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Antecedents of Screening Positive for Attention Deficit Hyperactivity Disorder in Ten-Year-Old Children Born
Alan Leviton1, Stephen R Hooper2, Scott J Hunter3
1Boston Children's Hospital and Harvard Medical School, Boston, Massachusetts.
Insights
Children born very preterm have higher rates of attention deficit hyperactivity disorder (ADHD). Key risk factors include maternal factors, prematurity complications, and inflammation, highlighting a need for early intervention.
Area of Science:
- Neurodevelopmental disorders
- Pediatric medicine
- Public health
Background:
- Attention deficit hyperactivity disorder (ADHD) is more prevalent in children born very preterm compared to those born at term.
- Understanding the specific risk factors associated with ADHD in this vulnerable population is crucial for early detection and intervention.
Purpose of the Study:
- To identify risk factors for attention deficit hyperactivity disorder (ADHD) in children born very preterm.
- To analyze the concordance of ADHD risk profiles between parent, teacher, and physician reports.
Main Methods:
- A cohort of 583 ten-year-old children born before 28 weeks gestation with IQ > 84 was assessed.
- Parent and teacher completed questionnaires (Child Symptom Inventory-4) and physician diagnoses were collected.
- Statistical analysis identified significant risk factors for ADHD based on multiple observer reports.
Main Results:
- Parental reports of ADHD risk profiles closely aligned with physician and combined observer reports.
- Significant risk factors included young maternal age, maternal obesity and smoking, magnesium use during delivery, placental inflammation (Mycoplasma sp.), low gestational age, low birth weight, male sex, and mechanical ventilation.
- Other identified factors included retinopathy of prematurity, necrotizing enterocolitis, antibiotic use, and ventriculomegaly.
Conclusions:
- Identified risk factors for ADHD in very preterm children can be categorized into four themes: low socioeconomic status, immaturity/vulnerability, inflammation, and epigenetic phenomena.
- These findings underscore the complex interplay of factors contributing to ADHD in extremely preterm infants.
- Further research into these themes may inform targeted prevention and management strategies.
Background:
The incidence of attention deficit hyperactivity disorder is higher among children born very preterm than among children who are mature at birth.
Methods:
We studied 583 ten-year-old children who were born before 28 weeks of gestation whose IQ was above 84 and had a parent-completed Child Symptom Inventory-4, which allowed classification of the child as having or not having symptoms of attention deficit hyperactivity disorder. For 422 children, we also had a teacher report, and for 583 children, we also had a parent report of whether or not a physician made an attention deficit hyperactivity disorder diagnosis.
Results:
The risk profile of screening positive for attention deficit hyperactivity disorder based on a parent's report differed from the risk profile based on the teacher's report, whereas the risk profile according to a physician and according to any two observers closely resembled the parent-reported profile. Among the statistically significant risk factors were young maternal age (parent, physician, and two observers), maternal obesity (parent, physician, and two observers), maternal smoking (parent, physician, and two observers), magnesium given at delivery for seizure prophylaxis (parent and two observers), recovery of Mycoplasma sp. from the placenta (teacher and two observers), low gestational age (parent and two observers), low birth weight (teacher and physician), singleton (parent, physician, and two observers), male (parent, teacher, physician, and two observers), mechanical ventilation on postnatal day seven (physician), receipt of a sedative (parent and two observers), retinopathy of prematurity (parent), necrotizing enterocolitis (physician), antibiotic receipt (physician and two observers), and ventriculomegaly on brain scan (parent and two observers).
Conclusions:
The multiplicity of risk factors identified can be subsumed as components of four broad themes: low socioeconomic state, immaturity or vulnerability, inflammation, and epigenetic phenomena.
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