ADHD symptoms and their neurodevelopmental correlates in children born very preterm

Abstract

23 This study investigated the association between attention-deficit/hyperactivity disorder (ADHD) 24 symptomatology in preschool-aged children who were born very preterm (<32 weeks) and cognitive 25 outcomes, clinical risk and socio-demographic characteristics. 119 very preterm children who participated 26 in the Evaluation of Preterm Imaging Study at term-equivalent age were assessed at a mean age of 4.5 27 years. Parents completed the ADHD Rating Scale IV, a norm-referenced checklist that evaluates ADHD 28 symptomatology according to diagnostic criteria, and the Behavior Rating Inventory of Executive 29 Function-Preschool version. Children completed the Wechsler Preschool and Primary Scales of 30 Intelligence and the Forward Digit Span task. Longitudinal data including perinatal clinical, qualitative 31 MRI classification, socio-demographic variables and neurodevelopmental disabilities were investigated in 32 relation to ADHD symptomatology. All results were corrected for multiple comparisons using false 33 discovery rate. Results showed that although the proportion of very preterm children with clinically 34 significant ADHD did not differ from normative data after excluding those with neurodevelopmental 35 disabilities, 32.7% met criteria for subthreshold ADHD inattentive type and 33.6% for combined type, 36 which was higher than the expected 20% in normative samples. Higher ADHD symptom scores (all) were 37 associated with greater executive dysfunction (inhibitory self-control, flexibility, and emergent 38 metacognition, corrected p<0.001 for all tests). Higher inattentive ADHD symptom scores were 39 associated with lower IQ (ρ=-0.241, p=0.036) and higher perinatal clinical risk (more days on mechanical 40 ventilation (ρ=0.206, p=0.025) and more days on parenteral nutrition (ρ=0.223, p=0.015)). Higher 41 hyperactive ADHD symptom scores instead were associated with lower socio-economic status (ρ=0.278, 42 p=0.002). These results highlight the importance of monitoring and supporting the development of very 43 preterm children throughout the school years, as subthreshold ADHD symptoms represent risk factors for 44 psychosocial problems and for receiving a future clinical diagnosis of ADHD. 45 3 46 List of Abbreviations and Acronyms: 47 ADHD (Attention-deficit/hyperactivity disorder) 48 MRI (magnetic resonance imaging) 49 NDD (Neurodevelopmental disability) 50 51 52 53 54 55 56 57 58 59 60 4 61 Introduction 62 Attention-deficit/hyperactivity disorder (ADHD) is a neurodevelopmental condition which affects 5-7%63 of children, depending on the source of information used to reach a diagnosis (1, 2). Children who were 64 born very preterm (< 32 weeks of gestation) have a 2-to 3-fold increased risk of being diagnosed with 65 ADHD compared to their term born peers (4-fold risk in those born at < 26 weeks) (3-7). 66According to the fifth edition of the Diagnostic and Statistical Manual of Mental Disorders (DSM-67 V), ADHD is characterized by two main symptom presentations, inattention and hyperactivity-68 impulsivit...

Neurodevelopmental disorders and somatic diagnoses in a national cohort of children born before 24 weeks of gestation

“…Because this was a retrospective study, we did not have access to the children's ADHD phenotype. However, other studies have reported that EPT born children with ADHD are most likely to be affected by the inattentive subtype and associated intellectual disabilities 5,6,37 …”

“…These disorders have included intellectual disabilities, cerebral palsy and visual and hearing impairment 2 . In addition, speech disorders, 3 attention deficit hyperactivity disorders (ADHD), 4–6 autism spectrum disorders (ASD), 7,8 psychological problems, 9 epilepsy 10 and sleep disturbances 11 have been reported after preterm birth but have not been included in the large cohort studies on neurodevelopmental outcome after EPT birth. The long‐term sequelae of EPT birth also include dysfunction of other organ systems that manifest as respiratory dysfunction, 12 poor growth 13 and kidney dysfunction 14 .…”

The role of inflammation in the prospective associations between early childhood sleep problems and ADHD at 10 years: Findings from a UK birth cohort study

“…Other socio-economic factors selected as covariates were child’s sex, preterm delivery, ethnicity (white vs non-white), maternal age when baby was born, and maternal socioeconomic status, which was measured using the Cambridge Social Interaction and Stratification Scale, which provides a total score (33). All these variables were selected as relevant confounders as there is a higher prevalence of ADHD in males (34), preterm children (35), white children (36), children with young mothers (37), and low socio-economic status (38).…”

Quantitative susceptibility mapping shows lower brain iron content in children with attention‐deficit hyperactivity disorder

“…Attention deficit hyperactivity disorder (ADHD) is one of the most common mental and behavioral disorders in childhood, characterized by inattention and hyperactivity. It is easy to be complicated with various behavioral problems such as learning difficulties, emotional disorders, and tic disorders, which seriously affect the academic and emotional development of children and adolescents, and have a great impact on family relations, partnership, and social function establishment (Aricò, Arigliani, Giannotti, & Romani, 2020; Becker, 2020; Craig, Bondi, O'Donnell, Pepler, & Weiss, 2020; Drechsler et al, 2020); Hoogman, Stolte, Baas, & Kroesbergen, 2020; Montagna et al, 2020; Slobodin & Masalha, 2020; Turan, Tunctürk, Çıray, Halaç, & Ermiş, 2021. ADHD is a multifactorial disease, which is related to nerve development, accumulation or lack of trace elements, and some factors have not been identified.…”