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Development of a risk calculator to predict attention-deficit/hyperactivity disorder in very preterm/very low birth
Adelar Pedro Franz1, Arthur Caye1, Bárbara Calil Lacerda1
1ADHD Outpatient Program, Hospital de Clínicas de Porto Alegre, Federal University of Rio Grande do Sul, Porto Alegre, Brazil.
Insights
A new risk calculator can identify very preterm/very low birth weight newborns at high risk for attention-deficit/hyperactivity disorder (ADHD). This tool aids early intervention for these vulnerable infants.
Area of Science:
- Neonatal Medicine
- Developmental Pediatrics
- Psychiatry
Background:
- Very preterm/very low birth weight (VP/VLBW) newborns face lifelong morbidities, including attention-deficit/hyperactivity disorder (ADHD).
- Current clinical methods lack markers to predict ADHD development in VP/VLBW infants based on birth presentation.
Purpose of the Study:
- To develop an individualized risk calculator for predicting ADHD in VP/VLBW newborns.
Main Methods:
- A retrospective prognostic study of VP/VLBW children (gestational age <32 weeks and/or birth weight <1.5 kg) born between 2010-2012.
- Clinical assessment for ADHD at 6 years using the Schedule for Affective Disorders and Schizophrenia for School-Age Children (K-SADS).
- Model-building utilized the least absolute shrinkage and selection operator (LASSO) method.
Main Results:
- 33% of 96 assessed VP/VLBW children (92% follow-up) were diagnosed with ADHD at age 6.
- The risk calculator, using seven parameters, achieved an AUC of .875 (corrected AUC: .806) for ADHD prediction.
- The calculator demonstrated statistically significant net benefits and specificity for ADHD compared to other psychopathologies.
Conclusions:
- The developed risk calculator effectively identifies VP/VLBW newborns at high risk for future ADHD diagnosis.
- Further external validation in population-based samples is recommended to enhance clinical utility.
Background:
Very preterm/very low birth weight (VP/VLBW) newborns can have lifelong morbidities, as attention-deficit/hyperactivity disorder (ADHD). Clinicians have no markers to discriminate which among those individuals will develop later ADHD, based only on the clinical presentation at birth. Our aim was to develop an individualized risk calculator for ADHD in VP/VLBW newborns.
Methods:
This retrospective prognostic study included a consecutive sample of all VP/VLBW children (gestational age <32 weeks and/or birth weight <1.5 kg) born between 2010 and 2012 from a clinical cohort in a Brazilian tertiary care hospital. Children were clinically assessed at 6 years of age for ADHD using the Schedule for Affective Disorders and Schizophrenia for School-Age Children (K-SADS). The least absolute shrinkage and selection operator (LASSO) method was used for model-building.
Results:
Ninety-six VP/VLBW children were assessed at 6 years of age (92% follow-up), of whom 32 (33%) were diagnosed with ADHD. The area under the ROC curve (AUC) for ADHD prediction based on seven parameters (late-onset sepsis confirmed by blood culture, necrotizing enterocolitis, neonatal seizures, periventricular leukomalacia, respiratory distress syndrome, length of hospital stay, and number of maternal ADHD symptoms) was .875 (CI, 0.800-0.942, p < .001; AUC corrected for optimism with bootstrapping: .806), a performance that is comparable to other medical risk calculators. Compared to approaches that would offer early intervention to all, or intervention to none, the risk calculator will be more useful in selecting VP/VLBW newborns, with statistically significant net benefits at cost:benefits of around 1:2 to around 10:6 (range of ADHD risk thresholds of 32%-62%, respectively). It also showed specificity for ADHD compared to other prevalent child psychopathologies.
Conclusions:
The risk calculator showed good performance for early identification of VP/VLBW newborns at high risk of future ADHD diagnosis. External validity in population-based samples is needed to extend clinical usefulness.
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