Early and repeated screening detects children with persistent attention-deficit/hyperactivity disorder

Area of Science:

• Developmental Psychology
• Child Psychiatry
• Epidemiology

Background:

• Preschool screening for attention-deficit/hyperactivity disorder (ADHD) lacks clinical utility due to symptom instability and single-time point assessment.
• Persistent ADHD symptoms across developmental stages are crucial for accurate diagnosis.
• Improving screening accuracy is vital for early intervention in children.

Purpose of the Study:

• To enhance the clinical usefulness of ADHD screening by identifying children with persistent ADHD from preschool to school age.
• To evaluate the accuracy of single-stage versus two-stage screening methods for persistent ADHD.
• To reduce false positives in ADHD screening through a repeated assessment approach.

Main Methods:

• Prospective longitudinal study of the Norwegian Mother, Father and Child Cohort (n=707).
• Diagnostic parent interview at 3.5 years, followed by parent questionnaires at ages 5 and 8 years.
• Utilized Child Behavior Checklist ADHD DSM-oriented scale for screening accuracy analysis at 3.5 and 5 years.

Main Results:

• Only 4% of children exhibited persistent ADHD from preschool to school age.
• Two-stage screening demonstrated higher accuracy in identifying persistent ADHD compared to single screening across all thresholds.
• The primary benefit of two-stage screening was a substantial reduction in false positives.

Conclusions:

• A small subgroup of children has persistent ADHD, necessitating distinction from those with fluctuating symptoms in screening studies.
• A two-stage screening process is recommended to improve the accuracy and clinical utility of ADHD screening.
• Reducing false positives is key to effective early identification and intervention for persistent ADHD.