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Poster #65 - Trajectories of ADHD symptoms across the school year: Implications for preschoolers’ school readiness

Thu, March 21, 2:15 to 3:30pm, Baltimore Convention Center, Floor: Level 1, Exhibit Hall B

Integrative Statement

Attention-Deficit/Hyperactivity Disorder (ADHD) is one of the most prevalent and impairing childhood psychological disorders (Polanczyk et al., 2007). Although ADHD is typically diagnosed during elementary school, recent research has begun to examine the prevalence of ADHD symptoms in preschoolers (e.g., Lavigne et al., 2009), and identify young children who are at-risk for developing ADHD later in childhood (Cunningham & Boyle, 2002). For this work, it is critical to differentiate developmentally abnormal elevations of ADHD symptoms in young children from more typical, time-limited, problem behaviors. To date, research has primarily focused on the continuity of symptom expression from preschool through elementary school (e.g., Lahey et al., 2004), leading to a lack of understanding of how ADHD symptoms may fluctuate within the preschool years. Thus, the present study aimed to examine trajectories of ADHD symptoms in an at-risk community sample across the course of one academic year. This study further assessed whether patterns of change in ADHD symptoms across the year were related to measures of school readiness.

Method
A sample of predominantly Head Start (67%) preschool children (N = 152; 52% male; Mage = 3.93; SDage = .67) was drawn from a larger program evaluation study. Teacher-reported ADHD symptoms from the Pittsburgh Modified Conners were assessed three times throughout the year: Baseline, 3-months, and 7-months. Four indices of school readiness from the Teaching Strategies Gold (i.e., language, cognitive, literacy, mathematics) were assessed at the end of the school year.

Results
Growth Mixture Modeling was used to identify subgroups of children with different patterns of change in ADHD symptoms across the year. Models were estimated with classes added iteratively and were compared based on a variety of widely-accepted fit statistics. Results demonstrated a 3-class model was the best fit for the data (see Figure 1). Age was included as a covariate. Class 1 (Intercept = 0.23; Slope = -0.02, p < .05) was labeled “Very-Low ADHD -Decreasing.” Class 2 (Intercept = 0.55; Slope = 0.04, ns) was labeled “Low ADHD - Stable.” Class 3 (Intercept = 1.67; Slope = -.04, p < .05) was labeled “Moderate ADHD - Decreasing.” Average ADHD symptoms differed significantly across all three groups at each time point (all ps < .05).

ANOVAs were used to compare groups on four indices of school readiness. Children in the Moderate ADHD - Decreasing group exhibited lower scores on all school readiness indices as compared to both the Low ADHD - Stable and Very-Low ADHD – Decreasing groups (see Table 1).

Discussion
Results support the identification of three groups of children with distinct trajectories of ADHD symptoms across the preschool year. Importantly, even though the Moderate ADHD – Decreasing group had an average symptom level under the clinical cutoff, this group performed lower across all measures of academic school readiness (i.e., language, literacy, cognitive, math) at the end of the preschool year as compared to both the “Low” groups. These findings have important implications for early intervention, suggesting that it is critical to address even moderate levels of ADHD symptoms as they occur.

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