Clinical Presentation of Attention-Deficit/Hyperactivity Disorder in Preschool Children: The Preschoolers with Attention-Deficit/Hyperactivity Treatment Study (PATS)

New York State Psychiatric Institute/Columbia University, 1041 Riverside Drive, New York, NY 10032, USA.
Journal of Child and Adolescent Psychopharmacology (Impact Factor: 2.93). 11/2007; 17(5):547-62. DOI: 10.1089/cap.2007.0075
Source: PubMed


The aim of this study was to describe the clinical presentation of preschoolers diagnosed with moderate to severe attention-deficit/hyperactivity disorder (ADHD) recruited for the multisite Preschool ADHD Treatment Study (PATS). The diagnosis and evaluation process will also be described.
A comprehensive multidimensional, multi-informant assessment protocol was implemented including the semistructured PATS Diagnostic Interview. Parent and teacher-report measures were used to supplement information from interviews. Consensus agreement by a cross-site panel on each participant's diagnoses was required. Analyses were conducted to describe the sample and to test associations between ADHD severity and demographic and clinical variables.
The assessment protocol identified 303 preschoolers (3-5.5 years) with moderate to severe ADHD Hyperactive/Impulsive or Combined type. The majority of participants (n = 211, 69.6%) experienced co-morbid disorders, with oppositional defiant disorder, communication disorders, and anxiety disorders being the most common. Participants with co-morbid communication disorders were found to be more anxious and depressed. ADHD severity was found to correlate with more internalizing difficulties and lower functioning. Although boys and girls had similar symptom presentations, younger children had significantly higher ADHD severity.
Preschoolers with moderate to severe ADHD experience high co-morbidity and impairment, which have implications for both assessment and treatment.

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    • "To optimize the effects of nonpharmacological therapies, early intervention approaches implemented during the preschool period have been proposed [18]. Such proposals are consistent with the fact that, even though most ADHD cases are first formally diagnosed and treated in middle childhood, ADHD often has its roots in the preschool period [19-21]. In fact, while significant levels of preschool-type ADHD symptoms may not always signal the early ‘onset’ of impairment, numbers of referrals of ADHD before the age of 5 years are growing [1,5,22]. "
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    ABSTRACT: The New Forest Parenting Programme (NFPP) is a home-delivered, evidence-based parenting programme to target symptoms of attention-deficit/hyperactivity disorder (ADHD) in preschool children. It has been adapted for use with 'hard-to-reach' or 'difficult-to-treat' children. This trial will compare the adapted-NFPP with a generic parenting group-based programme, Incredible Years (IY), which has been recommended for children with preschool-type ADHD symptoms.Methods/design: This multicentre randomized controlled trial comprises three arms: adapted-NFPP, IY and treatment as usual (TAU). A sample of 329 parents of preschool-aged children with a research diagnosis of ADHD enriched for hard-to-reach and potentially treatment-resistant children will be allocated to the arms in the ratio 3:3:1. Participants in the adapted-NFPP and IY arms receive an induction visit followed by 12 weekly parenting sessions of 11/2 hours (adapted-NFPP) or 21/2 hours (IY) over 2.5 years. Adapted-NFPP will be delivered as a one-to-one home-based intervention; IY, as a group-based intervention. TAU participants are offered a parenting programme at the end of the study. The primary objective is to test whether the adapted-NFPP produces beneficial effects in terms of core ADHD symptoms. Secondary objectives include examination of the treatment impact on secondary outcomes, a study of cost-effectiveness and examination of the mediating role of treatment-induced changes in parenting behaviour and neuropsychological function. The primary outcome is change in ADHD symptoms, as measured by the parent-completed version of the SNAP-IV questionnaire, adjusted for pretreatment SNAP-IV score. Secondary outcome measures are: a validated index of behaviour during child's solo play; teacher-reported SNAP-IV (ADHD scale); teacher and parent Eyberg Child Behaviour Inventory - Oppositional Defiant Disorder scale; Revised Client Service Receipt Inventory - Health Economics Costs measure and EuroQol (EQ5D) health-related quality-of-life measure. Follow-up measures will be collected 6 months after treatment for participants allocated to adapted-NFPP and IY. This trial will provide evidence as to whether the adapted-NFPP is more effective and cost-effective than the recommended treatment and TAU. It will also provide information about mediating factors (improved parenting and neuropsychological function) and moderating factors (parent and child genetic factors) in any increased benefit.Trial registration: Current Controlled Trials, ISRCTN39288126.
    Trials 04/2014; 15(1):142. DOI:10.1186/1745-6215-15-142 · 1.73 Impact Factor
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    • "Preschoolers with ADHD often suffer from other comorbid conditions, most commonly, oppositional defiant disorder (ODD), communication disorders, and anxiety disorders, and those with comorbidities are more impaired than those with ADHD alone (Egger, et al., 2006; Posner, et al., 2007). "
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    Journal of the Canadian Academy of Child and Adolescent Psychiatry = Journal de l'Academie canadienne de psychiatrie de l'enfant et de l'adolescent 02/2013; 22(1):47-54.
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    • "Evidence indicates that ADHD may be more severe and complicated in younger children and those with earlier onset ADHD. Within a sample of clinically diagnosed children 3 to 5.5 years of age with ADHD, parents and teachers rated symptoms as more severe in younger children (Posner et al., 2007[90]). Earlier age at onset of ADHD (recalled by parents in annual increments from birth to 6 years of age) within a clinical sample of elementary school-age children was also associated with higher rates of parent-reported aggressive symptoms (Connor et al., 2003[24]). Diagnosis during the preschool years also predicts the development of other psychiatric disorders and creates significant risk for the development of secondary impairments such as school failure and peer difficulties during adolescence. "
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