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9 Nov 2021

Oliveira MdS et al. Rev Paul Pediatr 2021; 40: e2020342

ADHD in childhood may be associated with a worsening in quality of life (QoL); therefore, this study aimed to identify associations between clinical characteristics of children with ADHD and their sociodemographic aspects, QoL and results from the Strengths and Difficulties Questionnaire (SDQ).*

This study was observational and cross-sectional in nature, and participants of the study were children treated at one of two neuropaediatric outpatient clinics in the Vale do Aço region, Minas Gerais, Brazil; one exclusively for the public health system and the other for individuals who have private health insurance. The study population included children aged 6–13 years, who had a clinical diagnosis of ADHD and were receiving follow-up. The guardians of the study population were required to complete several questionnaires and assessment scales related to their child’s signs and symptoms of ADHD, social behaviour, mental health, QoL and familial socioeconomic status.

Amongst the 72 children included in this study, 43% had the combined ADHD profile, 20.8% had the inattentive profile, 16.7% had the hyperactive profile and 19.5% did not meet the ADHD criteria, which the authors suspected was due to the child receiving drug treatment. Each subgroup was predominantly male (60%, 83.3%, 74.2% and 85.7%, respectively). An inattentive profile was more commonly identified in children aged 9 and 10 years (26.7% for both), a hyperactive profile was more prevalent among 9-year-olds (41.7%) while the combined profile mostly affected children aged 8 to 11 years. The mean age was 8.8 years among children with the hyperactive profile and 9.9 years among those with the inattentive profile. Children with the combined profile and those who did not meet the ADHD criteria presented with the oldest ages. With regards to guardian’s education levels, most had completed high school or higher education (56.9%); however, a notable number of guardians had not completed elementary school (22.2%). In terms of socioeconomic status, the majority of children belonged to class C according to the Brazilian Economic Classification Criteria (CCEB).

The SDQ revealed a mean score of 28.5 which was classified as abnormal (as opposed to normal or borderline), ranging from 17 to 42. Amongst those with the hyperactive profile, the lowest score was 24 (abnormal) and, in those with the combined profile, the mean score was 32.8 (abnormal). The mean SDQ score was lower among those who did not meet the classification criteria (22.9) followed by the inattentive (28.5), hyperactive (30.3) and combined (32.8) types, respectively.

In the inferential analysis between the ADHD subtypes and explanatory variables, most children were in grades 1 to 4 (51.4%) and belonged to social class C/D* (70.8%), and most guardians had completed high school or higher education (59.2%). Furthermore, most participants (80.6%) presented abnormal scores for the MTA-SNAP-IV.§ There was no statistically significant association between social class and MTA-SNAP-IV results, and the majority of participants (69.4%) considered their child’s QoL as ‘good’. In the multivariate analysis, the only variable that was associated with the MTA-SNAP-IV result was SDQ, demonstrating that the SDQ score was related to the likelihood of the child presenting abnormal MTA-SNAP-IV; a 1-point increment in the SDQ score increased the likelihood of the child having an abnormal MTA-SNAP-IV classification by 36.5% (odds ratio 1.36; 95% confidence interval 1.14–1.62; p<0.001).

This study was limited by its use of screening instruments in a population already diagnosed and on ADHD treatment, as these individuals are known to present comorbidities, which might confound data interpretation. Furthermore, the study was only conducted in two treatment centres and the sample was not population-based.

In conclusion, the authors summarised that belonging to social class C was associated with having an inattentive profile in children aged 8–9 years with ADHD. No relationship was found between QoL and ADHD, and children with abnormal MTA-SNAP-IV scores were more likely to also have abnormal SDQ scores.

Read more about quality of life and behaviour in children with ADHD here


*The SDQ consists of 25 semi-structured questions investigating a child’s social behaviour and problems related to child and adolescent mental health (Goodman, 1997)
The CCEB (ABEP, 2018) are socioeconomic classification criteria consisting of nine questions; each item answered receives a score, resulting in a rating from A1 (higher purchasing power) to E (lower purchasing power)
In this study, in the SDQ, a total score ≥20 was defined as abnormal (probable psychiatric disorder), ≥16 and ≤19 as borderline, and ≤15 as normal
§The Multimodal Treatment Study of Children with Attention-Deficit/Hyperactivity Disorder – Swanson, Nolan, and Pelham, version IV (MTA-SNAP-IV) includes 26 items related to signs and symptoms of inattention, hyperactivity/impulsivity and opposition/defiance (Swanson, 2020)

Disclaimer: The views expressed here are the views of the author(s) and not those of Takeda.

Associação Brasileira de Empresas de Pesquisa. Critério de Classificação Econômica Brasil (ABEP). São Paulo 2018: Available at: Accessed November 2021.

Goodman R. The Strengths and Difficulties Questionnaire: a research note. J Child Psychol Psychiatry 1997; 38: 581-586.

Oliveira MdS, Marinho MFD, Lemos SMA. Clinical characteristics of attention-deficit/hyperactivity disorder in children and adolescents: association with quality of life and behavioral aspects. Rev Paul Pediatr 2021; 40: e2020342.

Swanson J. SNAP-IV 26-item teacher and parent rating scale. Irvine, CA: University of California 2020. Available at: Accessed November 2021.

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