Screening for Attention Deficit Hyperactivity Disorder in Young Autistic Adults: The Diagnostic Accuracy of Three Commonly Used Questionnaires.
Melanie Palmer, Zhaonan Fang, Matthew J Hollocks and 4 others
PMID 37898580WHAT IT FOUND
Parent-reported SDQ ADHD subscale missed 40% of ADHD cases in autistic young adults, despite high specificity.
No single questionnaire, parent- or self-reported, met acceptable sensitivity and specificity thresholds simultaneously. Screening alone cannot rule out ADHD in this group.
Key findings
01Parent-reported SDQ ADHD subscale had high specificity (93%) but low sensitivity (60%) overall, meaning it correctly identified non-cases but missed many actual ADHD cases.
02No single measure met adequate thresholds for sensitivity and specificity simultaneously, indicating that questionnaires alone are insufficient for screening ADHD in autistic young adults.
03Self-reported measures also showed inadequate sensitivity, with the CAARS ADHD Index at 57% and SDQ ADHD subscale at 28% at optimal cut points.
STILL TO COME
How it was doneWhat they foundWhat it means for SLPs
Read the rest of this summary
You get three full summaries a month, free, and we do not ask for a card. Search, the TL;DRs and your library stay unlimited either way.
What it does not show
The YAPA assessment used to derive ADHD diagnoses has not been validated in autistic populations, so it is unclear how autism may influence reports on the YAPA. ADHD diagnoses were based on a research interview and do not equate to clinical diagnosis, which may account for other contextual factors. Small cell sizes prevented examination of self-reported ADHD screening instrument performance by IQ subgroups, limiting generalisability to autistic young adults with intellectual impairments. The study used Youden’s Index to identify optimal cut points, which places equal weighting on sensitivity and specificity, whereas clinical screening often prioritises sensitivity to reduce false negatives.
The easy way to misread this
Do not interpret the high specificity of the parent-reported SDQ ADHD subscale as evidence that it is a good screening tool. It missed 40% of ADHD cases (sensitivity 60%), meaning a low score on this questionnaire does not rule out ADHD in autistic young adults.