Parent-teacher agreement on ADHD symptom ratings: a systematic review and meta-analysis

Abstract

Background/objectives Accurate diagnosis of attention-deficit/hyperactivity disorder (ADHD) requires multi-informant assessments across different settings, yet consistent agreement between parents and teachers remains challenging. This systematic review and meta-analysis aimed to quantify the level of concordance between parent and teacher ratings of ADHD symptoms in children and adolescents and to examine the moderating effects of child gender and sample settings. Methods We conducted a comprehensive search of Web of Science, Embase, and PubMed from 1994 to May 2026(PROSPERO: CRD42024556281). Inclusion criteria encompassed studies assessing ADHD symptoms in individuals under 18 years using DSM-IV/V criteria and reporting Cohen’s Kappa for parent-teacher agreement. A random-effects meta-analysis was performed, with subgroup analyses based on gender and sample settings (clinical, school, community). Heterogeneity was assessed using the I² statistic. Results Eleven studies involving 8796 participants were included. The overall parent-teacher agreement was low (Kappa = 0.25, 95% CI: 0.18-0.31), with substantial heterogeneity (I² = 75.8%). Subgroup analyses revealed that gender had a minimal impact on agreement levels (boys: Kappa=0.25; girls: Kappa=0.32). However, sample settings significantly moderated agreement: school-based samples showed the highest concordance (Kappa=0.31), followed by community samples (Kappa=0.27), while clinical samples demonstrated the lowest and non-significant agreement (Kappa=0.07). Conclusions This meta-analysis confirmed low parent-teacher agreement in ADHD assessments, with the lowest agreement observed in clinical samples. Existing studies also suggest moderate agreement between parents themselves, although the limited data precluded a meta-analysis on this specific comparison. Nevertheless, these findings highlight that high levels of discrepancy across informants should be a focus of clinical attention. When integrating multi-informant data, such discrepancies must be explicitly interpreted, and standardized methods are needed to reconcile them in diagnostic decision-making. Systematic review registration https://www.crd.york.ac.uk/prospero/display_record.php?RecordID=4556281, identifier CRD4202455628.