Associations Between ADHD Symptoms and Diagnosis Across the Preschool Period

The purpose of the study was to examine which attention-deficit/hyperactivity disorder (ADHD) symptoms at ages 3 to 5 are most strongly associated with an ADHD diagnosis in a large dataset of preschoolers across the United States.

Data were drawn from the Environmental Influences on Child Health Outcomes (ECHO) Program, a large national dataset in the United States. Children were included if their caregiver(s) completed at least one of five measures that assessed ADHD symptoms at age 3 (N = 1,430), 4 (N = 1,453), and/or 5 (N = 2,029) years. ADHD diagnosis was determined by medical record and/or caregiver report. A series of logistic regression models were conducted with each symptom included as the independent variable and ADHD diagnosis as the dependent variable. Bootstrapped 99% confidence intervals of odds ratios were compared across symptoms. Next, age and interactions between age and symptoms were added to each logistic regression model.

All 10 symptoms assessed were significantly associated with an ADHD diagnosis. Being "on the go" and interrupts or intrudes were most strongly associated with a diagnosis. Associations between symptoms and diagnosis did not significantly differ by age despite significant interactions for difficulty with follow-through, fidgets, and interrupts or intrudes.

Results suggest that some symptoms may be more useful than others when determining if a preschool-aged child is likely to be diagnosed with ADHD. Providers should consider the context and impairment associated with the symptoms. Future work should build upon limitations to assess all 18 ADHD symptoms in children with and without ADHD diagnoses across developmental periods.