Cross-Informant Agreement and Discrepancies in ADHD Assessment During Adolescence: A Systematic Review and Meta-Analysis

Abstract

Highlights What are the main findings? Cross-informant agreement for adolescent attention-deficit/hyperactivity disorder symptoms was positive but modest and highly heterogeneous across caregiver, adolescent and teacher reports. Caregiver–adolescent pooled correlations averaged r = 0.33 for inattention and r = 0.32 for hyperactivity/impulsivity, with prediction intervals crossing zero; caregiver–teacher estimates were similar in magnitude, highly heterogeneous, and imprecise. What are the implications of the main findings? Discrepant ratings should be treated as source- and context-specific clinical information rather than resolved by selecting one informant as universally more accurate. Assessment and research should document informant identity, setting, independence, timing and both dimensional and categorical agreement using age-stratified results. Abstract Background/Objectives: Assessment of attention-deficit/hyperactivity disorder (ADHD) requires information across settings, but reports from adolescents, caregivers, teachers, and clinicians are often only partly concordant. This review synthesized cross-informant agreement and discrepancies in ADHD assessment among adolescents aged 10–19 years. Methods: MEDLINE, CINAHL, ERIC and Academic Search Complete were searched through EBSCO, together with PubMed and Scopus, on 19 July 2026. Eligible primary quantitative studies compared at least two independent informants assessing the same adolescent ADHD domain. Methodological quality was appraised with an adapted 11-item QAREL framework. Pearson correlations were pooled after Fisher z transformation using restricted maximum-likelihood random-effects models and Hartung–Knapp–Sidik–Jonkman confidence intervals. Results: The searches identified 1447 records; 30 reports (282 outcomes) were included. Caregiver–adolescent pooled r was 0.33 for inattention (k = 7, 95% CI 0.19–0.46; I2 = 88.1%; 95% prediction interval −0.07 to 0.64) and 0.32 for hyperactivity/impulsivity (k = 7, 95% CI 0.12–0.50; I2 = 94.8%; prediction interval −0.28 to 0.74). Despite the positive pooled point estimates, both prediction intervals were wide and crossed zero. Caregiver–teacher estimates were r = 0.29 for inattention (k = 4, 95% CI −0.02 to 0.55; I2 = 94.1%) and r = 0.27 for hyperactivity/impulsivity (k = 4, 95% CI −0.03 to 0.52; I2 = 83.0%); both confidence intervals crossed zero. Diagnostic agreement was generally low and sensitive to impairment and consensus rules. Conclusions: Informant reports were positively related on average, but the magnitude of agreement was highly heterogeneous and imprecisely estimated. Wide intervals, including caregiver–adolescent prediction intervals crossing zero and caregiver–teacher confidence intervals crossing zero, indicate that little or no agreement remains plausible in some comparable settings. Reports should therefore not be treated as clinically interchangeable, and pooled estimates should not be interpreted as universal levels of agreement.