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. 2024 Jun;33(6):1807-1815.
doi: 10.1007/s00787-023-02284-8. Epub 2023 Aug 25.

Early and repeated screening detects children with persistent attention-deficit/hyperactivity disorder

Kristin Romvig Overgaard  1   2 , Beate Oerbeck  3 , Svein Friis  3   4 , Are Hugo Pripp  5 , Heidi Aase  6 , Guido Biele  6 , Christine Baalsrud Ingeborgrud  4 , Guilherme V Polanczyk  7 , Pål Zeiner  3   4
Affiliations

Early and repeated screening detects children with persistent attention-deficit/hyperactivity disorder

Kristin Romvig Overgaard et al. Eur Child Adolesc Psychiatry. 2024 Jun.

Abstract

Preschool screening of attention-deficit/hyperactivity disorder (ADHD) has been found too inaccurate to be clinically useful. This may be due to the known instability of ADHD symptoms from preschool onwards, and the use of a single screening only. We hypothesized that by identifying a group of children with persistent ADHD from preschool to school age and repeating the screening, the clinical usefulness of screening would increase. This study is part of the prospective longitudinal, population-based Norwegian Mother, Father and Child Cohort Study, with a diagnostic parent interview at 3.5 years and follow-up with parent questionnaires at ages 5 and 8 years (n = 707). We identified a group classified with ADHD at all three time points (persistent ADHD). We then used the Child Behavior Checklist ADHD DSM-oriented scale at ages 3.5 and 5 years to investigate the accuracies of single- and two-stage screening at different thresholds to identify children with persistent ADHD. About 30% of the children were classified with ADHD at least once across time (at ages 3.5, 5, and/or 8 years), but only 4% (n = 30) had persistent ADHD. At all thresholds, the two-stage screening identified children with persistent ADHD more accurately than single screening, mainly due to a substantial reduction in false positives. Only a small group of children were classified with persistent ADHD from preschool to school age, underlining that future screening studies should distinguish this group from those with fluctuating symptoms when estimating screening accuracies. We recommend a two-stage screening process to reduce false positives.

Keywords: ADHD; Children; Longitudinal; Persistent; Preschool.

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Conflict of interest statement

Dr. Polanczyk has served as a consultant/speaker to Abbott, Aché, Medice, Novo Nordisk, and Takeda, and has received royalties from Editora Manole. He receives research support from Fundação de Amparo à Pesquisa do Estado de São Paulo (FAPESP) (Grant No. 16/22455–8). All other authors have no conflicts of interest to disclose.

Figures

Fig. 1
Fig. 1
Illustration of the ADHD measures and thresholds used at the different timepoints
Fig. 2
Fig. 2
ADHD Z-scores at 3.5, 5, and 8 years of age for the different ADHD groups
Fig. 3
Fig. 3
Percentages of screen positives by two-stage screening (3.5 and 5 years of age) for different CBCL thresholds by the ADHD groups
See this image and copyright information in PMC

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