ADHD News & Research

Study: ADHD Symptoms in Preschoolers May Exist Only in School or at Home Due to Varying Risk Factors

Preschool students who exhibit ADHD symptoms only at school — but not at home — are more likely to struggle with attention and inhibitory control, whereas preschoolers with home-situational ADHD symptoms are more likely to have parents with high levels of stress and self-reported harsher parenting perceptions.” This is the finding from a new study investigating the contextual risk factors related to cross-situational variability in ADHD symptoms in preschoolers.

July 30, 2020

ADHD in preschoolers is sometimes situational — symptoms flare in school but not at home, and vice versa. This variation in symptoms reported by teachers versus parents may stem, in part, from differences in contextual risk factors, according to a new study from Taiwan.1

The study found that children who exhibited ADHD symptoms only at school were more likely to have deficits in attentional control, specifically. When children demonstrated symptoms only at home, researchers found that their parents had higher levels of stress and rated their parenting as harsher than normal. Preschoolers with persistently high ADHD symptoms in both environments had deficits in attentional control, increased parental stress, and parents with harsher parenting perceptions.

Researchers studied 99 children aged 4 or 5 with symptoms of attention deficit hyperactivity disorder (ADHD or ADD) who were recruited from the community or hospitals in Taiwan. They used the Conner’s Kiddie Continuous Performance Test (K-CPT) and the Color Flanker Task to measure the subjects’ attention and inhibitory control. The severity of ADHD symptoms and internalizing and externalizing behavioral problems were measured using subjective rating scales with parent and teacher versions. The study also measured parental stress and perceptions of their own parenting. Children were assigned to one of the following four groups according to the severity of their ADHD symptoms as reported by their teachers and parents: Pervasive high-ADHD-symptoms (PHA), school-situational high-ADHD-symptoms (SHA), home-situational high-ADHD-symptoms (HHA), and pervasive low-ADHD-symptoms (PLA).

Researchers found that preschoolers with SHA and HHA differed in the risk factors associated with their ADHD symptoms. The SHA group struggled significantly with attention and inhibitory control, which was likely related to poor adaptation to school life, learning, and peer interactions. Parents of children in this group reported less parental distress and did not perceive their parenting as more harsh than that of other parents.

Parents of HHA preschoolers reported higher levels of stress and perceived their parenting as more harsh than did the other groups. Preschoolers with HHA struggled with attention but adapted well to school life, suggesting that they may share the poor neurocognitive function seen in preschoolers with SHA.

Teacher-reported ADHD symptoms were related to tests of inhibitory control, language ability, and academic performance. Parent-reported ADHD was related to parental distress, the presence of parental disorders like depression, and levels of family functioning. “The associations between parents’ perception of the severity of ADHD symptoms and the parent-child relationship are, therefore, bidirectional,” the study says. “Hence, parenting style and parental stress may be family-context risk factors for parent-reported ADHD symptoms.”

“In clinical practice, parental reports have generally been treated as the most accurate information for clinical evaluation of ADHD, owing to the familiarity of the parents with their children’s daily life and behavioral history,” the study goes on. “However, several studies have found that parental reports of ADHD symptoms are linked to impaired family relationships and parental stress.”

The study’s authors suggest that, due to this disparity, clinicians should take into account the situational risk factors associated with both parents’ and teachers’ symptom reports when assessing and treating ADHD in preschoolers.

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1Hwang-Gu, S.-L., Ni, H.-C., Liang, S. H.-Y., Lin, H.-Y., Tsao, L., Lin, C.-F., & Gau, S. S.-F. (2020). Contextual Factors Impact the Variability in ADHD Symptoms in Preschoolers with Situational Hyperactivity. Journal of Attention Disorders