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Attention Deficit Hyperactivity Disorders (ADHD) in extremely preterm children: Is hyperactivity really a problem?

Presented at the Neonatal Society 2009 Autumn Meeting (programme).

Johnson S1,4, Wolke D2, Hollis C3, Kochhar P3, Marlow N1

1 Academic Neonatology, Institute for Women’s Health, University College London, London, UK
2 Warwick Medical School, University of Warwick, Coventry, UK
3 School of Community Health Sciences, University of Nottingham, Nottingham, UK
4 School of Clinical Sciences, University of Nottingham, Nottingham, UK

Background: Extremely preterm (EP) survivors are at high risk for behavioural and attention problems in middle childhood which have a significant impact on attainment and integration at school.

Aim: To assess the prevalence of ADHD symptoms and diagnoses in EP children at 11 years of age.

Methods: Prospective whole-population study of all births <26 weeks gestation in UK and Ireland, 1995 (EPICure Study). Of 307 survivors at 11 years, 219 (71%) were assessed with 153 classmates born at term. Parents and teachers completed the Du Paul ADHD Rating Scale-IV (ADHD-RS-IV) to assess frequency of ADHD symptoms and completed a diagnostic psychiatric evaluation (Development and Well Being Assessment; DAWBA) from which ADHD diagnoses were assigned using DSM-IV criteria for 182 (83%) EP children and 138 (90%) classmates.

Results: Using z scores for ADHD-RS-IV scales, parents rated EP children with higher inattention (Standardised Mean Difference [SMD]: 1.2; 95%CI: 0.9, 1.5) and hyperactivity/impulsivity (SMD 0.7; 0.4, 0.9) than classmates, as did teachers (inattention: SMD 0.9; 0.7, 1.2 and hyperactivity/impulsivity: SMD 0.4; 0.1, 0.6). Ratings were significantly higher for inattention than hyperactivity. Overall, 21 (11.5%) EP children had ADHD diagnoses compared with 4 (2.9%) classmates (OR: 4.3; 1.4, 12.9). EP children were at significantly increased risk for ADHD-Inattentive subtype (OR: 10.5; 1.4 to 81.1) but not for ADHD-combined subtype (OR 2.1; 0.5, 7.9) compared with classmates.

Conclusion: EP children have a higher frequency of ADHD symptoms and diagnoses in middle childhood. In EP children the magnitude of risk is significantly greater for inattention than hyperactivity/impulsivity.

1. Botting, N., Powls, A., Cooke, R., & Marlow, N. (1997). Attention Deficit Hyperactivity Disorder and other psychiatric outcomes in very low birthweight children at 12 years. Journal of Child Psychology and Psychiatry, 38(8), 931-941.
2. Goodman, R., Ford, T., Richards, H., Gatward, R., & Meltzer, H. (2000). The Development and Well-Being Assessment: Description and initial validation of an integrated assessment of child and adolescent psychopathology. Journal of Child Psychology, Psychiatry and Allied Disciplines, 41(5), 645-655.

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