Logo: to the web site of Uppsala University

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.