A script concordance test to implement 2024 HAS ADHD guidelines in primary care.

BACKGROUND: The 2024 French Haute Autorité de santé (HAS) guidelines introduced the concept of an "ADHD-specialized physician" calling for competency-based models to support broader, evidence-based ADHD care for children and adolescents. However, no standardized assessment currently exists to evaluate the clinical reasoning required for this role. OBJECTIVE: This study describes the development and initial validation of a Script Concordance Test (SCT) designed to assess clinical reasoning in ADHD management, with potential applications as both a pedagogical and certification tool. METHODS: Following international standards for SCT design, the test was constructed using a structured blueprint aligned with HAS 2024 guidelines. A panel of 25 national experts completed the full version (72 items); after reviewing the items and excluding those with low consensus, 43 items were retained. Inter-rater agreement was analyzed using Kendall's coefficient of concordance (W=0.67). Qualitative validation was achieved through iterative expert consensus ensuring clarity, relevance, and representativeness. RESULTS: The expert panel demonstrated substantial concordance (Kendall's W=0.67) consistent with previous SCT validation studies in psychiatry and pediatrics. Qualitative reviews confirmed the clarity, representativeness, and clinical relevance of the retained items. CONCLUSIONS: This SCT provides a valid and adaptable method to assess higher-order clinical reasoning in ADHD care. By operationalizing the competencies implied in the HAS 2024 guidelines, it may support the emerging role of the "ADHD-specialized physician" and contribute to competency-based certification models similar to those used in other regulated medical practices.