Reliability and validity of the Chinese version of Questionnaire – Children with Difficulties for Chinese children or adolescents with attention-deficit/hyperactivity disorder: a cross-sectional survey

Abstract

Purpose

The Questionnaire – Children with Difficulties (QCD) has been developed and used to evaluate daily-life problems in children during specified periods of the day. The objective of this study was to evaluate the reliability and validity of the QCD for Chinese children or adolescents with attention-deficit/hyperactivity disorder (ADHD).

Patients and methods

Outpatients with ADHD aged 6–18 years who visited psychiatry clinics were enrolled at four study centers in China. Patients with severe psychiatric disorders were excluded. Parents of all enrolled patients were given the QCD, the Swanson, Nolan and Pelham IV (SNAP-IV), and the Weiss Functional Impairment Scale-Parent (WFIRS-P) questionnaires and were asked to complete all three questionnaires. The reliability of the QCD was examined by Cronbach’s alpha, which assessed the internal consistency of the questionnaire. Concurrent criterion validity of QCD scores was examined by Spearman’s correlation of QCD with SNAP-IV and WFIRS-P scores.

Results

A total of 200 Chinese patients were analyzed (average age, 10.4±2.66 years). The majority of patients were male (77.5%), and 49.0% had the combined ADHD subtype. Cronbach’s alpha for QCD was 0.88. Correlation coefficients of the QCD total score with SNAP-IV total score and WFIRS-P average score were −0.47 and −0.57, respectively. Correlations for the QCD with SNAP-IV and WFIRS-P were statistically significant (P<0.01). The area under the curve for sensitivity and specificity of the QCD compared with the SNAP-IV and WFIRS-P was 0.70 and 0.71, respectively. The ADHD severity discrimination threshold range of the QCD total score was 30–35.

Conclusion

Our study results found the QCD to be a reliable and valid instrument and recommend its use in clinical practice to identify and evaluate daily-life problems of ADHD patients during specified periods of the day in China.

Keywords:

• attention-deficit/hyperactivity disorder
• Questionnaire–Children with Difficulties (QCD)
• reliability
• validity

Supplementary materials

Figure S1 Flowchart of patient disposition.

Abbreviations: ADHD, attention-deficit/hyperactivity disorder; BAH, Beijing Anding Hospital; DSM-5, Diagnostic and Statistical Manual of Mental Disorders, 5th Edition; n, number of patients in each category; NBH, Nanjing Brain Hospital; SMHC, Shanghai Mental Health Center; SXH, The Second Xiangya Hospital of Central South University.

Figure S2 Sensitivity and specificity of the QCD questionnaire (A, QCD vs SNAP-IV; B, QCD vs WFIRS-P). QCD cut-off points: QCD from minimum to maximum value by every five points. SNAP-IV cut-point: a mean score of items 1–18 of <1.67 indicates insignificant ADHD symptoms, whereas ≥1.67 indicates significant ADHD symptoms. WFIRS-P cut-off point: the impaired functions <3 vs ≥3.

Abbreviations: AUC, area under the curve; QCD, Questionnaire – Children with difficulties; SNAP-IV, Swanson, Nolan and Pelham IV; WFIRS-P, Weiss Functional Impairment Rating Scale-Parent.

Table S1 Sensitivity, specificity, and accuracy of the QCD questionnaire against SNAP-IV and WFIRS-P (N=200)

Acknowledgments

This study was funded and supported by Eli Lilly and Company. The authors would like to thank Rakesh Ojha, PhD, from Syneos Health for medical writing, and Antonia Baldo from Syneos Health for editorial support in the preparation of this manuscript. The authors would also like to thank Wan Qi Zhao from Eli Lilly and Company for project management, and Wendong Chen and Yi Chen from Changsha Normin Medical Technology Ltd., for assistance in the project operational processes, data cleanup, and project management.

Author contributions

Yi Zheng, Yasong Du, Lin Yan Su, and Xiao Yan Ke contributed to the study design, data collection and analysis, and critical revision of the manuscript. Yanlei Zhang, Zheng Yuan, and Yun Chen contributed to the study design, data management, analysis, interpretation, and critical revision of the manuscript. Qing Liu contributed to the data management, analysis, interpretation, and critical revision of the manuscript. All authors contributed toward data analysis, drafting and revising the paper and agree to be accountable for all aspects of the work.

Disclosure

Yanlei Zhang, Zheng Yuan, Yun Chen, and Qing Liu are employees of Eli Lilly and Company. The other authors report no conflicts of interest in this work.