Current Psychiatry Reports

, 19:95 | Cite as

Preschool Predictors of ADHD Symptoms and Impairment During Childhood and Adolescence

  • Sarah O’Neill
  • Khushmand Rajendran
  • Shelagh M. Mahbubani
  • Jeffrey M. Halperin
Attention-Deficit Disorder (A Rostain, Section Editor)
Part of the following topical collections:
  1. Topical Collection on Attention-Deficit Disorder


Purpose of Review

This paper summarizes key, recently published research examining longitudinal outcomes for preschoolers with high levels of inattention and/or hyperactivity/impulsivity.

Recent Findings

Symptom trajectories show that hyperactivity/impulsivity declines across childhood. At the group level, the course of inattention appears more variable. However, identification of subgroups of children showing stable, rising, and falling inattention over time is promising. Early ADHD-like symptoms portend risk for academic and social difficulties, as well as comorbid emotional and behavioral problems in childhood and adolescence. Several early risk factors appear to moderate these relations, including comorbid symptoms, parental psychopathology, socioeconomic disadvantage, and perhaps neuropsychological dysfunction. Furthermore, high levels of inattention and/or hyperactivity/impulsivity during the preschool period appear to compromise development of regulatory and neuropsychological functions, which in turn increases risk for negative outcomes later in childhood.


Identified risk factors are targets for novel interventions, which ideally would be delivered early to at-risk children.


ADHD Attention-deficit/hyperactivity disorder Preschoolers Longitudinal Impairment Development 



This work was supported by the Eunice Kennedy Shriver National Institute of Child Health and Human Development (S.O., grant number SC2 HD086868) of the National Institutes of Health. The content is solely the responsibility of the authors and does not necessarily represent the official view of the National Institutes of Health.

Compliance with Ethical Standards

Conflict of Interest

Sarah O’Neill, Khushmand Rajendran, Shelagh M. Mahbubani, and Jeffrey M. Halperin declare that they have no conflict of interest.

Human and Animal Rights and Informed Consent

All reported studies/experiments with human or animal subjects performed by the authors have been previously published and complied with all applicable ethical standards (including Helsinki declaration and its amendments, institutional/national research committee standards, and international/national/institutional guidelines).


Papers of particular interest, published recently, have been highlighted as: •• Of major importance

  1. 1.
    American Psychiatric Association. Diagnostic and statistical manual of mental disorders. 5th ed. Washington DC: American Psychiatric Publishing; 2013.CrossRefGoogle Scholar
  2. 2.
    Abikoff HB, Thompson M, Laver-Bradbury C, Long N, Forehand RL, Miller Brotman L, et al. Parent training for preschool ADHD: a randomized controlled trial of specialized and generic programs. J Child Psychol Psychiatry. 2015;56:618–31. Scholar
  3. 3.
    Breaux RP, Brown HR, Harvey EA. Mediators and moderators of the relation between parental ADHD symptomatology and the early development of child ADHD and ODD symptoms. J Abnorm Child Psych. 2017;45:443–56. Scholar
  4. 4.
    Breaux RP, Griffith SF, Harvey EA. Preschool neuropsychological measures as predictors of later attention deficit hyperactivity disorder. J Abnorm Child Psych. 2016;44:1455–71. Scholar
  5. 5.
    Breaux RP, Harvey EA, Lugo-Candelas CI. The role of parent psychopathology in the development of preschool children with behavior problems. J Clin Child Adolesc Psychol. 2014;43(5):777–90. Scholar
  6. 6.
    Chorozoglou M, Smith E, Koerting J, Thompson MJ, Sayal K, Sonuga-Barke EJ. Preschool hyperactivity is associated with long-term economic burden: evidence from a longitudinal health economic analysis of costs incurred across childhood, adolescence and young adulthood. J Child Psychol Psychiatry. 2015;56:966–75. Scholar
  7. 7.
    Claessens A, Dowsett C. Growth and change in attention problems, disruptive behavior, and achievement from kindergarten to fifth grade. Psychol Sci. 2014;25(12):2241–51. Scholar
  8. 8.
    Curchack-Lichtin JT, Chacko A, Halperin JM. Changes in ADHD symptom endorsement: preschool to school age. J Abnorm Child Psych. 2014;42:993–1004. Scholar
  9. 9.
    Harvey EA, Lugo-Candelas CI, Breaux RP. Longitudinal changes in individual symptoms across the preschool years in children with ADHD. J Clin Child Adolesc Psychol. 2015;44:580–94. Scholar
  10. 10.
    •• Lahey BB, Lee SS, Sibley MH, Applegate B, Molina BS, Pelham WE. Predictors of adolescent outcomes among 4–6-year-old children with attention-deficit/hyperactivity disorder. J Abnorm Psychol. 2016;125:168. This longitudinal study across 13 points of time from age of 4-6 years to 18 years found that both inattention and hyperactivity declined with age and that children with ADHD exhibited greater numbers of symptoms of every dimension of psychopathology (i.e., inattention, hyperactivity-impulsivity, ODD, CD, anxiety, and depression) reported by parents and teachers or by the youth themselves CrossRefPubMedPubMedCentralGoogle Scholar
  11. 11.
    Leopold DR, Christopher ME, Burns GL, Becker SP, Olson RK, Willcutt EG. Attention-deficit/hyperactivity disorder and sluggish cognitive tempo throughout childhood: temporal invariance and stability from preschool through ninth grade. J Child Psychol Psych. 2016;57:1066–74. Scholar
  12. 12.
    Mlodnicka AE, O’Neill S, Marks DJ, Rajendran K, Bedard AC, Schneiderman RL, et al. Impact of occupational, physical, and speech and language therapy in preschoolers with hyperactive/inattentive symptoms: a naturalistic 2-year follow-up study. Children's Health Care. 2016;45:67–83. Scholar
  13. 13.
    O’Neill S, Schneiderman RL, Rajendran K, Marks DJ, Halperin JM. Reliable ratings or reading tea leaves: can parent, teacher, and clinician behavioral ratings of preschoolers predict ADHD at age six? J Abnorm Child Psychol. 2014;42(4):623–34. Scholar
  14. 14.
    O’Neill S, Thornton V, Marks DJ, Rajendran K, Halperin JM. Early language mediates the relations between preschool inattention and school-age reading achievement. Neuropsychology. 2016;30(4):398–404. Scholar
  15. 15.
    Plourde V, Boivin M, Forget-Dubois N, Brendgen M, Vitaro D, Marino C, et al. Phenotypic and genetic associations between reading comprehension, decoding skills, and ADHD dimensions: evidence from two population-based studies. J Child Psychol Psychiatry. 2015;56(10):1074–82. Scholar
  16. 16.
    Rabinovitz BB, O’Neill S, Rajendran K, Halperin JM. Temperament, executive control, and attention-deficit/hyperactivity disorder across early development. J Abnorm Psychol. 2016;125(2):196. Scholar
  17. 17.
    Rajendran K, Kruszewski E, Halperin JM. Parenting style influences bullying: a longitudinal study comparing children with and without behavioral problems. J Child Psychol Psychiatry. 2016;57:188–95. Scholar
  18. 18.
    Rajendran K, O’Neill S, Marks DJ, Halperin JM. Latent profile analysis of neuropsychological measures to determine preschoolers’ risk for ADHD. J Child Psychol Psych. 2015;56:958–65. Scholar
  19. 19.
    Russell AE, Ford T, Russell G. Socioeconomic associations with ADHD: findings from a mediation analysis. PLoS One. 2015;10(6):e0128248. Scholar
  20. 20.
    Sasser TR, Beekman CR, Bierman KL. Preschool executive functions, single-parent status, and school quality predict diverging trajectories of classroom inattention in elementary school. Dev Psychopathol. 2015;27(3):681–93. Scholar
  21. 21.
    Schmiedeler S, Schneider W. Attention-deficit hyperactivity disorder (ADHD) in the early years: diagnostic issues and educational relevance. Clin Child Psychol Psychiatry. 2014;19(3):460–75. Scholar
  22. 22.
    •• Shaw P, De Rossi P, Watson B, Wharton A, Greenstein D, Raznahan A, et al. Mapping the development of the basal ganglia in children with attention-deficit/hyperactivity disorder. J Am Acad Child Adolesc Psychiatry. 2014;53(7):780–9. This longitudinal study using advanced MRI techniques in 270 youth with ADHD and 270 sex-matched controls showed multiple group differences in the basal ganglia in individuals with ADHD, some that are fixed but others that are progressive over development CrossRefPubMedGoogle Scholar
  23. 23.
    Sjöwall D, Bohlin G, Rydell AM, Thorell LB. Neuropsychological deficits in preschool as predictors of ADHD symptoms and academic achievement in late adolescence. Child Neuropsychology. 2017;23(1):111–28. Scholar
  24. 24.
    Stenseng F, Belsky J, Skalicka V, Wichstrøm L. Peer rejection and attention deficit hyperactivity disorder symptoms: reciprocal relations through ages 4, 6, and 8. Child Dev. 2016;87:365–73. Scholar
  25. 25.
    Verlinden M, Jansen PW, Veenstra R, Jaddoe VW, Hofman A, Verhulst FC, et al. Preschool attention-deficit/hyperactivity and oppositional defiant problems as antecedents of school bullying. J Am Acad Child Adolesc Psychiatry. 2015;54:571–9. Scholar
  26. 26.
    Wang CH, Mazursky-Horowitz H, Chronis-Tuscano A. Delivering evidence-based treatments for child attention-deficit/hyperactivity disorder (ADHD) in the context of parental ADHD. Curr Psychiatry Rep. 2014;16(10):474. Scholar
  27. 27.
    Barkley RA. Behavioral inhibition, sustained attention, and executive functions: constructing a unifying theory of ADHD. Psychol Bull. 1997 Jan;121(1):65–94.CrossRefPubMedGoogle Scholar
  28. 28.
    Rapport MD, Alderson RM, Kofler MJ, Sarver DE, Bolden J, Sims V. Working memory deficits in boys with attention-deficit/hyperactivity disorder (ADHD): the contribution of central executive and subsystem processes. J Abnorm Child Psychol. 2008 Aug;36(6):825–37. Scholar
  29. 29.
    Sergeant J. The cognitive-energetic model: an empirical approach to attention-deficit hyperactivity disorder. Neurosci Biobehav Rev. 2000;24(1):7–12.CrossRefPubMedGoogle Scholar
  30. 30.
    Solanto MV, Abikoff H, Sonuga-Barke EJS, Schachar R, Logan GD, Wigal T, et al. The ecological validity of delay aversion and response inhibition as measures of impulsivity in AD/HD: a supplement to the NIMH multimodal treatment study of AD/HD. J Abnorm Child Psychol. 2001;29(3):215–28.CrossRefPubMedGoogle Scholar
  31. 31.
    Sonuga-Barke EJS, Dalen L, Remington B. Do executive deficits and delay aversion make independent contributions to preschool attention-deficit/hyperactivity disorder symptoms? J Am Acad Child Adolesc Psychiatry. 2003;42(11):1335–42.CrossRefPubMedGoogle Scholar
  32. 32.
    Fiks AG, Ross ME, Mayne SL, Song L, Liu W, Steffes J, et al. Preschool ADHD diagnosis and stimulant use before and after the 2011 AAP practice guideline. Pediatrics. 2016; 138(6).Google Scholar
  33. 33.
    Greenhill L, Kollins S, Abikoff H, McCracken J, Riddle M, Swanson J, et al. Efficacy and safety of immediate-release methylphenidate treatment for preschoolers with ADHD. J Am Acad Child Adolesc Psychiatry. 2006 Nov;45(11):1284–93.CrossRefPubMedGoogle Scholar
  34. 34.
    Sonuga-Barke EJ, Brandeis D, Cortese S, Daley D, Ferrin M, Holtmann M, et al. Nonpharmacological interventions for ADHD: systematic review and meta-analyses of randomized controlled trials of dietary and psychological treatments. Am J Psychiatry. 2013 Mar;170(3):275–89. Scholar
  35. 35.
    Biederman J, Mick E, Faraone SV. Age-dependent decline of symptoms of attention deficit hyperactivity disorder: impact of remission definition and symptom type. Am J Psychiatry. 2000;157:816–8.CrossRefPubMedGoogle Scholar
  36. 36.
    Harvey EA, Breaux RP, Lugo-Candelas CI. Early development of comorbidity between symptoms of attention-deficit/hyperactivity disorder (ADHD) and oppositional defiant disorder (ODD). J Abnorm Psychol. 2016;125:154. Scholar
  37. 37.
    Greene RW, Biederman J, Faraone SV, Monuteaux MC, Mick E, Dupre EP, et al. Social impairment in girls with ADHD: patterns, gender comparisons, and correlates. J Am Acad Child Adolesc Psychiatry. 2001;40(6):704–10.CrossRefPubMedGoogle Scholar
  38. 38.
    Staikova E, Gomes H, Tartter V, McCabe A, Halperin JM. Pragmatic deficits and social impairment in children with ADHD. J Child Psychol Psychiatry. 2013;54(12):1275–83. Scholar
  39. 39.
    Hart SA, Petrill SA, Willcutt E, Thompson LA, Schatschneider C, Deater-Deckard K, et al. Exploring how symptoms of attention-deficit/hyperactivity disorder are related to reading and mathematics performance: general genes, general environments. Psychol Sci. 2010;21(11):1708–15. Scholar
  40. 40.
    Langberg JM, Dvorsky MR, Molitor SJ, Bourchtein E, Eddy LD, Smith Z, et al. Longitudinal evaluation of the importance of homework assignment completion for the academic performance of middle school students with ADHD. J Sch Psychol. 2016;55:27–38. Scholar
  41. 41.
    Barkley RA. Driving impairments in teens and adults with attention-deficit/hyperactivity disorder. Psychiatr Clin North Am. 2004;27(2):233–60.CrossRefPubMedGoogle Scholar
  42. 42.
    Mannuzza S, Klein RG, Moulton JL. Lifetime criminality among boys with attention deficit hyperactivity disorder: a prospective follow-up study into adulthood using official arrest records. Psychiatry Res. 2008;160(3):237–46. Scholar
  43. 43.
    Sonuga-Barke EJ, Halperin JM. Developmental phenotypes and causal pathways in attention deficit/hyperactivity disorder: potential targets for early intervention? J Child Psychol Psychiatry. 2010;51(4):368–89. Scholar
  44. 44.
    Masten AS, Cicchetti D. Developmental cascades. Dev Psychopathol. 2010;22(3):491–5. Scholar
  45. 45.
    Marks DJ, Mlodnicka A, Bernstein M, Chacko A, Rose S, Halperin JM. Profiles of service utilization and the resultant economic impact in preschoolers with attention deficit/hyperactivity disorder. J Pediatr Psychol. 2009;34(6):681–9. Scholar
  46. 46.
    Heckman JJ. Schools, skills, and synapses. Econ Inq. 2008;46(3):289–324. Scholar

Copyright information

© Springer Science+Business Media, LLC 2017

Authors and Affiliations

  • Sarah O’Neill
    • 1
    • 2
  • Khushmand Rajendran
    • 3
  • Shelagh M. Mahbubani
    • 4
  • Jeffrey M. Halperin
    • 5
  1. 1.The City College and The Graduate CenterCity University of New YorkNew YorkUSA
  2. 2.Department of Psychology, The City College and The Graduate CenterThe City College of New YorkNew YorkUSA
  3. 3.Department of Social Sciences, Human Services and Criminal Justice, Borough of Manhattan Community CollegeCity University of New YorkNew YorkUSA
  4. 4.Department of PsychologyColumbia UniversityNew YorkUSA
  5. 5.Department of Psychology, Queens College and The Graduate CenterCity University of New YorkFlushingUSA

Personalised recommendations