Parent-reported Attention Deficit/Hyperactivity symptomatology in preschool-aged children: factor structure, developmental change, and early risk factors

Trajectory Analysis for Identifying Classes of Attention Deficit Hyperactivity Disorder (ADHD) in Children of the United States

Background

Attention Deficit Hyperactivity Disorder (ADHD) is a mental health disorder that affects attention and behavior. People with ADHD frequently encounter challenges in social interactions, facing issues, like social rejection and difficulties in interpersonal relationships, due to their inattention, impulsivity, and hyperactivity.

Methods

A National Longitudinal Survey of Youth (NLSY) database was employed to identify patterns of ADHD symptoms. The children who were born to women in the NLSY study between 1986 and 2014 were included. A total of 1,847 children in the NLSY 1979 cohort whose hyperactivity/inattention score was calculated when they were four years old were eligible for this study. A trajectory modeling method was used to evaluate the trajectory classes. Sex, baseline antisocial score, baseline anxiety score, and baseline depression score were adjusted to build the trajectory model. We used stepwise multivariate logistic regression models to select the risk factors for the identified trajectories.

Results

The trajectory analysis identified six classes for ADHD, including (1) no sign class, (2) few signs since preschool being persistent class, (3) few signs in preschool but no signs later class, (4) few signs in preschool that magnified in elementary school class, (5) few signs in preschool that diminished later class, and (6) many signs since preschool being persistent class. The sensitivity analysis resulted in a similar trajectory pattern, except for the few signs since preschool that magnified later class. Children's race, breastfeeding status, headstrong score, immature dependent score, peer conflict score, educational level of the mother, baseline antisocial score, baseline anxious/depressed score, and smoking status 12 months prior to the birth of the child were found to be risk factors in the ADHD trajectory classes.

Conclusion

The trajectory classes findings obtained in the current study can (a) assist a researcher in evaluating an intervention (or combination of interventions) that best decreases the long-term impact of ADHD symptoms and (b) allow clinicians to better assess as to which class a child with ADHD belongs so that appropriate intervention can be employed.

Genetic and phenotypic evidence of the predictive validity of preschool parent reports of hyperactivity/impulsivity and inattention

To determine the validity of parent reports (PRs) of ADHD in preschoolers, we assessed hyperactivity/impulsivity (HI) and inattention (IN) in 1114 twins with PRs at 1.5, 2.5, 4, 5, 14, 15, and 17 years, and teacher-reports at 6, 7, 9, 10, and 12. We examined if preschool PRs (1) predict high HI/IN trajectories, and (2) capture genetic contributions to HI/IN into adolescence. Group-based trajectory analyses identified three 6-17 years trajectories for both HI and IN, including small groups with high HI (N = 88, 10.4%, 77% boys) and IN (N = 158, 17.3%, 75% boys). Controlling for sex, each unit of HI PRs starting at 1.5 years and at 4 years for IN, increased more than 2-fold the risk of belonging to the high trajectory, with incremental contributions (Odds Ratios = 2.5-4.5) at subsequent ages. Quantitative genetic analyses showed that genetic contributions underlying preschool PRs accounted for up to a quarter and a third of the heritability of later HI and IN, respectively. Genes underlying 1.5-year HI and 4-year IN contributed to 6 of 8 later HI and IN time-points and largely explained the corresponding phenotypic correlations. Results provide phenotypic and genetic evidence that preschool parent reports of HI and IN are valid means to predict developmental risk of ADHD.

Genetic nurture versus genetic transmission of risk for ADHD traits in the Norwegian Mother, Father and Child Cohort Study

Identifying mechanisms underlying the intergenerational transmission of risk for attention-deficit/hyperactivity disorder (ADHD) traits can inform interventions and provide insights into the role of parents in shaping their children's outcomes. We investigated whether genetic transmission and genetic nurture (environmentally mediated effects) underlie associations between polygenic scores indexing parental risk and protective factors and their offspring's ADHD traits. This birth cohort study included 19,506 genotyped mother-father-offspring trios from the Norwegian Mother, Father and Child Cohort Study. Polygenic scores were calculated for parental factors previously associated with ADHD, including psychopathology, substance use, neuroticism, educational attainment, and cognitive performance. Mothers reported on their 8-year-old children's ADHD traits (n = 9,454 children) using the Parent/Teacher Rating Scale for Disruptive Behaviour Disorders. We found that associations between ADHD maternal and paternal polygenic scores and child ADHD traits decreased significantly when adjusting for the child polygenic score (pΔβ = 9.95 × 10-17 for maternal and pΔβ = 1.48 × 10-14 for paternal estimates), suggesting genetic transmission of ADHD risk. Similar patterns suggesting genetic transmission of risk were observed for smoking, educational attainment, and cognition. The maternal polygenic score for neuroticism remained associated with children's ADHD ratings even after adjusting for the child polygenic score, indicating genetic nurture. There was no robust evidence of genetic nurture for other parental factors. Our findings indicate that the intergenerational transmission of risk for ADHD traits is largely explained by the transmission of genetic variants from parents to offspring rather than by genetic nurture. Observational associations between parental factors and childhood ADHD outcomes should not be interpreted as evidence for predominantly environmentally mediated effects.

Postpartum depression and ADHD in the offspring: Systematic review and meta-analysis

BACKGROUND

Postpartum depression (PPD) is a disorder that has a severe impact on a woman's mental state and mood after birth. Research has shown that postnatal levels of family adversity and maternal psychopathology are associated with Attention Deficit Hyperactivity Disorder (ADHD). This paper is intended to examine the association among maternal PPD and the risk of ADHD in the offspring.

METHODS

Keyword search was conducted for PsycINFO, PubMed, Google Scholar, and Embase up to Feb 28, 2021; studies in English were deemed eligible. Random-effects meta-analysis and meta-regression analysis took place. Subgroup analyses by study design, geographical region, level of adjustment and study setting were performed.

RESULTS

Nine cohort studies and two case-control studies published from 2003 to 2019 were included in the qualitative synthesis; among them, eight studies were synthesized in the meta-analysis. Overall, maternal PPD was associated with an increased risk of ADHD in the offspring (pooled relative risk, RR = 1.69, 95%CI: 1.27-2.26). Significant associations were noted in the subsets of cohort studies, studies implementing multivariate analyses and registry-based surveys.

LIMITATIONS

Overall, a larger number of studies of the field are needed. Data collection relied on self-report and attrition bias limited the validity of eligible studies. Studies from developing countries were underrepresented. There was significant publication bias (p = 0.035, Egger's test).

CONCLUSIONS

The relationship between PPD and ADHD in children was found to be significant in this systematic review and meta-analysis and reveals the need for further investigation in various geographical regions.

Early Development of ADHD and ODD Symptoms from the Toddler to Preschool Years

OBJECTIVE

ADHD and ODD are commonly co-occurring, but often studied individually. This study evaluated common trajectories of these disorders and explored how they co-develop in early childhood.

METHOD

Community parents (N = 273) completed online surveys about their 2-year-old. Children's inattention, hyperactivity/impulsivity, and oppositional defiant disorder symptoms over 2 years were examined using latent class, dual trajectory, and cross-lagged analyses.

RESULTS

Most children followed low symptom trajectories. A small portion showed high, moderate, or increasing trajectories. The hyperactive/impulsive domain of ADHD showed a declining symptoms group. Children in high ODD groups were likely to be in high ADHD symptom groups; the converse was true but probabilities were lower. Hyperactive/impulsive symptoms predicted ODD symptoms across time, more than vice versa.

CONCLUSION

The study extends the small body of literature assessing early development of ADHD and ODD. Findings suggest that earlier intervention for symptoms of ADHD may mitigate risk of developing ODD.

Investigating the Measurement Invariance and Method-Trait Effects of Parent and Teacher SNAP-IV Ratings of Preschool Children

The Swanson, Nolan, and Pelham scale version IV (SNAP-IV) is widely used to assess symptoms of attention deficit hyperactivity disorder (ADHD) and oppositional defiant disorder (ODD) in children and adolescents. Nevertheless, there is insufficient data to support its use in preschool children. The study had three goals: First, to test the factorial validity of the three correlated-factors model of ADHD and ODD items of the SNAP-IV. Second, to investigate the measurement invariance of the items over time (6-month longitudinal interval) and by sex. Third, to investigate the convergent validity and method-specific influences on ADHD/ODD assessments with respect to multiple raters (parents/teachers) of children's symptoms. Participants were 618 preschool children (3.5-6 years) at baseline and 6-month follow-up. For model testing, we used confirmatory factor analysis for categorical observed variables. Method and trait effects were examined using the CT-C(M-1) model. The analyses showed partial measurement invariance over time and according to sex. Moreover, strong rater-specific effects were detected. The implication of the results for construct validation of the instrument and clinical assessment of ADHD and ODD traits are discussed.

The Developmental Course of Teacher-Rated ADHD Symptom Levels in an Early Childhood Community Sample

OBJECTIVE

This study examined trajectories of inattention and hyperactivity/impulsivity symptom levels across one preschool year and explored variation in trajectories by age, sex, and end-of-year impairment.

METHOD

Participants were 261 preschoolers (87% Head Start; 59% Caucasian; 53% boys; M_age = 3.97 years). Teachers rated ADHD symptom levels four times throughout one academic year.

RESULTS

Results showed a course of increasing inattention that decelerated over time and steadily increasing hyperactivity/impulsivity. Group-based finite mixture modeling revealed three trajectories of inattention: stable low (57%), change (32%), and stable high (11%), as well as three trajectories of hyperactivity/impulsivity: stable low (63%), increasing (26%), and stable high (11%). Compared to children with increasing or changing symptoms levels, children with stable high levels were more impaired and children with stable low symptom levels were less impaired.

CONCLUSION

Findings suggest a "wait and see" approach to treatment may miss an important opportunity for early intervention.

Behavioural Measures of Infant Activity but Not Attention Associate with Later Preschool ADHD Traits

Mapping infant neurocognitive differences that precede later ADHD-related behaviours is critical for designing early interventions. In this study, we investigated (1) group differences in a battery of measures assessing aspects of attention and activity level in infants with and without a family history of ADHD or related conditions (ASD), and (2) longitudinal associations between the infant measures and preschool ADHD traits at 3 years. Participants (N = 151) were infants with or without an elevated likelihood for ADHD (due to a family history of ADHD and/or ASD). A multi-method assessment protocol was used to assess infant attention and activity level at 10 months of age that included behavioural, cognitive, physiological and neural measures. Preschool ADHD traits were measured at 3 years of age using the Child Behaviour Checklist (CBCL) and the Child Behaviour Questionnaire (CBQ). Across a broad range of measures, we found no significant group differences in attention or activity level at 10 months between infants with and without a family history of ADHD or ASD. However, parent and observer ratings of infant activity level at 10 months were positively associated with later preschool ADHD traits at 3 years. Observable behavioural differences in activity level (but not attention) may be apparent from infancy in children who later develop elevated preschool ADHD traits.

Longitudinal pathways of engagement, social interaction skills, hyperactivity and conduct problems in preschool children

Preschool children's engagement/social interaction skills can be seen as aspects of positive functioning, and also act as protective aspects of functioning. On the other hand, hyperactivity/conduct problems are risk aspects that negatively affect children's everyday functioning. Few studies have investigated such orchestrated effects on mental health in young children over time. The aims of the study are first, to identify homogeneous groups of children having similar pathways in mental health between three time points. Second, to examine how children move between time points in relation to risk and protective factors. Alongitudinal study over 3 years, including 197 Swedish preschool children was used. Questionnaire data collected from preschool teachers. Statistical analysis using person-oriented methods with repeated cluster analyses. Children high in engagement/social skills and low in conduct problems continue to function well. Children with low engagement/social skills exhibiting both hyperactivity and conduct problems continue to have problems. Children with mixed patterns of protective factors and risk factors showed mixed outcomes. The stability of children's pathways was quite high if they exhibited many positive protective factors but also if they exhibited many risk factors. Children exhibiting a mixed pattern of protective and risk factors moved between clusters in a less predictable way. That stability in mental health was related to the simultaneous occurrence of either many protective factors or many risk factors supports the notion of orchestrated effects. The results indicate that early interventions need to have a dual focus, including both interventions aimed at enhancing child engagement and interventions focused on decreasing behavior problems.

Early Predictors of ADHD: Evidence from a Prospective Birth Cohort

Objective: To identify preschool predictors of registered ADHD diagnoses and compare two ADHD rating scales, Child Behavior Checklist (CBCL) and Conners' Parent Rating Scale (CPRS-R:S). Method: The Norwegian Mother and Child Cohort study (MoBa) is a prospective population-based cohort study. The sample were singletons whose mothers responded to MoBa questionnaires at child age 3 years (n = 57,986) and 5 years (n = 32,377). ADHD diagnoses were obtained from the Norwegian Patient Register. Predictors were child gender, development and symptoms, and maternal ADHD symptoms. We used Cox proportional hazard regression analyses. Results: In all final models, ADHD symptoms at age 3 and 5 years predicted later ADHD: Age 3, CBCL: hazard ratio (HR) = 3.23 (CI [2.59, 4.02]); age 5, CBCL: HR = 10.30 (CI [7.44, 14.26]); and age 5 CPRS-R:S: HR = 5.92 (CI [4.95, 7.07]). Conclusion: The findings underline the importance of taking early parent-reported symptoms seriously. Both rating scales were useful for predicting ADHD.

Addressing missing data in specification search in measurement invariance testing with Likert-type scale variables: A comparison of two approaches

In measurement invariance testing, when a certain level of full invariance is not achieved, the sequential backward specification search method with the largest modification index (SBSS_LMFI) is often used to identify the source of non-invariance. SBSS_LMFI has been studied under complete data but not missing data. Focusing on Likert-type scale variables, this study examined two methods for dealing with missing data in SBSS_LMFI using Monte Carlo simulation: robust full information maximum likelihood estimator (rFIML) and mean and variance adjusted weighted least squared estimator coupled with pairwise deletion (WLSMV_PD). The result suggests that WLSMV_PD could result in not only over-rejections of invariance models but also reductions of power to identify non-invariant items. In contrast, rFIML provided good control of type I error rates, although it required a larger sample size to yield sufficient power to identify non-invariant items. Recommendations based on the result were provided.

Using Repeated-Measures Data to Make Stronger Tests of the Association between Executive Function Skills and Attention Deficit/Hyperactivity Disorder Symptomatology in Early Childhood

Theoretical models of Attention deficit/hyperactivity disorder (ADHD) have long implicated executive function (EF) skills as contributing to the etiology, maintenance, and changes in ADHD symptomatology over time. Although there is interest making within-person inferences (i.e., deficits in EF skills give rise to ADHD behaviors), most of the evidence has been derived from studies that conflated between- and within-person sources of variance. Here, we use repeated-measures data to test within-person association between EF skills and ADHD behaviors. Participants included 1160 children from the Family Life Project, an ongoing prospective longitudinal study of child development in low-income, nonmetropolitan communities. We tested the magnitude of the association between EF skills and ADHD behaviors when children were 3, 4, and 5 years old. Consistent with meta-analyses, unadjusted bivariate associations between EF and ADHD (which reflect combined between- and within-person variation) were of moderate magnitude (rs = -0.20 to -0.30). However, after controlling for all time-invariant, between-person sources of variation, the within-person associations between EF skills and ADHD behaviors were weak (βs - 0.04 to -0.05, ps = 0.01). These results suggest that EF skills may contribute less prominently to ADHD behaviors in early childhood than is commonly assumed and provoke broader questions about developmental models of ADHD.

Practitioner Review: Assessment and treatment of preschool children with attention-deficit/hyperactivity disorder

BACKGROUND

Attention-deficit/hyperactivity disorder (ADHD) often emerges during the preschool years and remains impairing throughout the life span. Early identification and intervention may yield lasting benefits that alter the often-adverse trajectory of the disorder.

METHODS

This Practitioner Review provides up-to-date information regarding the evaluation and treatment of ADHD in preschool children. The clinical presentation of ADHD in preschool children, its persistence into later childhood, the applicability of DSM-5 criteria for preschoolers with ADHD, and early predictors of long-term trajectories are addressed, as well as current findings from randomized controlled trials of both nonpharmacological and pharmacological interventions.

RESULTS

Symptoms of hyperactivity/impulsivity extend down to age 3, but several inattention symptoms, as defined by DSM-V, less accurately differentiate preschoolers with and without ADHD. Most preschool youth with ADHD symptoms continue to manifest symptoms and impairment into school-age and adolescence. However, few predictors of persistence beyond early severity have been identified. Behavioral interventions constitute a first-line treatment for preschool ADHD symptoms, with telepsychiatry increasing in prominence to help to mitigate financial, geographic, and/or logistical barriers to care. Pharmacological interventions, particularly psychostimulants, also confer demonstrable benefits, yet efficacy and safety profiles are less desirable relative to findings in school-age youth.

CONCLUSIONS

Acute treatments have demonstrable efficacy, but do not appear to fundamentally alter underlying mechanisms or long-term trajectories.

Genetic and environmental links between motor activity level and attention problems in early childhood

Cross-lagged biometric models were used to examine genetic and environmental links between actigraph-assessed motor activity level (AL) and parent-rated attention problems (AP) in 314 same-sex twin pairs (MZ = 145, DZ = 169) at ages 2 and 3 years. At both ages, genetic correlations between AL and AP were moderate (ra2 = .35; ra3 = .39) indicating both overlap and specificity in genetic effects across the two domains. Within- and across-age phenotypic associations between AL and AP were entirely due to overlapping genetic influences. There was a unidirectional effect of AL at age 2 predicting later AP. For AP, genetic and environmental influences from age 2 were transmitted to age 3 via stability effects and from AL. For AL, across-age effects were transmitted only via stability. These results suggest that overactivity in late infancy may impact the later development of problems related to inattention, and that genetic factors explain the association between the two domains.

The ADHD rating scale-IV preschool version: Factor structure, reliability, validity, and standardisation in a Danish community sample

BACKGROUND

ADHD is a debilitating disorder with symptoms often appearing in early childhood. To facilitate early identification, developmentally appropriate and validated assessment tools for the preschool-age are needed.

AIMS

The current study aims to examine the psychometric properties of the ADHD Rating Scale (RS)-IV Preschool Version (-P) in a Danish community sample and provide national standardisation data.

METHODS AND PROCEDURES

Parents (n = 916) and kindergarten teachers (n = 275) of preschool children, aged 3-5 years, completed the ADHD RS-IV-P.

OUTCOMES AND RESULTS

Confirmatory factor analysis indicated that a three-factor model (inattention, hyperactivity, and impulsivity) best fit the data regardless of rater. Scales generally showed acceptable internal consistency, test-retest reliability, inter-rater reliability, and criterion validity. Boys received higher ratings on the ADHD RS-IV-P than girls and younger preschool children were rated as more inattentive than older preschool children.

CONCLUSIONS AND IMPLICATIONS

Our findings support the reliability and validity of the ADHD RS-IV-P and a three-factor model of ADHD. However, high factor correlations and similarity in model fit suggest that more research is needed to clarify the organisation of ADHD symptoms in preschool children. Furthermore, the external validity of separate ADHD dimensions at this age should be examined.

ADHD Prevalence in Spanish Preschoolers: Comorbidity, Socio-Demographic Factors, and Functional Consequences

OBJECTIVE

The object was to examine the prevalence of ADHD among preschoolers, analyzing comorbidity, and the association with socio-demographic factors.

METHOD

We conducted a two-phase epidemiological study of 1,104 preschoolers aged 3 to 6 years in Catalonia, Spain. The Early Childhood Inventory-4 (ECI-4) was administered to parents and teachers. Children at risk of ADHD were assessed using open-ended face-to-face interviews and were observed in a school setting. ADHD diagnoses were based on Diagnostic and Statistical Manual of Mental Disorders (4th ed.; DSM-IV) criteria.

RESULTS

The prevalence of ADHD diagnosis was 5.4%. Male sex and first-born status were risk factors for ADHD. Parents reported more symptoms (12.9%) than teachers (8.7%). Behavioral problems (odds ratio [OR] = 12, p = .001), autism spectrum disorder problems (OR = 9.5, p = .001), and obsessive-compulsive problems and tics (OR = 5.9, p = .001) were specifically related to ADHD diagnosis. Mother's health status and school achievement were lower in ADHD children.

CONCLUSION

Even at early stages of development, ADHD has high rates of comorbidity and a significant impact on school performance and family health.

Associated factors of behavioural problems in children at preschool age: the Hokkaido study on environment and children's health

BACKGROUND

Finding associated factors with childhood behavioural problems as early as preschool age is important. Studies have revealed several factors including socioeconomic factors, which may vary among different cultural background and population. However, investigation in general Japanese population of preschool age has not been well demonstrated. Thus, the objective of this study was to examine associated factors of childhood behavioural problems using Strengths and Difficulties Questionnaire (SDQ) in a prospective birth cohort study.

METHODS

Total 3813 SDQ were distributed between October 2014 and December 2015 to the subpopulation of prospective birth cohort study, the Hokkaido Study on Environment and Children's Health. The subpopulation consisted of participants who had reached age 5 and were born between April 2008 and December 2010. Baseline questionnaire filled at recruitment and birth record were used to obtain participant information. Children with total difficulties score ≧ 13 were defined as likelihood of behavioural problems. A total of 2553 children with valid answers were included into the analysis. The response rate was 67.1%.

RESULTS

Number of children with likelihood of behavioural problems was 521 (20.4%). Boys showed more problematic scores than girls. Multivariate analysis found that maternal pre-pregnancy BMI ≧ 30 kg/m² , primipara, maternal education lower than high school, family income during pregnancy < 3 million yen/year and boy gender were the factors associated with increased odds ratio of likelihood of child behavioural problems.

CONCLUSIONS

This study found that prenatal socioeconomic factors were associated with likelihood of child behavioural problems at preschool age in Japan.

A network analysis of developmental change in ADHD symptom structure from preschool to adulthood

Although there is substantial support for the validity of the diagnosis of ADHD, there is considerable disagreement about how to best capture developmental changes in the expression of ADHD symptomatology. The current paper examines the associations among the 18 individual ADHD symptoms using a novel network analysis approach, from preschool to adulthood. The 1,420 participants were grouped into four age brackets: Preschool (age 3-6, n = 109), childhood (age 6-12, n = 548), adolescence (age 13-17, n = 357), and young adulthood (age 18-36, n = 406). All participants completed a multi-stage, multi-informant diagnostic process, and self and informant symptom ratings were obtained. Network analysis indicated ADHD symptom structure became more differentiated over development. Two symptoms Often easily distracted and Difficulty sustaining attention appeared as central, or core, symptoms across all age groups. Thus, a small number of core symptoms may warrant extra weighting in future diagnostic systems.

CATEGORICAL DIAGNOSIS OF EXTREME HYPERACTIVITY, IMPULSIVITY, AND INATTENTION IN VERY YOUNG CHILDREN

Severe hyperactivity and impulsivity are common reasons for referral to infant mental health services. Past versions of ZERO TO THREE's () diagnostic nosology, the Diagnostic Classification of Mental and Developmental Disorders in Infancy and Early Childhood (DC:0-3), did not address this clinical issue because it had been addressed in other nosologies. These general diagnostic nosologies describe attention deficit hyperactivity disorder (ADHD), but with little attention to developmentally specific aspects of the diagnosis in very young children. Categorical diagnosis related to hyperactivity and impulsivity in very young children warrants careful review of existing literature. Explicit attention must be paid to ensure that categorical diagnoses serve to describe syndromes that cause significant impairment to the family to allow children and families to access effective supports and ensure that behaviors typical of the developmental level are not described as pathologic. This article reviews proposed diagnostic criteria for ADHD and overactivity disorder of toddlerhood as well as the rationale for the criteria and evidence supporting validity and reliability of the diagnoses in very young children. Clinical implications also are presented.

Expressive and receptive language skills in preschool children from a socially disadvantaged area

PURPOSE

Evidence suggests that children present with receptive language skills that are equivalent to or more advanced than expressive language skills. This profile holds true for typical and delayed language development. This study aimed to determine if such a profile existed for preschool children from an area of social deprivation and to investigate if particular language skills influence any differences found between expressive and receptive skills.

METHOD

Data from 187 CELF P2 UK assessments conducted on preschool children from two socially disadvantaged areas in a city in southern Ireland.

RESULT

A significant difference was found between Receptive Language Index (RLI) and Expressive Language Index (ELI) scores with Receptive scores found to be lower than Expressive scores. The majority (78.6%) of participants had a lower Receptive Language than Expressive score (RLI < ELI), 18.2% of participants had a higher Receptive score than score (RLI > ELI), with very few (3.2%) having the same Receptive and Expressive scores (RLI = ELI). Scores for the Concepts and Following Directions (receptive) sub-test were significantly lower than for the other receptive sub tests, while scores for the Expressive Vocabulary sub-test were significantly higher than for the other expressive sub tests.

CONCLUSION

The finding of more advanced expressive than receptive language skills in socially deprived preschool children is previously unreported and clinically relevant for speech-language pathologists in identifying the needs of this population.

Observed temperament from ages 6 to 36 months predicts parent- and teacher-reported attention-deficit/hyperactivity disorder symptoms in first grade

This study tested the prospective association between observational indicators of temperament, which were obtained across multiple assessments when children were 6-36 months of age, and parent and teacher reports of children's attention-deficit/hyperactivity disorder (ADHD) behaviors, when children were in first grade. Data were drawn from the Family Life Project and included 1,074 children for whom temperament and either parent- or teacher-reported ADHD behavioral data were available. The results of variable-centered regression models indicated that individual differences in temperament regulation, but not temperamental reactivity, was uniquely predictive of parent- and teacher-reported ADHD behaviors. Latent profile analyses were used to characterize configurations of temperamental reactivity and regulation. Person-centered regression models were subsequently estimated in which temperamental profile membership replaced continuous indicators of temperamental reactivity and regulation as predictors. The results of person-centered regression models indicated that temperamental reactivity and regulation both contributed (both alone and in combination) to the prediction of subsequent ADHD behaviors. In general, the predictive associations from early temperament to later ADHD were of modest magnitude (R 2 = .10-.17). Results are discussed with respect to interest in the early identification of children who are at elevated risk for later ADHD.

Assessing Attention and Disruptive Behavior Symptoms in Preschool-Age Children: The Utility of the Diagnostic Interview Schedule for Children

Data are presented from two samples of preschool children to evaluate the reliability, concurrent validity, and predictive validity of the ADHD, ODD, and CD sections of the Diagnostic Interview Schedule for Children, Fourth Edition (DISC-IV). Information was obtained from a community sample of 128 children (M_age = 53.16 months; 63 girls) and from a sample of 72 externalizing children (M_age = 45.23 months; 31 girls) plus 25 control children (M_age = 44.51 months; 8 girls). In both studies, the DISC-IV was administered to parents along with parent and teacher behavior rating scales, and teacher rating scales were obtained again later to evaluate the predictive validity of the DISC-IV (after approximately 6 months in Study 1, and 3 years in Study 2). The ADHD and ODD sections exhibited acceptable internal consistency in both studies, and showed concurrent validity with parent behavior rating scales. In both studies, the ADHD section was also concurrent with teacher reports. In Study 2, the ADHD, ODD, and CD sections distinguished externalizing children from controls. In both studies, the ADHD section predicted future teacher ratings beyond initial teacher ratings, and beyond initial parent rating scales; the ODD section similarly predicted later teacher ratings in Study 1. Findings provide strong support for the utility of the ADHD section for preschool children and moderate support for the ODD and CD sections.

Developmental predictors of inattention-hyperactivity from pregnancy to early childhood

OBJECTIVE

The objective of the study was to characterize the developmental sequence of pre- and postnatal risk factors for inattention-hyperactivity symptoms in preschoolers.

MATERIALS AND METHODS

Longitudinal data came from a French population based birth cohort study (EDEN; N = 1311 mother-child pairs followed from the pregnancy onwards). Inattention-hyperactivity symptoms were assessed with the Strengths and Difficulties Questionnaire when participating children were 3 years of age. Potential risk factors were classified in four domains (fetal exposures and child somatic characteristics, child temperament, child neurodevelopmental status, psychosocial environment) and four periods (before pregnancy, prenatal/birth, infancy, toddlerhood). Their role as potential moderator or mediator was tested with path analysis to determine the developmental sequence.

RESULTS

A low family socioeconomic status before pregnancy was the main environmental risk factor for inattention-hyperactivity symptoms at 3 years, and its effect occurred via two pathways. The first was a risk pathway, where lower SES was associated with higher maternal depression and anxiety during pregnancy; then to higher maternal and child distress and dysregulation in infancy; and in turn to higher levels of inattention-hyperactivity at 3 years. The second was a protective pathway, where higher SES was associated with longer duration of breastfeeding during infancy; then to better child neurodevelopmental status in toddlerhood; and in turn to lower levels of inattention-hyperactivity at 3 years.

DISCUSSION

This study identified psychosocial factors at several developmental periods that represent potential targets for preventing the emergence of inattention-hyperactivity symptoms in early childhood.

Changes in ADHD symptom endorsement: preschool to school age

To investigate endorsement patterns among the 18 DSM-IV symptoms of ADHD in a longitudinal sample of children with and without ADHD (n = 144), as assessed at ages 4-5, 5-6, and 6-7 years. Symptom endorsements and diagnoses were determined at all time-points via K-SADS-PL interview administered to parents and supplemented by teacher questionnaires and clinician observations. Changes in endorsement patterns over time for each of the 18 DSM-IV symptoms were ascertained. Several symptoms, particularly those of inattention, were infrequently endorsed and of apparently limited diagnostic utility at ages 4-5; hyperactive/impulsive symptoms were more frequently endorsed among young children with ADHD than were inattentive symptoms. However, by ages 6-7, inattention items were somewhat superior at discriminating ADHD from Non-ADHD children. Several DSM-IV and now DSM-V symptoms provide limited diagnostic differentiation prior to school-age, particularly those most commonly observed in the context of formal schooling. Consideration should be made in future iterations of the DSM that account for such developmental and contextual differences.

Different stability of social-communication problems and negative demanding behaviour from infancy to toddlerhood in a large Dutch population sample

BACKGROUND

Little is known about the stability of behavioural and developmental problems as children develop from infants to toddlers in the general population. Therefore, we investigated behavioural profiles at two time points and determined whether behaviours are stable during early development.

METHODS

Parents of 4,237 children completed questionnaires with 62 items about externalizing, internalizing, and social-communicative behaviour when the children were 14-15 and 36-37 months old. Factor mixture modelling identified five homogeneous profiles at both time points: three with relatively normal behaviour or with mild/moderate problems, one with clear communication and interaction problems, and another with pronounced negative and demanding behaviour.

RESULTS

More than 85% of infants with normal behaviour or mild problems at 14-15 months were reported to behave relatively typically as toddlers at 36-37 months. A similar percentage of infants with moderate communication problems outgrew their problems by the time they were toddlers. However, infants with severe problems had mild to severe problems as toddlers, and did not show completely normal behaviour. Improvement over time occurred more often in children with negative and demanding behaviour than in children with communication and interaction problems. The former showed less homotypic continuity than the latter.

CONCLUSIONS

Negative and demanding behaviour is more often transient and a less specific predictor of problems in toddlerhood than communication and interaction problems.

Attention-deficit hyperactivity disorder (ADHD) in the early years: diagnostic issues and educational relevance

In this study we discuss implications of the dimensional versus categorical approach in the diagnosis of attention-deficit hyperactivity disorder (ADHD) and focus on the educational relevance of an early assessment. In a longitudinal study in a German community sample we investigated the development of ADHD symptoms from kindergarten until the end of Grade 1 as well as the association to pre-academic skills and later academic performance. At three time points in kindergarten, children (original sample N = 793; Mn age 4 years 10 months) were assessed in regard to school-relevant precursors of reading, spelling and mathematical abilities; ADHD symptoms were rated by parents and preschool teachers. In elementary school academic performance in reading, spelling, and mathematics was measured with standardized tests. Results show that stability of ADHD symptoms during preschool was high considering the dimensional approach, whereas in regard to the categorical classification many children crossing the cut-off point at one measurement point did not do so at the next assessment. Furthermore, preschool ADHD symptoms were negatively correlated with all school-relevant precursors. This was more pronounced for symptoms of inattention than for hyperactivity/impulsivity. Observing later development, preschool ADHD symptoms predicted academic achievement in mathematics and reading at the end of Grade 1 even after individual differences in nonverbal intelligence and specific precursors had been statistically controlled for.

Longitudinal changes in individual symptoms across the preschool years in children with ADHD

The present study examined trajectories of individual Diagnostic and Statistical Manual of Mental Disorders (4th ed.) symptoms of attention-deficit/hyperactivity disorder (ADHD) and oppositional defiant disorder (ODD) across the preschool years in children with ADHD. It also evaluated whether preschool symptoms vary in their ability to discriminate children who later meet criteria for ADHD from typically developing children. ADHD and ODD symptoms were assessed annually in 75 ethnically diverse children (46 boys) who presented with behavior problems at age 3 and met criteria for ADHD 3 years later, and in 51 typically developing children (26 boys). Children with ADHD generally exhibited stable levels of hyperactivity/impulsivity but increases in several symptoms of inattention. Most ADHD symptoms showed at least fair utility in discriminating children with and without ADHD; however, 3 symptoms of inattention (carelessness, losing things, and forgetfulness) and 1 symptom of hyperactivity/impulsivity (blurting out answers) had relatively poor utility. These symptoms demonstrated only somewhat greater utility at age 4, but by the age of 5 were better able to classify children. Children with ADHD exhibited increases in several ODD symptoms, including symptoms related to negative affect. Although most symptoms of hyperactivity/impulsivity appear to extend well down to age 3, more developmentally appropriate symptoms of inattention may be required to develop more sensitive assessments for 3- and 4-year-old children.

A New Measure to Assess Psychopathic Personality in Children: The Child Problematic Traits Inventory

Understanding the development of psychopathic personality from childhood to adulthood is crucial for understanding the development and stability of severe and long-lasting conduct problems and criminal behavior. This paper describes the development of a new teacher rated instrument to assess psychopathic personality from age three to 12, the Child Problematic Traits Inventory (CPTI). The reliability and validity of the CPTI was tested in a Swedish general population sample of 2,056 3- to 5-year-olds (mean age = 3.86; SD = .86; 53 % boys). The CPTI items loaded distinctively on three theoretically proposed factors: a Grandiose-Deceitful Factor, a Callous-Unemotional factor, and an Impulsive-Need for Stimulation factor. The three CPTI factors showed reliability in internal consistency and external validity, in terms of expected correlations with theoretically relevant constructs (e.g., fearlessness). The interaction between the three CPTI factors was a stronger predictor of concurrent conduct problems than any of the three individual CPTI factors, showing that it is important to assess all three factors of the psychopathic personality construct in early childhood. In conclusion, the CPTI seems to reliably and validly assess a constellation of traits that is similar to psychopathic personality as manifested in adolescence and adulthood.

Assessment of attention in preschoolers

In the past two decades, there has been an increased interest in the assessment and treatment of preschool children presenting with concerns about attention problems. This article reviews the research and clinical literature involving assessment of attention and related skills in the preschool years. While inattention among preschoolers is common, symptoms alone do not necessarily indicate a disorder, and most often represent a normal variation in typical preschool child development. Thus, accurate identification of "disordered" attention in preschoolers can be challenging, and development of appropriate, norm-referenced tests of attention for preschoolers is also difficult. The current review suggests that comprehensive assessment of attention and related functions in the preschool child should include thorough review of the child's history, planned observations, and formal psychometric testing. The three primary methods of psychometric assessment that have been used to characterize attentional functioning in preschool children include performance-based tests, structured caregiver interviews, and rating scales (parent, teacher, and clinician). Among performance-based methods for measurement of attention in the preschool years, tests have been developed to assess sustained attention, selective (focused) attention, span of attention (encoding/manipulation), and (top-down) controlled attention--including freedom from distractibility and set shifting. Many of these tests remain experimental in nature, and review of published methods yields relatively few commercially available, nationally normed tests of attention for preschoolers, and an overall dearth of reliability and validity studies on the available measures.