Predictors of preschool attention-deficit/hyperactivity disorder diagnosis: a population-based study using national
Wagner Gurgel1, Miguel Garcia-Argibay2,3, Brian M D'Onofrio3,4
1Department of Psychiatry, Faculdade de Medicina FMUSP, Universidade de São Paulo, São Paulo, Brazil.
Insights
Preschool attention-deficit/hyperactivity disorder (ADHD) diagnosis is linked to many predictors. Early identification of these factors, including novel ones like gastroesophageal reflux, can improve prognosis.
Area of Science:
- Child and Adolescent Psychiatry
- Developmental Psychology
- Public Health
Background:
- Preschool diagnosis of attention-deficit/hyperactivity disorder (ADHD) indicates severity and poor prognosis.
- Identifying early predictors is crucial for intervention and improving outcomes.
Purpose of the Study:
- To investigate a comprehensive range of predictors associated with ADHD diagnosis in preschool-aged children.
- To identify novel risk factors for early-onset ADHD.
Main Methods:
- Population-based cohort study utilizing Swedish registers.
- Cox proportional-hazards models analyzed 41 predictors in over 630,000 children.
- Follow-up extended to December 2013, capturing diagnoses from age 3 to 5 years.
Main Results:
- 1,686 preschoolers (2.7%) received an ADHD diagnosis.
- 39 out of 41 investigated predictors were significantly associated with increased ADHD risk.
- Novel predictors identified include gastroesophageal reflux disease, premature contractions, and parental criminal history.
Conclusions:
- Numerous established and novel predictors for preschool ADHD were identified.
- This extensive list of early predictors can guide future clinical research.
- Findings support enhanced early identification strategies for preschool ADHD.
Background:
The diagnosis of attention-deficit/hyperactivity disorder (ADHD) in preschool years (before age 6 years) is a marker of severity and poor prognosis. This study investigated a broad range of predictors of ADHD diagnosis during preschool age.
Methods:
Population-based cohort study using Swedish registers. The final sample consisted of all children born in Sweden between 2001 and 2007 who could be linked to both of their biological parents, excluding those who died or emigrated (n = 631,695). Follow-up was completed December 31, 2013. Cox proportional-hazards models for survival analysis were used to identify the predictors that increased the risk of receiving a clinical diagnosis of ADHD from 3 to 5 years. Hazard ratios (HR) with 95% confidence intervals (CI) were presented for each of the 41 selected predictors covering early-onset psychiatric comorbidities, nonpsychiatric medical conditions, parental history and perinatal factors.
Results:
At the end of follow-up, 1,686 preschoolers (2.7% of the whole sample) had received a diagnosis of ADHD. We found that 39 out of 41 predictors were associated with increased risk of a later diagnosis of preschool ADHD. Novel associations with preschool ADHD diagnosis were found for gastroesophageal reflux disease (HR = 3.48), premature contractions during pregnancy (HR = 2.03), and criminal conviction history from any parent (HR = 2.14).
Conclusions:
A large number of novel and well-established predictors of preschool ADHD diagnosis were identified. This broad set of early predictors may direct future clinical research and assist in early identification of preschool ADHD.
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