PPV: 83%; NPV: 88%
WURS-61 n = 485, Reimherr et al. 202155 84% 94% PPV: 88%; NPV: 91%
WURS for Alcohol Dependence, Outpatients n = 355, Daigre et al. 201559 79.6% 60.3% Adults
WURS-25 + CAARS combined for cannabis addiction Questionnaire, n = 99, Notzon et al., 20208 71% 95% Adults
  • WURS-8
    • Ultra-short version with 8 questions from the WURS
    • Sensitivity of 86% at a cutoff of 853
    • Specificity of 65% at a cutoff of 853
  • WURS-K = German version of WURS 25
    • A 25-item abbreviated version of the WURS (61 items)
    • Sensitivity of
      • 27.7%58
      • 86% at a cutoff of 2053
      • 88% at a cutoff of 39, Swedish translation56
    • Specificity
      • 90.3%58
      • 70% at a cutoff of 39, Swedish translation56
      • 63% at a cutoff of 2053
    • Sensitivity of 60.7% compared to ASRS 1.1.58 (which, as a screening tool, has very limited diagnostic value)
    • Specificity of 60.8% compared to ASRS 1.1.58
    • AUC 87% at a cutoff of 39, Swedish translation56
    • Kappa 0.80–0.94 with a cutoff of 39, Swedish translation56
    • PPV 59% at a cutoff of 39, Swedish translation56
    • NPV 92% at a cutoff of 39, Swedish translation56
  • Q-ADHD-Child: a rating scale for ADHD symptoms in childhood based on the DSM-IV and ICD-10 criteria60

Bringing Back Memories of Childhood and School Days

A fundamental problem with questionnaires is that the people with ADHD must answer the questions on their own. Since many people with ADHD have extremely poor long-term memory, they cannot readily recall useful memories from their childhood.
In an interview, it can be helpful to plant emotional “seeds” that aid in recall. Questions that touch on emotional aspects can bring memories to the surface and trigger others, even after some time has passed. Examples:

  • What was the best part of your childhood?
  • What’s the worst thing?
  • What did your school backpack look like? What was its color, material, and smell? Was it heavy? Did it weigh you down?
  • What was it like in there?
  • What did the pencil case look like, and what was inside it? Your favorite pencil?
  • What kinds of notebooks were there? How big were they, and what color were they? What did they look like—clean or crumpled? Did they have dog-ears? Were they drawn on? Or were they often missing?
  • Did you bring anything to eat? Or money to buy candy from the kiosk? What was the best thing?
  • Who were the cool kids in class, and who were the nerds? And were there any mean kids?
  • Which teachers were cool, and which ones were mean?
  • What were the consequences for certain actions? What were the rewards?
  • What were you better at than most kids? What were you worse at?
  • What were the most embarrassing moments? The most shameful ones?
  • What were you proud of?
  • Did you have a nickname? Did you like it?
  • What was the most boring part of school? What was the most exciting?
  • Who were your favorite characters from stories, books, or movies?
  • What were your favorite candies?
  • What secrets did they keep from their parents?

4. Questionnaires for Identifying Comorbidities in Individuals with ADHD

For children who had already been diagnosed with ADHD, the following was helpful in identifying comorbidities:

A combination of two CBCL subscales—the Aggressive Behavior T-Score and the Delinquent Behavior T-Score—identified comorbidities in children with ADHD:61

Comorbidity CBCL Aggressive Behavior T-Score Cut-off CBCL Delinquent Behavior T-Score Cut-off Sensitivity Specificity Positive predictive value Negative predictive value
Any comorbidity 0.60 0.60 67% 45% 60% 65%
Any comorbidity 0.60 0.70 24% 96% 80% 63%
Any comorbidity 0.70 0.60 59% 12% 70% 67%
Any comorbidity 0.70 0.70 10% 97% 71% 59%
Conduct disorder 0.60 0.60 82% 80% 41% 96%
Conduct disorder 0.60 0.70 35% 99% 86% 90%
Conduct disorder 0.70 0.60 29% 94% 45% 89%
Conduct disorder 0.70 0.70 24% 99% 80% 89%
Bipolar 0.60 0.60 71% 74% 15% 98%
Bipolar 0.60 0.70 14% 95% 14% 95%
Bipolar 0.70 0.60 29% 92% 18% 95%
Bipolar 0.70 0.70 14% 96% 20% 95%
Major Depression 0.60 0.60 59% 75% 29% 92%
Major Depression 0.60 0.70 35% 91% 40% 89%
Major Depression 0.70 0.60 24% 95% 44% 88%
Major Depression 0.70 0.70 18% 96% 43% 88%
Multiple Fears 0.60 0.60 65% 75% 51% 84%
Multiple Fears 0.60 0.70 35% 88% 55% 77%
Multiple Fears 0.70 0.60 32% 93% 65% 77%
Multiple Fears 0.70 0.70 21% 95% 64% 75%
  • CBCL-DESR
    • Measures emotional dysregulation in children with ADHD
    • 40.0% of children with ADHD had a positive CBCL-DESR profile, compared with 3.5% of the control group62
    • Sensitivity 97.3%, specificity 79.6% at a cutoff of ≥179, ≤21062

Conversely, the Attention Problems Scale subscale of the Child Behavior Checklist (CBCL) showed the following results for people with ADHD when used to identify ADHD at a cutoff score of 63:63

  • an AUC of 84%
  • 74% of adolescents with GAD and ADHD scored above this cutoff (sensitivity)
  • 91% of adolescents with GAD but without ADHD were below this cutoff value (specificity)

The PTSD subscale of the CBCL is effective at distinguishing trauma from non-trauma cases and ADHD from non-ADHD cases, but it is not effective at distinguishing PTSD from ADHD.64

Reactivity, Intensity, Polarity, and Stability Questionnaire, Screening Version (RIPoSt-SV)

  • accuracy, sensitivity, specificity, and positive and negative predictive values of 80% or higher for clinically significant emotional dysregulation65
Questionnaire on Comorbid Disorders66 ADHD Depression Anxiety OCD Bipolar Disorder Stress Other Number of Questions
BAI (Beck Anxiety Inventory) Anxiety 21
BDI-II (Beck Depression Inventory-II) Depression 21
CES-D (Center for Epidemiologic Studies Depression Scale) Depression 20
DASS-21 (Depression, Anxiety, and Stress Scales-21) Depression Anxiety Stress 7 + 7 + 7
EPDS (Edinburgh Postnatal Depression Scale) postpartum depression 10
GAD-7 (Generalized Anxiety Disorder-7) generalisated anxiety disorder -7
GDS (Geriatric Depression Scale) Depression in Older Adults 15–30
HADS-D (Hospital Anxiety and Depression Scale – Depression Subscale) Depression Anxiety 7
HAM-D (Hamilton Depression Rating Scale) Depression 17–24
MDQ (Mood Disorder Questionnaire) Bipolar 13
PDSS-SR (Panic Disorder Severity Scale – Self-Report) Panic 7
PHQ-9 (Patient Health Questionnaire-9) Depression 9
PSQ (Questionnaire on Children’s Sleep Behavior) Sleep 22
SCL-90-R (Symptom Checklist 90-R) -90 (General)
Y-BOCS (Yale-Brown Obsessive-Compulsive Scale) Compulsions 10
PDI-4 (Provisional Diagnostic Instrument 4 ADHD Depression Generalized Anxiety Disorder Mania 17

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