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Predicting ADHD by Assessment of Rutter's Indicators of Adversity in Infancy
Søren D Østergaard1,2,3, Janne T Larsen4,3, Søren Dalsgaard4,3
1Department of Clinical Medicine, Aarhus University Hospital, Aarhus, Denmark.
Insights
Early childhood adversity indicators predict attention-deficit/hyperactivity disorder (ADHD) risk. Identifying high-risk children through Rutter’s adversity indicators in infancy can enable earlier diagnosis and intervention for ADHD.
Area of Science:
- Neurodevelopmental disorders
- Child psychology
- Public health
Background:
- Attention-deficit/hyperactivity disorder (ADHD) is a common neurodevelopmental disorder with early onset.
- Delayed diagnosis of ADHD contributes to significant morbidity and mortality.
- Early identification of at-risk children is crucial for timely intervention.
Purpose of the Study:
- To investigate if Rutter's indicators of adversity, assessed in infancy, can predict the development of ADHD.
- To determine the utility of early psychosocial adversity markers for identifying children at high risk for ADHD.
Main Methods:
- Utilized Danish nationwide registers to form a cohort of 994,407 children born between 1993-2011.
- Assessed Rutter's six indicators of adversity in infancy (0-12 months) and calculated a cumulative adversity score (RIA-score).
- Employed Cox regression to analyze the association between infancy RIA-scores and subsequent ADHD diagnosis, calculating hazard ratios and number needed to screen (NNS).
Main Results:
- A significant dose-response relationship was observed between infancy adversity scores and ADHD risk in both males and females.
- Children with RIA-scores of 5-6 had substantially higher hazard ratios for ADHD (11.0 for males, 11.4 for females) compared to those with RIA-scores of 0.
- Among males with the highest adversity scores, 37.6% were diagnosed with ADHD by age 20, with an NNS of 3.0.
Conclusions:
- Rutter's indicators of adversity assessed during infancy are strong predictors of ADHD development.
- These findings highlight the potential of using early adversity markers for the early identification of ADHD.
- This knowledge can inform strategies for earlier diagnosis and intervention, potentially improving outcomes for children with ADHD.
Background:
Attention-deficit/hyperactivity disorder (ADHD) is a prevalent neurodevelopmental disorder with early onset. ADHD is associated with significant morbidity and mortality, partly due to delayed diagnosis. Identification of children at high risk for developing ADHD could lead to earlier diagnosis and potentially change the negative trajectory of the illness for the better. Since early psychosocial adversity is considered to be a likely etiological risk factor for ADHD, markers of this construct may be useful for early identification of children at high risk. Therefore, we sought to investigate whether Rutter's indicators of adversity (low social class, severe marital discord, large family size, paternal criminality, maternal mental disorder, and placement in out-of-home care) assessed in infancy could serve as early predictors for the development of ADHD.
Methods And Findings:
Using data from the Danish nationwide population-based registers, we established a cohort consisting of all 994,407 children born in Denmark between January 1st 1993 and December 31st 2011 and extracted dichotomous values for the six Rutter's indicators of adversity at age 0-12 months (infancy) for each cohort member. The cohort members were followed from their second birthday and the association between the sum of Rutter's indicators of adversity (RIA-score) in infancy and subsequent development of ADHD was estimated by means of Cox regression. Also, the number needed to screen (NNS) to detect one case of ADHD based on the RIA-scores in infancy was calculated. During follow-up (9.6 million person-years), 15,857 males and 5,663 females from the cohort developed ADHD. For both males and females, there was a marked dose-response relationship between RIA-scores assessed in infancy and the risk for developing ADHD. The hazard ratios for ADHD were 11.0 (95%CI: 8.2-14.7) and 11.4 (95%CI: 7.1-18.3) respectively, for males and females with RIA-scores of 5-6, compared to males and females with RIA-scores of 0. Among males with RIA-scores of 5-6, 37.6% (95%CI: 27.0-50.7) had been diagnosed with ADHD prior to the age of 20, corresponding to a NNS of 3.0 (95%CI: 2.2-4.0).
Conclusions:
Rutter's indicators of adversity assessed in infancy strongly predicted ADHD. This knowledge may be important for early identification of ADHD.
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