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Screening for attention-deficit/hyperactivity disorder (ADHD): can high-risk children be identified in first grade?
Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Women's and Children's Health, Pediatrics. (Socialpediatrisk forskning/Sarkad)
Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Women's and Children's Health, Pediatrics. (Allmänpediatrisk forskning/Nordvall)
Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Women's and Children's Health, Pediatrics. (Allmänpediatrisk forskning/Nordvall)
2013 (English)In: Child Care Health and Development, ISSN 0305-1862, E-ISSN 1365-2214, Vol. 39, no 2, 268-276 p.Article in journal (Refereed) Published
Abstract [en]

Aim 

Recent studies have demonstrated the beneficial long-term effects of an indicated parent support programme for acting out behaviour in pre-school children with attention-deficit/hyperactivity disorder (ADHD) traits. In this study we wanted to assess different thresholds for screening with the Conners scale for hyperactive-inattentive behaviours in first grade for ADHD in grade four.

Method

The study population consisted of 422 first graders (6- to 7-year-olds) in one municipality in Stockholm County who were screened with Conners 10-item scale and followed up by ADHD assessment in grade four. Sensitivity, specificity, likelihood ratios, and positive predictive value (PPV) of the screening by parents and teachers in first grade for being diagnosed with ADHD in fourth grade were calculated.

Results 

The prevalence of pervasive and situational ADHD was 5.7% and 5.9% respectively. A score ≥10 on the Conners scale in first grade in teachers' reports identified 63% [95% confidence interval (CI): 43-79] of children diagnosed with pervasive ADHD in grade four (P < 0.001) with a PPV of 29% and a positive likelihood ratio (LR+) of 6.72. Parental reports of a score ≥10 yielded a lower sensitivity (29%; 95% CI: 15-49), PPV of 20% and LR+ of 4.24 for pervasive ADHD. The best predictor was a combination of parent and teacher scores ≥10 with a PPV of 50% and LR+ of 16.63. Associations with situational ADHD were weak with LR+ of 1.81 and 2.49, respectively, for teachers' and parental scores ≥10.

Conclusions

This study indicates a strong association between a teacher's report of a score ≥10 on the Conners scale in first grade and pervasive ADHD in grade four, while parental reports were less predictive.

Place, publisher, year, edition, pages
2013. Vol. 39, no 2, 268-276 p.
Keyword [en]
ADHD, behavioural screening, Conners 10-item scale, CD, disruptive behaviour, parent and teacher ratings, school children. Wilson and Jungner criteria
National Category
Medical and Health Sciences
Identifiers
URN: urn:nbn:se:uu:diva-101030DOI: 10.1111/j.1365-2214.2012.01382.xISI: 000314127800015PubMedID: 22515618OAI: oai:DiVA.org:uu-101030DiVA: diva2:211578
Available from: 2009-04-16 Created: 2009-04-16 Last updated: 2017-12-13Bibliographically approved
In thesis
1. Health Complaints, Bullying and Predictors of Attention-deficit/Hyperactivity Disorder (ADHD) in 10-year-olds in a Swedish Community
Open this publication in new window or tab >>Health Complaints, Bullying and Predictors of Attention-deficit/Hyperactivity Disorder (ADHD) in 10-year-olds in a Swedish Community
2009 (English)Doctoral thesis, comprehensive summary (Other academic)
Abstract [en]

Attention-deficit/hyperactivity disorder (ADHD) is one of the most common behavioural disturbances in school children. The aims of this thesis were to explore the association of ADHD with recurrent health complaints and bullying behaviour in children in grade four, and to evaluate whether it is possible to predict ADHD in grade four by screening before or at school entry.

Cohort study in a population of 577 fourth graders (10-year-olds) in Sigtuna, a municipality in Stockholm County. All children were screened for attention and behaviour problems by parents and teachers in fourth grade. In a second step children with high scores underwent further clinical and cognitive assessments. Information about health complaints and bullying was collected from the children themselves in a classroom questionnaire. Hypotheses were tested in multivariate analyses with adjustment for sex and parental education. Screening with developmental indicators and Conners scale from routine child health services was performed. Sensitivity, specificity and positive predictive value for being diagnosed with ADHD in fourth grade was calculated.

Recurrent abdominal pain, sleeping problems, and tiredness were associated with ADHD (adjusted relative risks: 2.2 [1.4-3.4], 1.7 [1.1-2.7], and 2.7 [1.7-4.1] respectively). ADHD was associated with bullying others students (adjusted odds ratios; 3.8 [95% C.I.: 2.0-7.2]) as well as being bullied (often 10.8 [4.0-29.0] and sometimes 2.9 [1.5-5.7]). The predictive value of developmental deviations for ADHD was no more than 20% and 50% when combining a Conner score of at least 10 from both parents and teachers.

This thesis demonstrates a connection between ADHD in one as well as two settings (home and school), health complaints, and bullying in school children. Treatment strategies for ADHD need to include an effective evaluation and treatment of health complaints and effective interventions for bullying. Evaluation of ADHD should be considered in children with recurrent health complaints and in children involved in bullying. Screening does not identify children who are diagnosed with ADHD in grade four with a high degree of selectivity. It may be more important for schools to have an effective strategy for identifying and dealing with children who develop ADHD when these problems evolve, rather than before school entry.

Place, publisher, year, edition, pages
Uppsala: Acta Universitatis Upsaliensis, 2009. 124 p.
Series
Digital Comprehensive Summaries of Uppsala Dissertations from the Faculty of Medicine, ISSN 1651-6206 ; 454
Keyword
ADHD, health complaints, psychosomatic, bullying, developmental screening, preschool children, school children, behavioural screening, Conners 10-item scale, Wilson and Jungner criteria
National Category
Medical and Health Sciences
Research subject
Medicine
Identifiers
urn:nbn:se:uu:diva-100928 (URN)978-91-554-7503-1 (ISBN)
Public defence
2009-05-07, Rosénsalen, Akademiska barnsjukhuset, ing 95, Uppsala, Uppsala, 09:15 (Swedish)
Opponent
Supervisors
Available from: 2009-04-16 Created: 2009-04-14 Last updated: 2009-04-21

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Holmberg, KirstenSundelin, ClaesHjern, Anders

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