Early life predictors of attention deficit/hyperactivity disorder symptomatology profiles from early through middle childhood

Rhinorrhea and watery eyes in infancy and risk of attention-deficit hyperactivity disorder in school-age children

Increased parasympathetic nervous system (PNS) activity is associated with attention-deficit/hyperactivity disorder (ADHD) inattentive symptoms, but not hyperactive-impulsive symptoms, and may contribute to inattentive subtype etiology. Guided by prior work linking infant rhinorrhea and watery eyes without a cold (RWWC) to PNS dysregulation, we examined associations between infant RWWC and childhood ADHD symptoms in a longitudinal cohort of Black and Latinx children living in the context of economic disadvantage (N = 301 youth: 158 females, 143 males). Infant RWWC predicted higher inattentive (relative risk [RR] 2.16, p < .001) but not hyperactive-impulsive (RR 1.53, p = .065) ADHD symptoms (DuPaul scale), administered to caregivers at child age 8-14 years. Stratified analyses revealed that these associations were present in females but not males, who were three times more likely to have higher ADHD current total symptoms if they had infant RWWC than if they did not. Additionally, associations between RWWC and inattention symptoms were observed only in females. RWWC may thus serve as a novel risk marker of ADHD inattentive-type symptoms, especially for females.

Predicting childhood ADHD-linked symptoms from prenatal and perinatal data in the ABCD cohort

This study investigates the capacity of pre/perinatal factors to predict attention-deficit/hyperactivity disorder (ADHD) symptoms in childhood. It also explores whether predictive accuracy of a pre/perinatal model varies for different groups in the population. We used the ABCD (Adolescent Brain Cognitive Development) cohort from the United States (N = 9975). Pre/perinatal information and the Child Behavior Checklist were reported by the parent when the child was aged 9-10. Forty variables which are generally known by birth were input as potential predictors including maternal substance-use, obstetric complications and child demographics. Elastic net regression with 5-fold validation was performed, and subsequently stratified by sex, race/ethnicity, household income and parental psychopathology. Seventeen pre/perinatal variables were identified as robust predictors of ADHD symptoms in this cohort. The model explained just 8.13% of the variance in ADHD symptoms on average (95% CI = 5.6%-11.5%). Predictive accuracy of the model varied significantly by subgroup, particularly across income groups, and several pre/perinatal factors appeared to be sex-specific. Results suggest we may be able to predict childhood ADHD symptoms with modest accuracy from birth. This study needs to be replicated using prospectively measured pre/perinatal data.

Profiles of interpersonal relationship qualities and trajectories of internalizing problems among Chinese adolescents

Adolescence is a significant period for the formation of relationship networks and the development of internalizing problems. With a sample of Chinese adolescents (N = 3,834, 52.01% girls, Mage = 16.68 at Wave 1), the present study aimed to identify the configuration of adolescents' relationship qualities from four important domains (i.e., relationship quality with mother, father, peers, and teachers) and how distinct profiles were associated with the development of internalizing problems (indicated by depressive and anxiety symptoms) across high school years. Latent profile analysis identified a five-profile configuration with four convergent profiles (i.e., relationship qualities with others were generally good or bad) and one "Father estrangement" profile (i.e., the relationship quality with others were relatively good but that with father was particularly poor). Further conditional latent growth curve analysis indicated the "Father estrangement" profile was especially vulnerable to an increase in the internalizing problems as compared with other relationship profiles. This study contributes to understanding the characteristics of interpersonal relationship qualities and their influences on adolescent internalizing problems in a non-Western context. Results were further discussed from a culturally specific perspective.

Explaining the Association Between Fetal Growth and Childhood ADHD Symptoms: Cross-cohort Replication

The association between restricted fetal growth and symptoms of attention deficit/hyperactivity disorder (ADHD) in childhood is well-replicated and robust. However, fetal growth is determined by many prenatal factors and associations with mental health may be confounded by familial and social context. In this study, we sought to quantify the relative contributions of prenatal factors and familial confounds to the association between fetal growth and ADHD symptoms. Two independent cohorts were analyzed, the Adolescent Brain Cognitive Development study (ABCD; United States) and the Growing Up in Ireland (GUI) study. ADHD symptoms were measured by the Child Behavior Checklist (ABCD) and the Strengths & Difficulties questionnaire (GUI) at age 9-10. Using sequential regression models, we assessed the change-in-association between fetal growth and ADHD symptoms after controlling for sex, familial factors (socioeconomic/demographic factors & family psychiatric history) and prenatal factors (pregnancy complications & maternal substance-use during pregnancy). Converging findings from cohorts suggested that over a quarter of the association between fetal growth and ADHD symptoms is attributable to familial confounds. The degree to which the association was explained by prenatal factors differed by cohort-pregnancy complications explained a larger proportion of the effect in ABCD (7.9%) than GUI (2.7%), and maternal substance-use explained a larger proportion of the effect in GUI (22.7%) compared to ABCD (4.8%). Different explanations of the fetal growth-ADHD association across cohorts suggests cohort-specific, and potentially nationally-specific, risk factors for fetal growth and related neurodevelopmental outcomes. The evidence suggests early prevention of ADHD in Ireland should focus on minimizing maternal smoking during pregnancy. In the US, prevention and treatment of pregnancy complications are highlighted as viable targets for intervention.

Maternal Parenting and Toddler Temperament: Predictors of Early School Age Attention-Deficit/Hyperactivity Disorder-Related Behaviors

Detection of early risk for developing childhood attention-deficit/hyperactive disorder (ADHD) symptoms, inattention and hyperactivity, may be critical for prevention and early intervention. Temperament and parenting are two promising areas of risk, representing potential targets for preventive intervention; however, studies have rarely tested these factors longitudinally using multiple methods and reporters. In a longitudinal sample of 312 low-income boys, this study tested the hypothesis that negative emotionality (NE) and effortful control (EC) in toddlerhood (1.5-3.5 years old) would predict mother- and teacher-reported ADHD-related behaviors at school age (5-7 years old). Direct effects of observed warm, supportive and harsh maternal parenting were tested in relation to ADHD-related behaviors and as moderators of associations between NE and EC and ADHD-related behaviors. Several predictions were supported: 1) Greater maternal-reported toddler NE positively predicted mother-reported ADHD behaviors; 2) Greater observed EC was associated with fewer mother- and teacher-reported ADHD-related behaviors; 3) Warm, supportive parenting predicted fewer teacher-reported ADHD-related behaviors, and harsh parenting predicted more ADHD-related behaviors as reported by parents and teachers; 4) Harsh parenting moderated the association between observed EC and mother-reported ADHD-related behaviors. Together, the findings suggest that lower child EC, lower warm/supportive parenting, and greater harsh parenting in toddlerhood independently signal increased risk for later ADHD-related behaviors; further, the association between low EC and ADHD-related behaviors was amplified in the context of high levels of harsh parenting.

Prenatal and Postnatal Predictive Factors for Children's Inattentive and Hyperactive Symptoms at 5 Years of Age: The Role of Early Family-related Factors

We examined several parent-reported prenatal and postnatal factors as potential risk factors for attention-deficit and hyperactivity disorder (ADHD) symptomatology in 5-year-old children. Our study is based on the CHILD-SLEEP birth cohort. Several parental questionnaires were collected prenatally (32nd pregnancy week) and postnatally (i.e. child aged 3, 8, and 24 months and at 5 years). At 5 years of age, ADHD symptoms were assessed using questionnaires. Our main results showed that being a boy, parental depressive symptoms, more negative family atmosphere or a child's shorter sleep duration, and maternal authoritarian parenting style predicted inattentive/hyperactive symptoms. Maternal and paternal authoritative parenting style predicted less inattentive/hyperactive symptoms. Children with several risk factors together had the highest risk for inattentive/hyperactive symptoms. Our findings emphasise the need for early screening and treatment of parental mental health, and early evidence-based targeted parental support, to enable early intervention in those children at a risk of developing ADHD.