Parent and Adolescent Agreement on Ratings of ADHD Symptoms
- 1Nationwide Children's Hospital
Abstract
ObjectiveParent-adolescent disagreement in ratings of attention-deficit/hyperactivity disorder (ADHD) symptoms can complicate clinical assessment. This study examined parent-adolescent agreement in ADHD symptom ratings and characteristics associated with disagreement.
MethodParticipants were 1,008 parent-adolescent dyads recruited from a nationally stratified U.S. community sample. Adolescents were 12-18 years old (49.6% female) and along with their parents completed measures of ADHD and depressive symptoms. Agreement on Inattention (IN), Hyperactivity/Impulsivity (HI), and Total ADHD scores was examined. Item-level agreement was assessed using weighted kappa, Gwets AC2, percent agreement, and polychoric correlations. Associations between age, sex, and severity of ADHD and depression with levels of agreement were analyzed.
ResultsAgreement for ADHD factor and total symptom scores was moderate (intraclass correlations = 0.67-0.71), with moderate-to-strong rank-order correspondence. Adolescents reported slightly higher ADHD symptom levels than parents, although the mean difference was small. Item-level agreement was moderate to high (Gwets AC2 = 0.79-0.95). Several HI items demonstrated the kappas paradox, with relatively low kappa values despite high Gwets AC2 and percent agreement. Q-correlations revealed low agreement on relative strengths and weaknesses. Age and sex were not associated with disagreement and parent-reported ADHD severity and adolescent-reported depressive symptoms were associated with disagreement.
ConclusionsParent and adolescent ratings showed moderate agreement across boys and girls ages 12-18; however, disagreement related to relative strengths and weaknesses. Disagreement was associated with ADHD and depressive symptom severity. Findings suggest that ratings from parents and adolescents offer unique perspectives on the assessment of ADHD symptoms.
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BibTeX
@misc{evans2026parent,
title = {{Parent and Adolescent Agreement on Ratings of ADHD Symptoms}},
author = {S. W. Evans and S. K. Bhaskar and E. Rosenthal and M. McClellan and R. Boley and E. A. Youngstrom},
howpublished = {medRxiv},
year = {2026},
month = oct,
doi = {10.64898/2026.10.02.26364585},
url = {https://www.medrxiv.org/content/10.64898/2026.10.02.26364585v1},
note = {CC BY-NC-ND},
}
RIS
TY - UNPB
TI - Parent and Adolescent Agreement on Ratings of ADHD Symptoms
AU - S. W. Evans
AU - S. K. Bhaskar
AU - E. Rosenthal
AU - M. McClellan
AU - R. Boley
AU - E. A. Youngstrom
PY - 2026
DA - 2026/10/02
PB - medRxiv
DO - 10.64898/2026.10.02.26364585
UR - https://www.medrxiv.org/content/10.64898/2026.10.02.26364585v1
AB - ObjectiveParent-adolescent disagreement in ratings of attention-deficit/hyperactivity disorder (ADHD) symptoms can complicate clinical assessment. This study examined parent-adolescent agreement in ADHD symptom ratings and characteristics associated with disagreement. MethodParticipants were 1,008 parent-adolescent dyads recruited from a nationally stratified U.S. community sample. Adolescents were 12-18 years old (49.6% female) and along with their parents completed measures of ADHD and depressive symptoms. Agreement on Inattention (IN), Hyperactivity/Impulsivity (HI), and Total ADHD scores was examined. Item-level agreement was assessed using weighted kappa, Gwets AC2, percent agreement, and polychoric correlations. Associations between age, sex, and severity of ADHD and depression with levels of agreement were analyzed. ResultsAgreement for ADHD factor and total symptom scores was moderate (intraclass correlations = 0.67-0.71), with moderate-to-strong rank-order correspondence. Adolescents reported slightly higher ADHD symptom levels than parents, although the mean difference was small. Item-level agreement was moderate to high (Gwets AC2 = 0.79-0.95). Several HI items demonstrated the kappas paradox, with relatively low kappa values despite high Gwets AC2 and percent agreement. Q-correlations revealed low agreement on relative strengths and weaknesses. Age and sex were not associated with disagreement and parent-reported ADHD severity and adolescent-reported depressive symptoms were associated with disagreement. ConclusionsParent and adolescent ratings showed moderate agreement across boys and girls ages 12-18; however, disagreement related to relative strengths and weaknesses. Disagreement was associated with ADHD and depressive symptom severity. Findings suggest that ratings from parents and adolescents offer unique perspectives on the assessment of ADHD symptoms.
ER -