Preschool development, temperament and genetic liability as early markers of childhood ADHD: A cohort study

Abstract

Background: ADHD is associated with multiple adverse outcomes and early identification is important. The present study sets out to identify early markers and developmental characteristics during the first 30 months of life that are associated with ADHD 6 years later. Methods: 9201 participants from the prospective Avon Longitudinal Study of Parents and Children (ALSPAC) birth cohort were included. Outcome measures were parent-rated ADHD symptom scores (Strengths and Difficulties Questionnaire, SDQ) and ADHD diagnosis (Development and Wellbeing Assessment, DAWBA) at age 7. Seventeen putative markers were identified from previous literature and included: pre-and peri-natal risk factors, genetic liability (ADHD polygenic risk scores, PRS), early development, temperament scores and regulatory problems. Associations were examined using regression analysis. Results: Univariable regression analysis showed that multiple early life factors were associated with future ADHD outcomes, even after controlling for sex and socioeconomic status. In a multivariable linear regression model; temperament activity scores (B = 0.107, CI = 0.083-0.132), vocabulary delay (B = 0.605, CI = 0.211-0.988), fine motor delay (B = 0.693, CI = 0.360-1.025) and ADHD PRS (B = 0.184, CI = 0.074-0.294) were associated with future symptoms (R 2 = 10.7%). In a multivariable logistic regression model, ADHD PRS (OR = 1.39, CI = 1.10-1.77) and temperament activity scores (OR = 1.09, CI = 1.04-1.16) showed association with ADHD diagnosis. Conclusion:As well as male sex and lower socio-economic status, high temperament activity levels and motor and speech delays in the first 30 months of life, are associated with childhood ADHD. Intriguingly, given that genetic risk scores are known to explain little of the variance of ADHD outcomes, we found that ADHD PRS added useful predictive information. Future research needs to test whether predictive models incorporating aspects of early development and genetic risk scores are useful for predicting ADHD in clinical practice.Anita Thapar and Kate Langley contributed equally to this study.This is an open access article under the terms of the Creative Commons Attribution License, which permits use, distribution and reproduction in any medium, provided the original work is properly cited.

Word-Finding Difficulties as a Prominent Early Finding in a Later Diagnosis of Attention Deficit Hyperactivity Disorder

“…12 A few more early markers have already been identified, including poor neurocognitive and executive functions, 13 delays or deficits in qualitative features of motor development (fine and gross), 14,15 temperamental activity, and vocabulary delay. 16 Findings from a recent meta-analysis indicate that multiple neurocognitive and behavioral alterations are involved in the early development of ADHD, with the most significant effect sizes found for sensory processing, activity level, and aspects of executive function (inhibition, flexibility, planning/organization, intraindividual variability, impulsivity, and global executive function). 6 However, it may be suggested that these areas reflect (or are similar to) ADHD symptoms, and a broader perspective, including focus on earlier developmental symptoms, is still needed.…”

A randomized controlled trial on the digital socio-emotional competence training Zirkus Empathico for preschoolers

“…Preschool age constitutes a significant time for the initial onset of mental health problems, which often accompany and impact individuals throughout their lives 26 , 27 . The most common mental health presentations in childhood include emotional (e.g., anxiety disorder: childhood prevalence 5.2%) 28 , 29 and behavioral difficulties (e.g., attention-deficit/hyperactivity disorder: childhood prevalence 3.7%) 28 , 30 . Preschool prevention and intervention programs often involve the strengthening of SEC 31 as it serves as an important resilience factor against psychological distress 32 – 34 .…”

Polygenic risk scores and early manifestations of attention‐deficit/hyperactivity disorder

“…Tobarra-Sanchez et al (2022) andRiglin et al (2022) discuss their main findings in context of three important limitations. These limitations are important to address in future research as they constrain a broader use of PRS in psychiatric research and clinical contexts.First, PRS for ADHD and other neurodevelopmental conditions at present explain only a small fraction of variance in ADHD and early manifestations of ADHD, and is therefore a weak instrument.While larger GWAS samples will increase the predictive ability, ADHD PRS will likely never, on their own, be able to predict future diagnoses in a meaningful way.…”

“…Nevertheless, it is possible that PRS in the future, through larger sample sizes and phenotypic refinement, could be used to improve outcome prediction and aid clinical decision-making, together with other clinical variables. As suggested byTobarra-Sanchez et al (2022), future research needs to explore whether predictive models incorporating aspects of early development and PRS are useful for predicting ADHD in clinical practice.…”

“…two publications byTobarra-Sanchez et al (2022) andRiglin et al (2022) provides novel insight into associations between polygenic risk scores and early manifestations of ADHD. In the future, the combined use of aspects of early development, other relevant clinical information and PRS may be used to improve outcome prediction and aid clinical decision-making.…”