The Developmental Course of Potential Precursors in the First Year of Life and the Emergence of ADHD Symptoms in Early Childhood.

Transcription

1 The Developmental Course of Potential Precursors in the First Year of Life and the Emergence of ADHD Symptoms in Early Childhood. Mirjam Meeuwsen, prof. Dale Hay, prof. Stephanie van Goozen School of Psychology, Cardiff University

2 ADHD in early childhood Bulk of research done on schoolaged children: DSM not developmentally appropriate Many indicators of ADHD are normative in preschoolers (e.g. high activity levels, poor inhibitory control, short attention span) Some studies of preschoolers: Symptoms very common in preschool persistently elevated levels of ADHD more comparable to later prevalence rates Hyperactiveimpulsive symptoms more common, but decreases with age, inattention less common, but increases with age.

3 Early Developmental Course of ADHD Longitudinal stability established repeatedly, but Most preschool measures taken quite late in development (mostly after 3 years old) Broad age ranges Early Markers that have been linked with later ADHD Temperament traits: Negative affect, surgency (approach) and low effortful control Behavioural disinhibition (boldness, approach, spontaneity) Executive Function tasks: Inhibitory control large Delay aversion large Interference control small Working memory small Vigilance/arousal small

4 Aims & Hypotheses It is not well understood how normal variation in activity and attention develop into symptoms of ADHD. Aim: explore early developmental course of ADHD by using data from longitudinal community sample (CCDS). Hypotheses: temperament traits and activity levels at 6 months will predict symptoms of ADHD. Simple executive functioning skills (which are firstly consolidated around 33 months) will relate to symptoms of ADHD, but more complex skills may not.

5 Method Temperament Activity levels during various tasks Activity Levels during tasks Cognitive tasks ADHD symptom scale

6 6 months assessment Method o Temperament (activity levels scale of Infant Behaviour Questionnaire; IBQ: Rothbart, 1981) o Actigraph Actitrainer: o Baseline (3 mins) o Attention (turtle) task (3 mins) o Emotional Challenge (restraint/car seat; 30 sec.)

7 Activity Results 6 months Boys Girls 0 Baseline Attention Restraint Activity levels during conditions differed significantly (but still correlated) Boys more active than girls during baseline (p =.07) Temperament and Activity Levels during attention: rho =.13, p <.05

8 Method: Wave 5 (33 months) Activity Measures Baseline Attention (tower task) Emotional Challenge (Restraint task) Emotional Challenge (Frustration) Peer Interaction (free play 5 minutes)

9 Behavioural Regulation and Cognitive Flexibility Factor Scores

10 Toddlers ADHD Symptoms Structural model used to construct Toddler ADHD factor scores with standardised path coefficients

11 Activity Results 33 months Boys Girls Baseline Attention Restraint Frustration Birthday Party Activity levels during conditions differed significantly, except attention and frustration (but still correlated) Boys more active than girls during peer interaction (at simulated Birthday Party)

12 Results 33 months Symptoms of ADHD, cognitive tasks & factor scores Raisin Whisper BigBear/LittleBear Tower Behavioural Regulation Cognitive flexibility Toddler s ADHD symptoms *.02.14*.11 Raisin Whisper BB/LB Tower BR.22** ** ** **.14*.76**.000 NB: significance level ** <.01 * <.05 <.10 No gender differences in ADHD symptoms, but boys behavioural regulation score were marginally poorer than girls (t (229) = 1.84, p =.07).

13 Results continuity Activity levels, continuity over time Restraint, rho =.19, p =.07, other conditions no sign corr. Temperamental activity levels Toddlers ADHD symptoms Behavioural Regulation NB: significance level ** <.01 * <.05 <.10 Cognitive Flexibility 21** Activity levels at 6 months Baseline Attention Restraint Activity levels 33 months Baseline Attention * Restraint.22** Frustration Peer Interaction.17*.10.04

14 Wave 6 (age = 7 yrs, N = 151) CBCL ADHD scale (Achenbach & Rescorla, 2000) Conners 3AIP (Conners, 2008) W6 CBCL ADHD scale Conners 3 AIP Active Temperament (6mth) Toddlers ADHD symptoms Behavioural Regulation Cognitive flexibility.10.43**.21* **.19*.03 NB: significance level ** <.01 * <.05 <.10 No correlations with activity levels at 6 mth. At 33 mth higher activity levels during peer interaction (rho =.32 **) and restraint (rho =.26 ).

15 Summary Temperamental activity levels (6mths) related to toddlers symptoms of ADHD, but not at 7 yrs ADHD symptoms related to reduced performance on tasks and behavioural regulation factor. Toddlers ADHD symptoms and behavioural regulation predict ADHD symptoms at 7 yrs Activity levels: restraint (6 mth) behavioural regulation (33 mth) Restraint, peer interaction (33 mth) ADHD symptoms (toddlerhood AND childhood) Some continuity in activity levels during restraint.

16 Conclusion Findings offer some support for longitudinal stability in early precursors of ADHD symptoms. Despite differences in settings, methods and reporters Possible early markers: activity during restraint?, cognitive tasks Limitation; definition of behaviour regulation Might contain several aspects of inhibition (under executive or motivational control, i.e. whisper and raisin). Clinical limitations, measures not suitable for diagnosis, however focus here on symptoms/ precursors

17 Further Interest risk factors Familial Patterns (parental ADHD symptoms) Perinatal Adversity Family Environment (parental warmth and conflict) Future Goals: Path analysis including all risk factors (familial risk, perinatal risk and environmental risk) Wave 6: Conner s ADHD scale, PAPA diagnoses/symptom scores, CBLC

18 Thank You For Listening! And a special thank you to everybody in the CCDSteam, who helped with datacollection and coding. Questions???