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Preschool development, temperament and genetic liability as early markers of childhood ADHD: A cohort study
Esther Tobarra-Sanchez1,2, Lucy Riglin1, Sharifah S Agha1,2
1Child and Adolescent Psychiatry Section Division of Psychological Medicine and Clinical Neurosciences and MRC Centre for Neuropsychiatric Genetics and Genomics School of Medicine Cardiff University Cardiff UK.
Insights
Early identification of attention-deficit/hyperactivity disorder (ADHD) is crucial. Temperament, motor, and speech delays in the first 30 months are associated with later ADHD diagnosis, along with genetic risk scores.
Area of Science:
- Developmental Psychology
- Genetics
- Pediatrics
Background:
- Attention-deficit/hyperactivity disorder (ADHD) is linked to numerous negative outcomes, underscoring the importance of early identification.
- Identifying early developmental markers within the first 30 months of life is critical for predicting later ADHD diagnosis.
Purpose of the Study:
- To identify early markers and developmental characteristics in the first 30 months of life associated with ADHD at age 6.
- To investigate the predictive value of various early life factors, including genetic liability, for childhood ADHD.
Main Methods:
- Utilized data from 9201 participants in the prospective Avon Longitudinal Study of Parents and Children (ALSPAC) birth cohort.
- Assessed ADHD symptoms and diagnosis at age 7 using parent-rated questionnaires (SDQ, DAWBA).
- Examined associations between 17 putative early life markers (prenatal factors, genetic liability, early development, temperament) and ADHD outcomes via regression analysis.
Main Results:
- Multivariable analysis revealed that temperament activity scores, vocabulary delay, fine motor delay, and ADHD polygenic risk scores (PRS) were associated with future ADHD symptoms (R² = 10.7%).
- ADHD PRS (OR=1.39) and temperament activity scores (OR=1.09) were significantly associated with ADHD diagnosis.
- Early developmental factors and genetic risk showed predictive value for ADHD, even after controlling for sex and socioeconomic status.
Conclusions:
- High temperament activity levels and motor/speech delays in early childhood are associated with later ADHD diagnosis.
- ADHD polygenic risk scores, despite explaining limited variance, provided useful predictive information for ADHD.
- Future research should explore the clinical utility of predictive models integrating early development and genetic risk for ADHD.
Background:
ADHD is associated with multiple adverse outcomes and early identification is important. The present study sets out to identify early markers and developmental characteristics during the first 30 months of life that are associated with ADHD 6 years later.
Methods:
9201 participants from the prospective Avon Longitudinal Study of Parents and Children (ALSPAC) birth cohort were included. Outcome measures were parent-rated ADHD symptom scores (Strengths and Difficulties Questionnaire, SDQ) and ADHD diagnosis (Development and Wellbeing Assessment, DAWBA) at age 7. Seventeen putative markers were identified from previous literature and included: pre- and peri-natal risk factors, genetic liability (ADHD polygenic risk scores, PRS), early development, temperament scores and regulatory problems. Associations were examined using regression analysis.
Results:
Univariable regression analysis showed that multiple early life factors were associated with future ADHD outcomes, even after controlling for sex and socio-economic status. In a multivariable linear regression model; temperament activity scores (B = 0.107, CI = 0.083-0.132), vocabulary delay (B = 0.605, CI = 0.211-0.988), fine motor delay (B = 0.693, CI = 0.360-1.025) and ADHD PRS (B = 0.184, CI = 0.074-0.294) were associated with future symptoms (R 2 = 10.7%). In a multivariable logistic regression model, ADHD PRS (OR = 1.39, CI = 1.10-1.77) and temperament activity scores (OR = 1.09, CI = 1.04-1.16) showed association with ADHD diagnosis.
Conclusion:
As well as male sex and lower socio-economic status, high temperament activity levels and motor and speech delays in the first 30 months of life, are associated with childhood ADHD. Intriguingly, given that genetic risk scores are known to explain little of the variance of ADHD outcomes, we found that ADHD PRS added useful predictive information. Future research needs to test whether predictive models incorporating aspects of early development and genetic risk scores are useful for predicting ADHD in clinical practice.
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