Diagnostic Accuracy of “System for the Assessment of Children and Adolescents” (SENA) for Emotional Disorders in Youth: Insights from the EmoChild Study in Spain

• This study evaluates SENA’s accuracy in detecting emotional disorders and suicidal thoughts • SENA showed good sensitivity (78.5%-80.4%) but moderate specificity (65.9%-66.1%). • SENA showed high sensitivity for generalized anxiety, social anxiety, and PTSD. • SENA is useful for early screening but requires refined thresholds for better specificity. • Results have implications for improving screening in educational & clinical settings. Objective: To evaluate the diagnostic accuracy of the System for the Assessment of Children and Adolescents (SENA) in identifying emotional disorders and suicidal thoughts and behaviors. SENA is a widely used Spanish screening tool for assessing emotional and behavioral symptoms in youth. Method: 526 primary and secondary pupils aged 8-16 in several Spanish regions (a subset of the EmoChild Project, n=5,652 completed SENA), completed the SENA and underwent with clinical interviews using KSADS-COMP within 3 months. We screened potential participants by identifying possible positive and negative cases based on a T-score equivalent to the 75th percentile and served as a cut-off point for accessing a diagnostic interview. Results: SENA’s Emotional subscale showed a sensitivity (SN) of 78.5% in children and 80.4% in adolescents for detecting any emotional disorder, with specificities (SP) of 65.9% and 66.1%, and Area Under the ROC curve (AUC) of .74 in children and .73 in adolescents. AUCs were adequate for all subscales (0.72-0.93) other than obsessive compulsive disorder (AUC=.67). Specific subscales performed best: Generalized Anxiety Disorder (SN=100%, SP=88.4%) and Social Anxiety Disorder-SAD (SN = 91.4%, SP = 80.3%) in children, and SAD (SN=88.1%, SP=72.5%), Post-Traumatic Stress Disorder (SN=81.2%, SP=68.2%) and suicidal thoughts in adolescents (SN=84.5%, SP=73.8%). Conclusions: SENA is a valuable screening tool for educational and clinical settings, facilitating early intervention through a standardized and user-friendly assessment. Nevertheless, there is need for refined thresholds to enhance specificity and clinical alignment.