Symptoms of autism spectrum disorder (ASD) and attention-deficit/hyperactivity disorder (ADHD) often co-occur, challenging timely and accurate diagnosis. We assessed the performance of three parent-report measures in discriminating ASD from ADHD without ASD (ADHDw/oASD) in school-age verbally fluent children. We examined the Autism Symptom Interview (ASI) School-Age and two widely used parent questionnaires: Social Responsiveness Scale-2nd Edition (SRS-2) and Social Communication Questionnaire-Lifetime (SCQ-L). Receiver operating characteristic curves assessed each instrument’s performance against the best-estimate clinician DSM-5 diagnosis of ASD or of ADHDw/oASD (n=74, n=102, respectively; 6-11 years). These yielded moderate accuracies: AUC=0.85, 0.79, 0.78 for SCQ-L, ASI, SRS-2, respectively. AUC pairwise comparisons reached our statistical significance (p<0.01) for the SCQ-L vs. the SRS-2. Within instruments, sensitivity and specificity varied across ASD cutoffs. Along with the between-instrument variability, this indicates that clinicians and researchers have valid options, depending on the settings and their goals. Comparing children correctly and incorrectly classified as ASD showed no differences in demographics, intellectual abilities, nor in any specific clinical profile(s), except for the degree of parent concerns across ASD- and comorbid psychopathology-related symptoms. Together, results suggest that complementing parent screeners with multiple sources may be needed to best differentiate school-age verbally fluent children with ASD vs. ADHDw/oASD.
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