Clinician observations of preschoolers' behavior help to predict ADHD at school age

Don't rely on one source of information about your preschoolers' inattention or hyperactivity. Rather, consider how your child behaves at home as well as information from his or her teacher and a clinician. This advice comes from Sarah O'Neill, of The City College of New York, based on research she conducted at Queens College (CUNY), in an article published in Springer's Journal of Abnormal Child Psychology. The study examines how well parent, teacher, and clinician ratings of preschoolers' behavior are able to predict severity and diagnosis of attention deficit hyperactivity disorder (ADHD) at age six.

Characterized by developmentally inappropriate levels of inattention, hyperactivity, and impulsivity, ADHD is one of the most frequently diagnosed childhood psychiatric disorders. Although many studies focusing on school-aged children have shown that parents and teachers—rather than clinician observations alone—are more likely to assess ADHD accurately, scant evidence exists to support similar conclusions with preschoolers.

To fill this gap in the research, O'Neill and colleagues followed a group of 104 hyperactive and/or inattentive three- and four-year-olds for a period of two years. Both parents and teachers rated the preschoolers' . In addition, clinicians, who were blind to parent and teacher reports, completed ratings of preschoolers' behavior during a psychological testing session. By the time the children reached age six, more than half (53.8 percent) had been diagnosed with ADHD. The likelihood of such a diagnosis increased when all three informants had rated the child as high on symptoms at age three or four. Furthermore, after analyzing the reports separately, the research team found that parents' reports were critical, particularly when combined with either teacher or clinician reports.

Teacher reports alone were not as useful, and the research team ascribed the relative inability of educators' reports to predict a child's ADHD status over time to possible situational variables. Preschoolers may initially have difficulty adjusting to the structured classroom setting, but this disruptive behavior is time-limited to the transition to school. Teachers' perceptions of "difficult" behavior may also be affected by factors such as classroom setting and size as well as their expectations of children's behavior.

As a result of the study findings, O'Neill and her team emphasize the importance of using information from multiple informants who have seen the child in different settings. Parent reports of preschoolers' behavior appear to be crucial, but these alone are not sufficient. Augmenting the parent report with that of the teacher and/or clinician is necessary. Also important are clinician observations of preschoolers during , which are predictive of an ADHD diagnosis and its severity over time. Being able to identify children at risk for poorer outcomes may help educators and clinicians to plan appropriate interventions.

"Consider a child's behavior in different contexts," O'Neill emphasized. "Although parents' reports of preschoolers' inattention, , or impulsivity are very important, ideally we would not rely solely on them. At least for young , the clinician's behavioral observations appear to hold prognostic utility."

More information: O'Neill, S. et al. (2013). Reliable Ratings or Reading Tea Leaves: Can Parent, Teacher, and Clinician Behavioral Ratings of Preschoolers Predict ADHD at Age Six? Journal of Abnormal Child Psychology. DOI: 10.1007/s10802-013-9802-4

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