Preschool Predictors of ADHD Symptoms and Impairment During Childhood and Adolescence
Purpose of Review
This paper summarizes key, recently published research examining longitudinal outcomes for preschoolers with high levels of inattention and/or hyperactivity/impulsivity.
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.
KeywordsADHD 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
- 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. https://doi.org/10.1111/jcpp.12437.CrossRefPubMedPubMedCentralGoogle Scholar
- 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. https://doi.org/10.1037/abn0000086. 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.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. https://doi.org/10.1111/jcpp.12505.CrossRefGoogle Scholar
- 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. https://doi.org/10.1080/02739615.2014.979918.CrossRefPubMedGoogle Scholar
- 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. https://doi.org/10.1007/s10802-013-9802-4.CrossRefPubMedPubMedCentralGoogle Scholar
- 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. https://doi.org/10.1111/jcpp.12394.CrossRefPubMedGoogle Scholar
- 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. https://doi.org/10.1016/j.jaac.2014.05.003. 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
- 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. https://doi.org/10.1016/j.jaac.2015.05.002.CrossRefPubMedGoogle Scholar
- 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. https://doi.org/10.1007/s10802-008-9215-y.CrossRefPubMedGoogle Scholar
- 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
- 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
- 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. https://doi.org/10.1176/appi.ajp.2012.12070991.CrossRefPubMedGoogle Scholar
- 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. https://doi.org/10.1177/0956797610386617.CrossRefPubMedPubMedCentralGoogle Scholar
- 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. https://doi.org/10.1016/j.jsp.2015.12.004.CrossRefPubMedPubMedCentralGoogle Scholar
- 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. https://doi.org/10.1016/j.psychres.2007.11.003.CrossRefPubMedPubMedCentralGoogle Scholar