A 2026 review of child behavior questionnaires found that the five-item hyperactivity-inattention subscale of the Strengths and Difficulties Questionnaire, or SDQ, had the strongest overall measurement evidence among the broad screening scales examined.
The finding comes with important limits. None of the 12 reviewed instruments met every quality standard, and the review did not compare the questionnaires directly in a head-to-head study. The results do not establish that the SDQ is the best ADHD assessment tool overall.
What the review examined
Researchers reviewed 36 English-language studies involving children aged 18 or younger with ADHD. The studies were selected from 17,361 records identified through PubMed, Web of Science, Scopus and ProQuest.
The review assessed measurement properties using COSMIN standards. These included whether a questionnaire measures the intended concept, produces consistent results, works similarly across groups and can distinguish between children with and without ADHD.
The researchers assessed ADHD-related subscales rather than necessarily judging every part of each questionnaire. The SDQ itself contains 25 items across five subscales. Five items cover hyperactivity and inattention, and matching parent, teacher and self-report versions are available in many languages.
Where the SDQ evidence was strongest
The SDQ hyperactivity-inattention subscale received a sufficient overall rating for every measurement property tested in the review.
Evidence was rated high quality for its cross-cultural validity, test-retest reliability, association with ADHD-related scores on the Child Behavior Checklist, and ability to distinguish children with and without ADHD.
Other findings were less certain. Evidence for structural validity and internal consistency was moderate quality because results were inconsistent. Evidence for content validity was low quality because no study assessed it directly.
The review also did not find included studies assessing measurement error, responsiveness to change or criterion validity for the reviewed scales. Responsiveness matters when tracking whether scores change with treatment. Criterion validity would require comparison with a recognized gold standard, and the review noted that ADHD has no universally accepted gold standard.
A screening result is not a diagnosis
The SDQ is a general screening questionnaire, not a dedicated ADHD diagnostic measure. Its hyperactivity-inattention score should not be used as a substitute for a full assessment.
In one study of 250 children aged 6 to 17 who had been referred for ADHD assessment, a probable SDQ hyperactivity rating correctly ruled out about 75% to 85% of children who did not have ADHD. However, it identified only about 43% to 45% of children who did have ADHD.
That pattern is a practical warning: a high score may indicate that further assessment is warranted, while a low score does not rule out ADHD.
How other broad scales performed
The review identified concerns with the Attention Problems subscale of the Child Behavior Checklist. High-quality evidence indicated that it did not show cross-cultural validity, including differences between US and Australian samples and between Dutch and Israeli samples.
Under the review’s COSMIN rules, those findings supported a recommendation against using that subscale on the basis of its cross-cultural performance. The authors advised caution when using it outside North America. These findings apply only to the CBCL Attention Problems syndrome scale—not the separate DSM-oriented ADHD scale or the questionnaire as a whole.
The CADBI inattention and hyperactivity-impulsivity subscales had high-quality evidence for structural validity and for functioning similarly over time, by sex and across countries. However, no included study assessed their reliability over time or their comparison with other measures.
The Five to Fifteen had moderate-quality evidence for structure and internal consistency, although one study found that its scores did not differ between boys and girls in the expected way. The Child and Adolescent Behavior Inventory had high-quality evidence for test-retest reliability but low-quality evidence for structure and internal consistency, largely based on small samples.
The remaining seven instruments had limited or unsatisfactory evidence for their ADHD subscales.
What families and professionals should take from it
The review supports the SDQ as a relatively brief, accessible option for gathering information about children’s behavior across settings. Its parent, teacher and self-report formats may also help collect perspectives from more than one source.
But a questionnaire score is one piece of information. The review did not pool sensitivity or specificity, directly compare the instruments, or show that the SDQ can confirm or exclude ADHD on its own. It also included only English-language validation studies, and the authors acknowledged that some COSMIN judgments involved reviewer subjectivity.
For families concerned about attention, activity or impulsivity, a low SDQ score should not be treated as definitive reassurance, and a high score should not be treated as a diagnosis. The appropriate meaning of any result depends on the broader assessment and the setting in which the questionnaire was completed.
AI tools were used to assist with the preparation of this article.
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