Do Preschoolers' Neuropsychological Functioning and Hyperactivity/Inattention Predict Social Functioning Trajectories Through Childhood?

OBJECTIVE: This longitudinal study examined whether preschool attention deficit hyperactivity disorder (ADHD) symptoms and neuropsychological functioning predicted trajectories of children's social functioning from age 3 to 4 through 12 years. METHODS: Three- and four-year-old children (N = 208; 72.6% boys) were evaluated annually through age 12. Parent and teacher Attention Deficit/Hyperactivity Disorder Rating Scale, Fourth Edition responses during the initial evaluation were used to categorize preschoolers as "High" or "Low" risk for ADHD. Children's neuropsychological functioning was assessed using the NEPSY. Teachers' reports of children's social functioning were obtained annually from preschool through age 12 years using the Adaptability, Functional Communication, and Social Skills subscales of the Behavioral Assessment System for Children, Second Edition. Hierarchical linear modeling was used to assess the trajectories of social functioning and determine whether preschoolers' neuropsychological functioning and ADHD risk status predicted social functioning at age 12 years, and/or change in social functioning throughout childhood. All models controlled for baseline socioeconomic status. RESULTS: High Risk children had significantly lower teacher-rated Adaptability and Social Skills at age 12 years. High Risk children and those with lower Verbal neuropsychological functioning in preschool had lower teacher-rated Functional Communication at 12 years old. Lower preschool Verbal neuropsychological functioning predicted greater positive change in teacher-rated Functional Communication across childhood. CONCLUSIONS: Early identification of and intervention for children exhibiting ADHD behaviors is critical given the enduring negative impact of these behaviors on social functioning. Screening preschoolers for verbal difficulties is encouraged given their long-term impact on children's ability to clearly express thoughts and feelings and obtain and provide information.

Preschool Predictors of ADHD Symptoms and Impairment During Childhood and Adolescence.

PURPOSE OF REVIEW: This paper summarizes key, recently published research examining longitudinal outcomes for preschoolers with high levels of inattention and/or hyperactivity/impulsivity. RECENT FINDINGS: Symptom trajectories show that hyperactivity/impulsivity declines across childhood. At the group level, the course of inattention appears more variable. However, identification of subgroups of children showing stable, rising, and falling inattention over time is promising. Early ADHD-like symptoms portend risk for academic and social difficulties, as well as comorbid emotional and behavioral problems in childhood and adolescence. Several early risk factors appear to moderate these relations, including comorbid symptoms, parental psychopathology, socioeconomic disadvantage, and perhaps neuropsychological dysfunction. Furthermore, high levels of inattention and/or hyperactivity/impulsivity during the preschool period appear to compromise development of regulatory and neuropsychological functions, which in turn increases risk for negative outcomes later in childhood. Identified risk factors are targets for novel interventions, which ideally would be delivered early to at-risk children.

Parenting style influences bullying: a longitudinal study comparing children with and without behavioral problems.

BACKGROUND: More optimal parenting has been linked with lower rates of bullying. However, it is not clear whether parenting can alter the trajectories of bullying among children diagnosed with ADHD or ODD as well as those who are not so diagnosed. This study examined whether parenting at age 4-5 years was associated with changes in bullying over the next 4 years among children with Attention-deficit/Hyperactivity Disorder (ADHD) with and without comorbid Oppositional Defiant Disorder (ODD) relative to children without these disorders. METHOD: Children from the New York metropolitan area (n = 162) were prospectively studied over six annual assessment points between preschool and 9 years of age. Parenting was assessed by laboratory observations of the parent and child; teachers rated child bullying, and parents reported on children's diagnostic status (Neither ADHD nor ODD, ADHD but not ODD, both ADHD and ODD). RESULTS: Children with comorbid ADHD and ODD were more likely to bully than the other two groups. Hierarchical linear modeling revealed a fall in bullying over five years. Diagnostic status was significantly associated with initial levels of bullying. Irrespective of diagnostic group, children receiving more parent support for child autonomy at age 4 to 5 years showed a significantly greater decline in bullying than those provided with little support for autonomy. There was no longitudinal link between parent negative affect, emotionally supportive parenting and quality of parent-child interactions with bullying. CONCLUSIONS: Greater parent support for child autonomy at age 4-5 years is related to reduced bullying. Interventions that encourage parent support for child autonomy at the time of entry into school may reduce bullying during early school years.

Latent profile analysis of neuropsychological measures to determine preschoolers' risk for ADHD.

BACKGROUND: Hyperactive/Inattentive preschool children show clear evidence of neuropsychological dysfunction. We examined whether patterns and severity of test scores could reliably identify subgroups of preschoolers with differential risk for ADHD during school-age. METHOD: Typically developing (TD: n = 76) and Hyperactive/Inattentive (HI: n = 138) 3-4 year olds were assessed annually for 6 years (T1-T6). Latent profile analysis (LPA) was used to form subgroups among the HI group based on objective/neuropsychological measures (NEPSY, Actigraph and Continuous Performance Test). Logistic regression assessed the predictive validity of empirically formed subgroups at risk for ADHD diagnosis relative to the TD group and to each other from T2 to T6. RESULTS: Latent profile analysis yielded two subgroups of HI preschoolers: (a) selectively weak Attention/Executive functions, and (b) pervasive neuropsychological dysfunction across all measures. Both subgroups were more likely to have ADHD at all follow-up time-points relative to the TD group (OR range: 11.29-86.32), but there were no significant differences between the LPA-formed subgroups of HI children at any time-point. CONCLUSIONS: Objective/neuropsychological measures distinguish HI preschoolers from their TD peers, but patterns and severity of neuropsychological dysfunction do not predict risk for ADHD during school-age. We hypothesize that trajectories in at-risk children are influenced by subsequent environmental and neurodevelopmental factors, raising the possibility that they are amenable to early intervention.

Impact of maternal posttraumatic stress disorder and depression following exposure to the September 11 attacks on preschool children's behavior.

To evaluate whether conjoined maternal posttraumatic stress disorder (PTSD) and depression are associated with increased behavioral problems among terrorism-exposed preschool children (N = 116; 18-54 months), this study compared clinically significant child behavioral problem rates among the preschool children of mothers with PTSD and depression, depression alone, and neither disorder. Behavioral problems were independently rated by mothers and preschool teachers. Maternal depression and PTSD, relative to maternal depression alone, and to neither disorder, were associated with substantially increased child problems. Notably, maternal depression and PTSD were associated with increased emotional reactivity (relative risk [RR] = 5.9 by mother's and 3.4 by teacher's reports) and aggressive behavior problems (RR = 11.0 by mother's and RR = 5.9 by teacher's reports). This was corroborated by teacher ratings. Implications for intervening with terrorism-exposed preschool children are discussed.

Roles of perinatal problems on adolescent antisocial behaviors among children born after 33 completed weeks: a prospective investigation.

BACKGROUND: There is uncertainty about the extent to which mildly sub-optimal perinatal characteristics among individuals born near-term (>33 weeks of gestation) are associated with various subsequent childhood problems, including antisocial behavior. There is even more uncertainty about whether the pathway to antisocial behavior differs by gender. METHODS: A sample of 1689 infants, born near-term, was followed from birth for over 30 years. Using structural equation modeling (SEM), the study evaluated hypothesized mechanisms linking perinatal problems to antisocial behavior, mediated through the following variables in early and later childhood: neurological abnormalities at age 1; hearing, speech, and language problems at age 3; cognitive function at age 4; and academic performance at age 7. Childhood problems were assessed by trained research clinicians, blind to perinatal status. An 'antisocial behavior' variable was created, based on retrospective self-report of six antisocial incidences assessed in adulthood. RESULTS: Path coefficients showed that birthweight, head circumference, and Apgar scores were indirectly associated with antisocial behavior in the presence of one or more of the following: neurological abnormalities, abnormality in language, speech, and hearing, cognitive function, or academic performance. We found gender differences only in the associations between hearing and IQ and between language perception and IQ. Poor academic performance was associated with antisocial behavior in both boys and girls. CONCLUSION: Our hypothesis, that perinatal problems may progress to antisocial behavior when mediated by various markers of early childhood problems, was confirmed. Adverse perinatal events need to be considered in identifying infants who are at risk for academic problems and antisocial behavior, even when the infant is born relatively close to term (i.e., >33 weeks). Poor academic performance, which is indirectly influenced by a variety of neurological and cognitive problems during the perinatal period, infancy, and early childhood appear to increase antisocial behavioral problems in both girls and boys.

The relationship between PTSD arousal symptoms and depression among mothers exposed to the World Trade Center attacks.

Posttraumatic stress disorder (PTSD) is associated with greater risk of developing comorbid depression. However, little is known about the relationship between specific PTSD symptom clusters and comorbid depression. Approximately 4 years after the World Trade Center (WTC) attacks, we examined the association between PTSD symptom clusters and depression severity among 64 mothers directly exposed to the WTC attacks. Severity scores were computed for each PTSD symptom cluster by summing symptom frequency. Partial correlations with depression severity were calculated separately for PTSD symptom clusters, controlling for demographic variables, time elapsed since the attacks, WTC attack exposure, meeting PTSD criterion A, and the other cluster scores. Higher arousal symptom cluster scores were significantly correlated with persistent depression, but the re-experiencing and avoidance symptom clusters were not. Subsequent analyses isolating shared symptoms of PTSD and depression from those unique to PTSD suggest a complex interrelationship among symptoms of arousal, numbing, and depression.

Prenatal exposure to disaster-related traumatic stress and developmental trajectories of temperament in early childhood: Superstorm Sandy pregnancy study.

BACKGROUND: Little is known about the impact of prenatal maternal stress (PNMS) on the developmental trajectory of temperament and few studies have been able to incorporate a natural disaster as a quasi-experimental stressor. The current study investigated PNMS related to Superstorm Sandy ('Sandy'), a hurricane that struck the New York metropolitan area in October 2012, in terms of objective exposure during pregnancy, subjective stress reaction as assessed by maternal symptoms of post-traumatic stress, and their impact on the developmental changes in temperament during early childhood. METHOD: A subsample of 318 mother-child dyads was drawn from the Stress in Pregnancy Study. Temperament was measured at 6, 12, 18, and 24 months of age. RESULTS: Objective exposure was associated with greater High-Intensity Pleasure, Approach, Perceptual Sensitivity and Fearfulness, but lower Cuddliness and Duration of Orientation at 6 months. Objective exposure and its interaction with subjective stress reaction predicted developmental changes in temperament. In particular, objective exposure was linked to greater increases in Activity Level but decreases in High-Intensity Pleasure, Approach, and Fearfulness. The combination of objective exposure and subjective stress reaction was also associated with greater increases in Activity Level. LIMITATIONS: Temperament was measured solely via maternal report. Trimester-specific effects of Sandy on temperament were not examined. CONCLUSION: This is the first study to examine the effects of prenatal maternal exposure to a natural disaster on trajectories of early childhood temperament. Findings suggest that both objective stress exposure and subjective stress reaction in-utero predict developmental trajectories of temperament in early childhood.

Relational and academic components of resilience in maltreated adolescents.

This study examines the components of resilience in adolescents (aged 11-15 years; n = 816) who were referred to the child welfare system for maltreatment. Data from a national probability study of children and families in the child welfare system showed that adolescents faced a number of risk factors like maltreatment, poverty, and exposure to violence in the community. Social competence, academic achievement, and a sense of relatedness to caregiver were fit in a structural equation model as components of latent resilience. Social competence and the quality of relationship with a caregiver were strongly linked to latent resilience.

Temperament, executive control, and attention-deficit/hyperactivity disorder across early development.

Research examining factors linking early temperament and later attention-deficit/ hyperactivity disorder (ADHD) is limited by cross-sectional approaches and having the same informant rate both temperament and psychopathology. The authors used multiinformant/multimethod longitudinal data to test the hypothesis that negative emotionality during preschool is positively associated with ADHD symptom severity in middle childhood, but developing executive control mediates this relation. Children (N = 161) with and without ADHD were evaluated 3 times: parent and teacher temperament ratings and NEPSY visual attention at ages 3-4 years; Wechsler Intelligence Scale for Children-4th edition Working Memory Index and NEPSY Response Set at age 6 years; and ADHD symptoms using the Kiddie-SADS at age 7 years. Parent and teacher ratings of preschoolers' temperament were combined to form an anger/frustration composite. Similarly, an executive functioning composite was derived from age 6 measures. Bootstrapping was used to determine whether age 6 executive functioning mediated the relation between early anger/frustration and later ADHD symptom severity, while controlling for early executive functioning. Preschoolers' anger/frustration was significantly associated with later ADHD symptoms, with this relation partially mediated by age 6 executive functioning. Developing executive control mediates the relation between early anger/frustration and later ADHD symptom severity, suggesting that anger/frustration influences ADHD symptom severity through its impact on developing executive control. Early interventions targeting the harmful influences of negative emotionality or enhancing executive functioning may diminish later ADHD severity.

The interplay among temperament, neuropsychological abilities, and global functioning in young hyperactive/inattentive children.

Cognition and emotion have been shown to interact and influence psychological functioning. However, to date these interactions have only been examined cross-sectionally among inattentive and/or hyperactive/impulsive children. This study investigated the moderating effects of neuropsychological functioning at age 3-4 years on the relation between negative emotionality at age 3-4 years and global functioning 1 year later, at age 4-5 years. Hyperactive/inattentive (H/I; n = 114) preschoolers entered the study (BL: baseline) and were seen again 1 year later (F1). Children's BL scores on a neuropsychological test (NEPSY) and their temperament as rated by parents (Child Behavior Questionnaire) and teachers (Temperament Assessment Battery for Children-Revised) were obtained, as were clinicians' ratings of their global functioning (Children's Global Assessment Scale) at F1. Hierarchical linear regression analyses revealed that BL temperament variables accounted for significant variance in F1 Global Functioning. Significant interactions indicated that higher Verbal Executive abilities were associated with better child functioning when parent-rated Effortful Control was high, but not when Effortful Control was low. Additionally, high levels of Nonverbal Executive skills were associated with higher child global functioning when both parent- and teacher-rated negative affect was low, but not when negative affect was high.

Early language mediates the relations between preschool inattention and school-age reading achievement.

OBJECTIVE: Early inattention is associated with later reading problems in children, but the mechanism by which this occurs is unclear. We investigated whether the negative relation between preschoolers' ADHD symptoms and 8-year-old reading achievement is directly related to the severity of inattention or is mediated by early language skills. METHOD: Children (n = 150; 76% boys) were evaluated at 3 time points: preschool (T1), mean (SD) age = 4.24 (.49) years; 1 year later (T2), mean (SD) age = 5.28 (.50) years; and during school age (T3), mean (SD) age = 8.61 (.31) years. At T1, parents' Kiddie-SADS responses were dimensionalized to reflect ADHD severity. Children completed the Language domain of the NEPSY (i.e., A Developmental Neuropsychological Assessment) at T1 and again at T2. At T3, children completed the Wechsler Individual Achievement Test, Second Edition Word Reading, Pseudoword Decoding, Reading Comprehension, and Spelling subtests, and their teachers completed ratings of Reading and Written Expression performance in school. The mediating effect of T2 Language on the relation between preschool Inattention and age 8 Reading was examined using the nonparametric bootstrapping procedure, while controlling for T1 Language. RESULTS: Language ability at T2 mediated the path from preschool inattention (but not hyperactivity/impulsivity) to 8-year-old reading achievement (both test scores and ratings) after controlling for preschoolers' language ability. CONCLUSIONS: Early attentional deficits may negatively impact school-age reading outcomes by compromising the development of language skills, which in turn imperils later reading achievement. Screening children with attentional problems for language impairment, as well as implementing early intervention for both attentional and language problems may be critical to promote reading achievement during school years. (PsycINFO Database Record

Impact of occupational, physical, and speech and language therapy in preschoolers with hyperactive/inattentive symptoms: A naturalistic 2-year follow-up study.

OBJECTIVE: Impact of speech and language therapy (ST) and occupational/physical therapy (OT/PT) on language and motor skills was examined in hyperactive/inattentive children. METHODS: Preschoolers were divided into those receiving and not receiving ST or OT/PT. RESULTS: Children receiving ST showed no gains in language functioning relative to those not receiving ST. OT/PT yielded similar results for motor functions. Hours of a service did not predict improvement. However, children who received ST showed improvement in social skills. DISCUSSION: The apparent lack of benefit suggests the need for further investigation into efficacy of these treatments in hyperactive/inattentive preschool children.

Reliable ratings or reading tea leaves: can parent, teacher, and clinician behavioral ratings of preschoolers predict ADHD at age six?

To assess the relative ability of parent, teacher, and clinician behavioral ratings of preschoolers to predict ADHD severity and diagnosis at 6 years of age. Hyperactive/inattentive preschoolers [N = 104, 75 % boys, Mean (SD) age = 4.37 (0.47) years] were followed over 2 years (mean = 26.44 months, SD = 5.66). At baseline (BL), parents and teachers completed the ADHD-RS-IV and clinicians completed the Behavioral Rating Inventory for Children following a psychological testing session. At age 6, [Mean (SD) age = 6.62 (0.35) years], parents were interviewed with the K-SADS-PL; teachers completed the ADHD-RS-IV; and laboratory measures of hyperactivity, impulsivity, and inattention were obtained from children. Hierarchical logistic and linear regression analyses examined which combination of BL ratings best predicted 6-year-old ADHD diagnosis and severity, respectively. At age 6, 56 (53.8 %) children met DSM-IV criteria for a diagnosis of ADHD. BL ratings from parent/teacher/clinician, parent/teacher and parent/clinician combinations significantly predicted children who had an ADHD diagnosis at age 6. Parent and clinician, but not teacher, behavior ratings were significant independent predictors of ADHD diagnosis and severity at 6-years-old. However, only clinician reports of preschoolers' behaviors predicted laboratory measures of over-activity and inattention at follow-up. Cross-situationality is important for a diagnosis of ADHD during the preschool years. Among parents, teachers and clinicians, positive endorsements from all three informants, parent/teacher or parent/clinician appear to have prognostic value. Clinicians' ratings of preschoolers' inattention, impulsivity and hyperactivity are valid sources of information for predicting ADHD diagnosis and severity over time.

Inattention symptoms predict level of depression in early childhood.

OBJECTIVE: To investigate the potential bidirectional relationships between severity of inattention and depression across early childhood. METHODS: Children (N = 216) from the New York, NY, metropolitan area were recruited when they were aged 3 to 4 years (T1) and studied again at age 6 (T2) and 7 (T3) years. Child inattention symptoms were measured using the Kiddie-Schedule for Affective Disorders and Schizophrenia for School-Aged Children-Present and Lifetime, along with both parent and teacher reports on the Behavior Assessment System for Children, Second Edition (BASC-2). Severity of child depression was assessed at each time point using parent and teacher reports on the BASC-2. After examining correlations between child inattention and depression, structural equation modeling was used to investigate whether child inattention was longitudinally related to child depression, and whether child depression symptoms were associated with later child inattention. RESULTS: Severity of child inattention at T1 and T2 was longitudinally associated with increased severity of child depression at T2 and T3, respectively. Early child depression was not longitudinally associated with later child inattention. CONCLUSION: Child inattention is a risk factor for increased levels of child depression. Pediatricians and clinicians who assess children's inattention symptoms also need to investigate symptoms of depression. This study makes a case for treating children's inattention symptoms at preschool and early childhood, before emotional problems become more severe.

Neuropsychological functioning and severity of ADHD in early childhood: a four-year cross-lagged study.

Children with attention deficit/hyperactivity disorder (ADHD) have poorer neuropsychological functioning relative to their typically developing peers. However, it is unclear whether early neuropsychological functioning predicts later ADHD severity and/or the latter is longitudinally associated with subsequent neuropsychological functioning; and whether these relations are different in children with and without early symptoms of ADHD. This study aimed to examine the longitudinal associations between ADHD severity and neuropsychological functioning among children at high and low risk of developing ADHD. Hyperactive/Inattentive (H/I; n = 140) and Typically developing (TD; n = 76) preschoolers (age 3-4 years) were recruited (BL) and followed annually for 3 years (F1, F2, and F3). Teachers rated the children's ADHD severity and impairment using the Behavior Assessment System for Children-2 and the Children's Problem Checklist, respectively. Parent reports of children's ADHD severity were obtained using the Kiddie-Schedule for Affective Disorders and Schizophrenia - Present and Lifetime version. Neuropsychological functioning was assessed using the NEPSY. In the full sample, there were bidirectional longitudinal associations between neuropsychological functioning and ADHD severity between F1 and F3. Among H/I children, neuropsychological functioning at F1 and F2 predicted ADHD severity at F2 and F3, respectively. In contrast, among TD children the only significant relationship observed was that elevated ADHD symptoms at F2 were associated with poorer neuropsychological functioning at F3. Improved neuropsychological functioning may attenuate ADHD symptoms and associated impairment among H/I children during the early school years. Interventions designed to improve neuropsychological functioning among young H/I children may be beneficial in reducing their ADHD severity.

Association between variation in neuropsychological development and trajectory of ADHD severity in early childhood.

OBJECTIVE: This longitudinal study examined if changes in neuropsychological functioning were associated with the trajectory of symptoms related to attention deficit hyperactivity disorder (ADHD) and impairment between preschool and school age. METHOD: The sample consisted of 3- and 4-year-old children (N=138) who were identified as being at risk for ADHD based on parent and teacher reports. Neuropsychological functioning was measured annually using the NEPSY at four time points (mean ages, 4.19, 5.36, 6.35, and 7.35 years). ADHD symptoms and impairment were assessed with semiannual parent and teacher reports using the ADHD Rating Scale-IV and the Children's Problems Checklist at 10 time points (mean ages at baseline and final assessment, 4.19 and 8.81 years, respectively). Hierarchical linear modeling was used to assess the trajectories of change in neuropsychological functioning and ADHD severity as well as the association of change in neuropsychological functioning with change in ADHD severity over time. RESULTS: Baseline neuropsychological functioning was not significantly associated with the slope of change in ADHD severity. However, the magnitude of change in neuropsychological functioning was linearly associated with the trajectory of ADHD symptom severity and impairment, such that individuals with greater neuropsychological growth over time had a greater diminution of ADHD severity and impairment. Family socioeconomic status at baseline was significantly associated with initial ADHD severity and impairment, but not with change over time. CONCLUSIONS: Interventions that enhance neuropsychological functioning at an early age may be beneficial in attenuating long-term ADHD severity and impairment.

Factors associated with service use among immigrants in the child welfare system.

This study investigated child, caregiver, and caseworker factors associated with greater use of family support services by immigrant families in the U.S. child welfare system. Among child factors, higher levels of internalizing behavior problems (Odds Ratio (O.R.)=3.60), externalizing behavior problems (O.R.=2.62) and a history of neglect (O.R.=4.23) were associated with greater family support service use. Among caregiver factors, prior reports of maltreatment (O.R.=6.77), a serious mental health problem of the caregiver (O.R.=6.86), cognitive impairments (O.R.=10.46) in the primary caregiver, the primary caregivers' history of arrests (O.R.=6.47) and domestic violence (O.R.=2.87), were associated with heavy service use. Caseworkers' training on cultural issues (O.R.=61.35), their concerns over bureaucracy (O.R.=25.38) and concern over rules and regulations (O.R.=6.08) were also associated with greater service use among immigrant families. This research suggests that use of family support services may be determined not only by the family's demographic factors and risk level but also by caseworkers' training in cultural competence and their perception of organizational problems.