Identifying learning problems in children evaluated for ADHD: the Academic Performance Questionnaire.

Objective: The objective of this study was to assess the usefulness of the Academic Performance Questionnaire (APQ) to identify low reading and math achievement in children who are being evaluated for attention-deficit/hyperactivity disorder (ADHD).

Methods: Charts of 997 patients who were seen in a multidisciplinary ADHD evaluation program were reviewed. Patients who were in first-through sixth-grade and had complete APQ and Wechsler Individual Achievement Test II Basic Reading and Numerical Operations subtests were enrolled in this study. The 271 eligible patients were randomly assigned to a score-development group (n = 215) and a validation group (n=56). By using data from the score-development sample, APQ questions that predicted low academic achievement were identified and the scores for these questions were entered into a logistic regression to identify the APQ questions that independently predicted low achievement.

Results: Only 2 APQ questions, 1 about reading and 1 about math, independently predicted low achievement. By using these 2 questions, the area under the receiver operating characteristic curve was 0.834, and the optimal combination of sensitivity and specificity occurred when the total score for the 2 items was >4. This cutoff had a sensitivity of 0.86 and a specificity of 0.63 in the score-development group and a sensitivity of 1.0 and a specificity of 0.53 in the validation sample.

Conclusions: The APQ may be a useful screening tool to identify children being evaluated for ADHD who need additional testing for learning problems. Although the predictive value of a negative screen on the APQ is good, the predictive value of a positive test is relatively low.