Impairment in Young Preschool Children with Symptoms of Attention-Deficit/Hyperactivity Disorder and Co-occurring Oppositional Defiant Disorder and Conduct Disorder

Abstract

Background: We have limited knowledge of the impact of attention-deficit/hyperactivity disorder (ADHD) symptoms on the daily functioning of young preschool children. Objective: This study investigated the level of impairment related to symptoms of ADHD in different functional domains. It also addressed how impairment caused by ADHD was related to ADHD subtype, symptom load, gender, and the cooccurrence of oppositional defiant disorder, conduct disorder, or both. Method: Participating children (N = 807) who were 3.5 years old were recruited from a population-based sample included in The Norwegian Mother and Child Cohort Study. Children who scored above the 90th percentile for ADHD symptoms were included in the present sample. The assessment of the symptoms and functional impairment described in the Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition, text revision, was based on parental ratings and the semi-structured psychiatric interview entitled "The Preschool Age Psychiatric Assessment." Results: Added burden and discord within family relationships were the areas that were most severely affected. All domain scores were strongly intercorrelated, and they were added to each child's total score. Children with symptoms of ADHD, inattentive type (mean [M], 3.5; standard deviation [SD], 3.4), or ADHD, hyperactive/impulsive type (M, 2.9; SD, 2.7), were significantly less impaired than children with symptoms of ADHD, combined type (M = 6.4; SD = 3.8; p < .001). Furthermore, co-occurring oppositional defiant disorder was associated with higher impairment scores (M, 6.1; SD, 4.3) than ADHD alone (M, 3.2; SD, 2.9; p < .001. About 30% of the variance of impairment score of ADHD was explained by symptoms of ADHD and co-occurring symptoms of oppositional defiant disorder and conduct disorder. Few gender differences were observed. Conclusion: Overall, these non-referred young children with clinical symptoms of ADHD were only modestly impaired. Impairment related to ADHD occurred mainly in the areas of family functioning, and it was associated with ADHD subtype and comorbidity. Still, it is important to assess the impact of ADHD symptoms and coexisting difficulties among preschoolers to identify children and families who are in need of early intervention efforts.

ADHD Prevalence in Spanish Preschoolers: Comorbidity, Socio-Demographic Factors, and Functional Consequences

“…We also found that symptoms of disruptive disorder and ASD are specifically related to ADHD diagnosis, as described by Antshel (2014) and Bendiksen, Svensson, et al (2014). Common neurobiological pathways and an underlying endophenotype between ADHD and ASD have been suggested by several authors (Christakou et al, 2013; Craig et al, 2015; Polderman, Hoekstra, Posthuma, & Larsson, 2014; Ronald, Larsson, Anckarsäter, & Lichtenstein, 2014).…”

Predictive validity of attention-deficit/hyperactivity disorder from ages 3 to 5 Years

“…The ADHD section of the PAPA concluded with an impairment section [ 28 ]. Whenever a parent reported at least one ADHD symptom, impairment was scored for six functional domains: (1) family relationships; (2) friends; (3) learning; (4) play/leisure activities; (5) child’s quality of life; and (6) family burden.…”

“…The functional domains gave a total impairment scale score (range 0–18), with Cronbach’s ɑ = 0.83. A sum score of three was equivalent to the 75th percentile for the participants who responded to the questionnaire at 5 years, in line with an earlier study of all participants at age 3 years old, and was taken to indicate a moderate level of impairment [ 28 ]. Thus, an impairment score of ≥ 3 was chosen as the threshold for impairment to be present.…”

Comorbid Development of Disruptive Behaviors from age 1½ to 5 Years in a Population Birth-Cohort and Association with School Adjustment in First Grade

“…Some studies found a higher prevalence, severity or stability of DB in boys (Bendiksen et al 2014;Keenan et al 2011;Leblanc et al 2008;Wichstrøm et al 2012), whereas others observed only weak or no gender differences Basten et al 2015;Bufferd et al 2012;Wichstrøm et al 2012). In addition, sex differences did not always refer to the same DB in the different studies.…”

“…There is also evidence that the comorbidity observed in school age children is already present in early childhood (Bendiksen et al 2014;Bufferd et al 2012;Egger & Angold, 2006;Gadow & Nolan, 2002;Wichstrøm et al 2012). Moreover, preschool DB symptoms related to ADHD, ODD and CD have been associated with adjustment problems in the first years of school attendance (Brennan et al 2014;Campbell et al 2006;Cherkasova et al 2013;Lavigne et al 2001;Leblanc et al 2008;Shaw, Bell & Gilliom, 2000).…”