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. 2025 May 13:10870547251340028.
doi: 10.1177/10870547251340028. Online ahead of print.

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

Ruqayah Alhajji  1 , Elaine Walsh  2 , Kenneth Charles Pike  2 , Freda F Liu  3   4 , Monica Oxford  2 , Mark A Stein  4   5
Affiliations

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

Ruqayah Alhajji et al. J Atten Disord. .

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.

Keywords: ADHD; SWAN; accuracy; rating scales; validity.

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