Scientific Papers

A precision mental health model for predicting stability of 4-year-olds’ ADHD symptoms to age 6 diagnostic status rights and content



Estimates of the stability of a preschooler’s diagnosis of 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 < 5% to > 40% across CTA tree branches and from < 5% to > 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.

Section snippets


In a longitudinal study of children transitioning from preschool to early elementary school,16 demographic information and parent reports of child ADHD symptoms were obtained at ages 4 and 5 years. Parents participated in a structured psychiatric interview at age 6 (grade 1 for most children) to determine if their child met diagnostic criteria for any subtype of ADHD (ADHD-any). At age 4, 796 children and parents were recruited from 23 primary care pediatric clinics (n = 613 children) and 13

Sample Characteristics

Mean enrollment age was 4.44 years (Table); 391 (49.1%) of participants were boys. Parent-reported race/ethnicity was: 433 (54.4%) White, non-Hispanic; 162 (20.3%) Hispanic; 133 (16.7%) African American; 19 (2.4%) Asian; and 35 (4.4%) self-described as multi-racial or other. Race/ethnicity was not reported by 14 (1.8%) parents. For 31 families (3.9%), a primary caretaker father participated. All social classes were represented: 303 (38.1%) in the highest class (Class I), 290 (36.4%), Class II,


The clinical practice guidelines for ADHD of the AAP32 considers diagnosing ADHD in preschool children (ages 4-5 years) as a “special circumstance.” One of the challenges for diagnosing ADHD in preschoolers is that some ADHD symptoms are developmentally common at that age, and it is uncertain whether their symptoms will persist into elementary school. Any decision by the pediatrician/parent team about pursing a multidisciplinary evaluation or treating a preschooler for ADHD will be made in the

Declaration of Competing Interest

The authors have no conflicts to disclose


This study was supported by NIMH RO1 MH 066866, Principal Investigator, John V. Lavigne. The authors gratefully acknowledge the community practices of the Pediatric Practice Research Group and the Chicago Public Schools for their participation in this study.

Conflict of Interest


Declarations of Interests


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