Year 2021
October 2021


Abstract Title
Parent-Child Agreement on the Patient Health Questionnaire (PHQ-9) in Youths with Autism Spectrum Disorder (ASD)

S.Y. LU1, T.J. GOH1


Institute of Mental Health1

Background & Hypothesis

Identification of depression in ASD individuals is confounded by impairments inherent in ASD. It is further compounded by a lack of validated measures. We evaluate the concordance between parent-child ratings on the PHQ-9 in screening for depression in ASD.


As part of a larger study, 110 verbal autistic youths, of which 96 (87.3%) were males and 14 (12.7%) were females; Mage = 14.61 (SD = 2.28) years, and their parents completed the PHQ-9 independently. Kendall’s test of concordance, Spearman correlations and Fleiss’ Kappa analyses were conducted.


Mean child- and parent-rated PHQ-9 scores were 8.70 (SD = 5.98) and 5.97 (SD = 5.47) respectively. Overall, parent-child rating was positively correlated (r = 0.50, p < .001), and Kendall’s agreement was significant (W = .22, p < .001). Parent-ratings were lower than child-ratings (U = 4390.50, z = -3.53, p < .001; d = 0.49). Item analyses indicated significant correlations between parent-child ratings (rs > .20, p < .05) on all but one item. Fleiss’ kappas showed that agreements between parent- and child-ratings across each item were weak, k < .21 (p < .05), with agreement rates between 35.5% and 62.7%.

Discussion & Conclusion

Our results suggested a weak concordance between parent-child ratings on the PHQ-9, with parents reporting lower scores than their child. Parent and child ratings were more similar on extreme scores (i.e. ‘0’ and ‘3’) for some items. Response patterns across items were examined. Specific evaluation of the sensitivity and specificity of the PHQ, and the recommended cut-off score is warranted.