Early life predictors of attention deficit/hyperactivity disorder symptomatology profiles from early through middle childhood

Abstract

This study used repeated measures data to identify developmental profiles of elevated risk for ADHD (i.e., six or more inattentive and/or hyperactive-impulsive symptoms), with an interest in the age at which ADHD risk first emerged. Risk factors that were measured across the first 3 years of life were used to predict profile membership. Participants included 1,173 children who were drawn from the Family Life Project, an ongoing longitudinal study of children's development in low-income, nonmetropolitan communities. Four heuristic profiles of ADHD risk were identified. Approximately two thirds of children never exhibited elevated risk for ADHD. The remaining children were characterized by early childhood onset and persistent risk (5%), early childhood limited risk (10%), and middle childhood onset risk (19%). Pregnancy and delivery complications and harsh-intrusive caregiving behaviors operated as general risk for all ADHD profiles. Parental history of ADHD was uniquely predictive of early onset and persistent ADHD risk, and low primary caregiver education was uniquely predictive of early childhood limited ADHD risk. Results are discussed with respect to how changes to the age of onset criterion for ADHD in DSM5 may affect etiological research and the need for developmental models of ADHD that inform ADHD symptom persistence and desistance.

Prenatal and Postnatal Predictive Factors for Children’s Inattentive and Hyperactive Symptoms at 5 Years of Age: The Role of Early Family-related Factors

“…Additionally, and consistent with our hypothesis [ 22 , 23 ], we found that a maternal authoritarian parenting style is associated with children’s later inattentive/hyperactive symptoms. Some previous studies suggest that harsh and/or intrusive parenting may be related to the disrupted development of children’s attentional control [ 9 , 22 , 23 ]. It has been reported that maternal intrusiveness at 6 months old or maternal overstimulating behaviour at 3.5 years old, as measured by questionnaires, are associated with teachers reporting more ADHD symptoms at 11 years old.…”

“…Nevertheless, previous research on early parenting and later symptoms of inattention/hyperactivity have also reported contradictory findings [ 9 , 22 , 23 , 37 – 40 ]. These studies suggest that poorer parenting in early childhood may serve as a risk factor that moderates and exacerbates a child’s predisposition to present symptoms of inattention and hyperactivity.…”

“…Although it is well documented that ADHD is a highly heritable disorder [3,4], it has been estimated that 10-40% of the variance associated with ADHD is accounted for by other than genetic factors [5]. More specifically, the development of ADHD is multifactorial, including a contribution of both genetic [3] and several prenatal, perinatal, and postnatal risk factors [4][5][6][7][8][9][10][11][12]. Taking into account that ADHD emerges early in life and is related to a wide variety of negative physical, psychosocial, and academic outcomes [13], identifying early causal risk factors for ADHD is of crucial relevance, as this would enable early intervention in children at risk of developing ADHD [14].…”

“…Several prenatal and postnatal maternal factors have been associated with children’s elevated risk of later diagnosis of ADHD, such as a family history of ADHD [ 3 , 9 , 15 ], lower maternal education [ 15 , 16 ], single parenthood [ 12 , 16 ], maternal younger age [ 7 , 12 ], mother’s prenatal and/or postnatal depression [ 8 , 12 , 17 , 18 ], unhealthy maternal behaviours during pregnancy, including smoking [ 5 , 6 , 12 , 17 , 19 ] or alcohol use [ 5 , 20 ], and premature birth/low birth weight or delivery complications [ 6 , 7 , 9 , 12 ]. Postnatal factors such as early exposure to severe adverse life events [ 19 , 21 ], harsh-intrusive/hostile parenting style [ 9 , 22 , 23 ], and exposure to certain chemicals (such as lead, phthalates, and organophosphate pesticides) [ 19 ] have been also related to difficulties in symptoms of inattention and/or hyperactivity later in childhood. Finally, according to a previous meta-analysis, children’s sleeping difficulties, and especially shorter sleep duration, is associated with symptoms of inattention/hyperactivity [ 24 ], both in cross-sectional [ 25 ] and longitudinal studies [ 10 , 26 ].…”

“…These studies suggest that poorer parenting in early childhood may serve as a risk factor that moderates and exacerbates a child’s predisposition to present symptoms of inattention and hyperactivity. For instance, early intrusive (controlling/parent-agenda driven behaviours) and/or negative (hostile verbal and physical punishment) parenting when the child is 6-months-old has been associated with inattentive/hyperactive symptoms at preschool [ 9 , 23 ] and school age [ 9 , 22 ]. Furthermore, maternal sensitive parenting during infancy and early preschool age has been associated with the development of inhibitory [ 38 ] and attentional [ 40 ] control at preschool age and fewer ADHD or oppositional defiant disorder (ODD) symptoms at school age [ 37 ].…”