The Strengths and Weaknesses of Attention-Deficit/Hyperactivity Symptoms and Normal Behaviors Scale (SWAN): Diagnostic Accuracy and Clinical Utility

Abstract

Objective:

To examine the Strengths and Weaknesses of ADHD–Symptoms and Normal Behavior scale (SWAN) clinical utility as a diagnostic measure of ADHD in an ADHD clinic sample.

Method:

In a sample of 357 children (6–11 years old) referred for evaluation at an academic medical center, we explored the SWAN’s diagnostic and convergent validity with the Hyperactivity–Inattention subscale of the Strengths and Difficulties Questionnaire (SDQ/HI) and concurrent validity with the Impairment Rating Scale (IRS).

Results:

The averaged (SWAN total) and the SWAN Hyperactivity/Impulsivity subscale (SWAN HI) showed significant and large correlations with the SDQ/HI (r = .69 and .65), respectively. The SWAN Attention Deficit subscale (SWAN AD) had a significant but smaller correlation (r = .49). The SWAN total had moderate correlation with the IRS average score ( = .33). In receiver operating characteristic (ROC) curve analyses (area under the curve (AUC) = 0.71) for the SWAN total, the SWAN distinguished ADHD cases from non-ADHD cases with sensitivity of 83% but specificity of 47%.

Conclusion:

In a clinical sample, the SWAN total scores displayed a near-normal distribution. ADHD cases were distinguished from non-ADHD cases by the SWAN. The SWAN showed adequate convergent and concurrent validity with other symptoms and impairment measures.