A Precision Mental Health Model for Predicting Stability of 4-year-olds' Attention Deficit/Hyperactivity Disorder Symptoms to Age 6 Diagnostic Status

• Published in: Academic pediatrics 2024-04, Vol.24 (3), p.433-441
• Main Authors: Lavigne, John V., Hopkins, Joyce, Ballard, Rachel J., Gouze, Karen R., Ariza, Adolfo J., Martin, Caroline P.
• Format: Article
• Language: English
• Subjects: Attention Deficit Disorder with Hyperactivity - therapy; attention deficit/hyperactivity disorder stability; Child; Child, Preschool; classification tree analysis; Educational Status; Female; Humans; machine learning; Male; Mental Health; Parents; precision mental health; preschoolers; psychoeducation; Schools
• ISSN: 1876-2859; 1876-2867; 1876-2867
• DOI: 10.1016/j.acap.2023.09.003

Estimates of the stability of a preschooler’s diagnosis of Attention Deficit/Hyperactivity Disorder (ADHD) into early elementary school vary greatly. Identified factors associated with diagnostic instability provide little guidance about the likelihood a particular child will have ADHD in elementary school. This study examined an approach to predicting age 6 ADHD-any subtype (ADHD-any) from preschoolers’ demographics and ADHD symptoms. Participants were 796 preschool children (Mage = 4.44; 51% boys; 54% White, non-Hispanic) recruited from primary pediatric care and school settings. Parents completed ADHD Rating Scales at child ages 4 and 5 years, and a structured diagnostic interview (DISC-YC) at ages 4 and 6. Classification tree analyses (CTAs) examined the predictive utility of demographic and symptom variables at ages 4 and 5 years for age 6 ADHD. Over half (52.05%) of preschoolers meeting diagnostic criteria for ADHD-any at age 4 did not meet those criteria at age 6; more than half (52.05%) meeting criteria for ADHD-any at age 6 had not met those criteria at age 4. A CTA conducted at age 4 predicted age 6 ADHD-any diagnosis 65.82% better than chance; an age 5 CTA predicted age 6 ADHD-any 70.60% better than chance. At age 4, likelihood of age 6 ADHD-any diagnosis varied from 40% across CTA tree branches and from 78% at age 5. Parent-reported patterns of preschool-age symptoms may differentially predict ADHD-any at age 6. Psychoeducation regarding these patterns may aid in decision about pursuing multidisciplinary evaluations or initiating treatment.