Diagnostic Accuracy and Proposed Cut-Off Values of the ASRS-R for Screening ADHD in Chinese Children and Adolescents: A Case-Control Study

Building on the prior validation of the Revised Adult ADHD Self-Report Scale (ASRS-R), this case-control study aimed to derive proposed cut-off scores for screening ADHD in Chinese children and adolescents aged 8-14 years. The study included 457 children and adolescents (106 with DSM-5 diagnosed ADHD, 351 controls) from a Shenzhen hospital. Reliability (Cronbach's α = 0.929) and validity (GFI = 0.954; rs = 0.604 with SNAP-IV) were good. ROC analysis was used to determine proposed cut-offs. For the total score, the proposed cut-off was 27.5 (AUC = 0.881, 95% CI: 0.847-0.915), with sensitivity 89.6% and specificity 77.8%. Adjusted for population prevalence, positive and negative predictive values were 21.6% and 99.1%. For inattention and hyperactivity-impulsivity subscales, proposed cut-offs were 19.5 (AUC = 0.846) and 17.5 (AUC = 0.853), respectively. The ASRS-R demonstrates satisfactory screening efficacy for Chinese children and adolescents aged 8-14 years. These preliminary cut-offs, characterized by exceptional ability to rule out non-ADHD cases, provide evidence-based support for early ADHD screening in school, community, and clinical settings. However, these cut-offs require external validation, ideally in consecutively recruited and community-based samples.