Attention-deficit/hyperactivity disorder (ADHD) is one of the most common neurodevelopmental disorders and comprises three major symptoms: inattention, hyperactivity, and impulsivity (1). Using the criteria outlined in the Diagnostic and Statistical Manual of Mental Disorders (5th ed.; DSM-5; 2), studies have estimated that the global rates of ADHD among children are from 2% to 7% (with a ~5% average) and determined that the condition affects from 2.58% to 6.76% of adults worldwide (3, 4). Similarity, a recent meta-analysis study revealed that approximately 7.6% of children aged 3 to 12 years and 5.6% of teenagers aged 12 to 18 years have ADHD. These prevalence rates are higher than those reported in previous studies using different diagnostic criteria (5). As a result, there has been a rapid increase in the number of patients receiving treatment for ADHD across all age group (6). According to the Centers for Disease Control and Prevention (7) data collected between 2016–2019 indicate that male children in the United States are more than twice as likely to receive an ADHD diagnosis compared to their female peers.

The exact cause of ADHD is unknown, but it is believed that neurological factors that affect the brain’s structure may be behind the condition (8). Symptoms of ADHD significantly affect an individual’s social, academic, and professional function, particularly when early diagnosis is lacking (9). Consequently, researchers emphasize the importance of early diagnosis to support both children and their parents in terms of seeking necessary and appropriate services (10, 11). It is recommended that diagnosis includes monitoring for established symptoms of ADHD over a 6-month time period and that this monitoring occurs at two or more sites (e.g., school and home; 12). Parental involvement is a crucial aspect of early intervention for the condition (1).

In recent years, Sudan has witnessed an increase in the prevalence of ADHD among children and adolescents (13). Despite research in other countries underscoring the pivotal role of parents in mitigating the impact of the condition, there is a scarcity of studies on parent-rated measures of ADHD in Sudan. One notable effort identified during our literature review is the study by El-Hassan Al-Awad and Sonuga-Barke (14), an early investigation that examined both parent- and teacher-driven models for assessing ADHD. This study utilized Conners’ Rating Scales, introduced in the early 1970s, which are based on checklists allowing teachers to assess the efficacy of drug therapy for behavioral disorders (15, 16). Although this series of scales remains in use for ADHD assessment, the version employed in the El-Hassan Al-Awad and Sonuga-Barke study is now 25 years old and differs from the one examined in current research. While the scales demonstrated high levels of reliability and internal consistency in their study involving a stratified sample of 300 families with children aged 6–10 years, the dynamic nature of ADHD rates in Sudan necessitates updated investigations. Subsequent research in Sudan has predominantly focused on validating teacher-rated measures of ADHD (e.g., Madani A (2007) ¹ , Fathi J (2010) ² , Khalaf Allah K (2011) ³ 17). Certain pediatric researchers in Sudan have explored various aspects of ADHD diagnosis, examining its impact on parents and the influence parents can exert on children with ADHD (e.g. Mohammed H (2014) ⁴ , 9, 18). These studies have utilized international ADHD scales. For instance, Mohammed H (2014) ⁴ translated and validated the Weiss Functional Impairment Rating Scale (WFIRS-P) for use in Sudan, administering it to 120 parent-child pairs visiting clinics to assess socio-demographic characteristics and functional impairment levels. Osman et al. (9) validated the Swanson, Nolan and Pelham Teacher and Parent Rating Scale (SNAP-IV) for assessing ADHD and oppositional defiance disorder (ODD) in adolescents/young adults and children. Although their research included a pilot study with 50 students, detailed information on the validity and reliability of their results was not provided.

A plurality of measurement instruments can assist in testing convergent validity. Hence, the availability of another valid ADHD scale for Sudan would be desirable. The ADHD Rating Scale—5 for Children and Adolescents has already been translated into Arabic and applied in Saudi Arabia by Alhossein and Bakhiet (19). This version is intended to be used here as well, however, the linguistic similarities between Sudan and Saudi Arabia do not diminish the necessity for a revalidation due to significant cultural, historical and ethnic differences.

Due to the aforementioned drawbacks to the existing literature on measures of ADHD for the Sudanese context, this study aimed to bridge the identified gaps by investigating the psychometric properties of the ADHD Rating Scale—5 for Children and Adolescents, Home Version (ADHD Rating Scale—5; 20) using a large sample of children and adolescents from Sudan. The aim of this study is to examine the reliability and diagnostic validity of the ADHD Rating Scale—5 for this country. To achieve this, the knowledge gained from the Western normative sample regarding reliability and factor structure will be attempted to be replicated, as well as the results obtained from the school version for Sudan (13). It is assumed that there will be a high congruence between the findings of this study and those of previous studies. Such a congruency is of fundamental importance because, despite compulsory education and state-funded schooling, Sudan still suffers from an extremely low enrollment rate, especially in rural areas. The ability to diagnose based on data collected by parents themselves is therefore of greater significance in Sudan than in Western countries. Furthermore, a general improvement in diagnostic validity is advisable, as mis- and overdiagnoses of ADHD can have significant consequences for the individuals affected as well as their families (21–23).

This study employed a descriptive research design with some confirmatory elements to assess the psychometric properties of the ADHD Rating Scale—5 for use in Sudan (24). Approval to conduct the research was obtained from Ministry of Education in Sudan. To ensure effective implementation and understanding of the scale among parent participants, thirty-five graduate students from the University of Khartoum were recruited to provide support throughout the research process. A workshop was then presented to these 35 individuals regarding completing, correcting, and grading the scale. This workshop also taught the grad students how to present the scale to the parents, including instructions on how to explain the process of completing the scale. Next, to facilitate the recruitment process, the 35 graduate students were divided into seven groups of five and directed to contact schools located in the seven localities of each of Khartoum.

Reliability and factor structure of the ADHD-Rating Scale were conducted on the same sample as in the present study by Alhossein, et al (13) but using the school version, thus teachers instead of parents as raters. Within this section, the researchers want to focus on a comparison between their results and those from Alhossein, et al. (13) in the context of the results given by DuPaul, Power, et al. (20) and DuPaul, Reid, et al. (32) showing that the use of one or the other versions results in similar reliability and factor structure.

Initially, what we found for the symptom items was a noticeably lower reliability in the home compared to that of the school version (Inatt. total|Hyp.-Imp. total: α = .87|.86 vs.92|.90), where the differences also exceeded the respective 95% confidence intervals of around ± .01. This is true for the total scales and consistently across the changes in α for all items if dropped. However, the same pattern was found by DuPaul, Reid, et al. (32) in their comparison (Inatt. total|Hyp.-Imp. total: α = .93|.91 vs.96|.95). The same was found for the factor loadings, which are higher for the school version both in the Sudanese sample (bi-factorial model: λ = .65 to.80 vs.58 to.71) and in the U.S. normative sample (bi-factorial model: λ = .86 to.94 vs.75 to.91; (20), Figure 2 ). Differences also can be found regarding the bi-factorial model fits. Whereas DuPaul, Power, et al. (20) reported better CFI and TLI but worse RMSEA from the application of the scale in schools (CFI = .994 vs.993; TLI = .993 vs.991; RMSEA = .057 vs.040), all three fit-indices were worse for the Sudanese school application (CFI = .946 vs.951; TLI = .939 vs.944; RMSEA = .063 vs.049).

DuPaul, Power, et al. (20) give no reliabilities for impairment scores whereas in the Sudanese sample, Cronbach’s alpha from the school and home versions just slightly deviated and stayed within the 95% confidence intervals (Inatt. total|Hyp.-Imp. total: α = .87|.87 vs.84|.86). Factor loadings in the six-factor model from the U.S. sample show virtually no differences between teachers and parents (λ = .93 to.99 vs.92 to.98). This is also the case for the Sudanese sample (λ = .74 to.83 vs.73 to.87). Fit indices are slightly worse for application at schools compared to application at home both in the United States (CFI = .995 vs.997; RMSEA = .076 vs.050) and the Sudanese sample (CFI = .932 vs.938; RMSEA = .112 vs.105). In summary, although the gained values for reliability, factor loadings, and fits are lower or worse with the Sudanese sample as compared to the U.S. sample, the differences between teachers and parents follow the same pattern in both applications.

It is well-established in the literature that family participation in identifying and diagnosing children with disabilities is crucial. Parents can provide specialists with valuable data about their children’s behavior. Diagnosis cannot yield reliable results without the inclusion of parents’ insights and evaluations of their children’s behavior (33, 34). Given that parents are the most aware of their children’s behavior, the significance of parental assessment when collecting data on children and adolescents with ADHD should not be underestimated (e.g., 32, 35).

It is crucial to characterize and quantify children’s behaviors and symptoms in the home environment as this setting can provide insights not apparent in the school environment (36, 37). Despite the recognized importance of parental scales, there were previously a lack of standardized scales suitable for the Sudanese context to identify children with ADHD. This provided the impetus for our research, which aimed to extract indices of validity and reliability from the ADHD Scale-5 for Children and Adolescents, Home Version that is based on the DSM-5 diagnostic criteria for ADHD (2).

Our adaptation of the scale demonstrated reliability in the Sudanese context. Correlations among items and their respective dimensions and the total score were calculated to establish the scale’s internal consistency. All correlations were significant (p ≤.05 and.01). This finding aligns with DuPaul’s (38) report of good internal consistency for the ADHD Rating Scale-5. We employed confirmatory factor analysis to establish the construct validity of the Sudanese version of the ADHD Rating Scale-5. This analysis revealed the scale to have a two-factor structure, a finding that is consistent with previous investigations of not just the ADHD Rating Scale-5 but other ADHD scales. This finding is also consistent with DuPaul et al. (39), (2016), which established the conceptual validity of the ADHD Rating Scale-5. We also established the scale’s reliability through Cronbach’s α and McDonald’s coefficients; the reliability coefficients for the two dimensions were 0.85–0.87 and 0.77–0.89, respectively. All reliability coefficients were high, a finding that agrees with those of previous studies (e.g., 39, 2016).

While our study demonstrated that both reliability and construct validity are also satisfied when utilizing the ADHD Rating Scale-5 for Children and Adolescents with parent ratings, our results raised some concerns about the usefulness of the involvement of parents in processes of psychological screening and diagnosis, as both criteria were overall better fulfilled by the teachers’ ratings (13). In particular this applies as parent involvement can cause negative side effects as concerns, uncertainty until anxiety, if they are not familiar with the issue (40–42). However, as the same studies show somewhat positive effects of family involvement in screening and diagnosis were educated about their children’s problems, their findings do imply the exclusion of the parents not necessarily, but an involvement after prior information and permanent support by a trained psychological staff. Moreover, considering the limited knowledge about the positive impact of parents in care and treatment of these children is little secured (43). Therefore, a decision regarding this issue should be based on a cost-benefit analysis that includes parental characteristics.

The raw data supporting the conclusions of this article will be made available by the authors, without undue reservation.

The studies involving humans were approved by the Institutional Ethics Committee in Sudan University of Science and Technology. No. DSR – IEC – 02 -1- 2023. The studies were conducted in accordance with the local legislation and institutional requirements. Written informed consent for participation in this study was provided by the participants’ legal guardians/next of kin.

MA: Writing – original draft, Writing – review & editing. DB: Writing – original draft, Writing – review & editing. AAl: Writing – original draft, Writing – review & editing. SB: Writing – original draft, Writing – review & editing. RA: Writing – original draft, Writing – review & editing. AAb: Writing – original draft, Writing – review & editing. NA: Writing – original draft, Writing – review & editing. HA: Writing – original draft, Writing – review & editing.