New research from Stanford University School of Medicine shows that preschoolers with attention-deficit hyperactivity disorders are less likely to be ready for school than other children their age, according to new research.
The study will be published online on July 21st. PediatricsThe comprehensive examination of school readiness among young children with ADHD is the first time that this study has been done. While there have been several studies that have examined academic difficulties in ADHD school-aged children, few studies have looked at whether these children start school behind their peers.
Irene Loe MD assistant professor of pediatrics said, “We were pretty surprised at how many kids in the ADHD group were not school-ready.” The study found that 79% of ADHD children had impaired school readiness, compared to 13% of children in a control group. Loe stated that it was a high percentage.
Hannah Perrin MD, a Stanford fellow in developmental and behavior pediatrics, is the study’s lead author.
Inattention, hyperactivity, and impulsivity are all common symptoms of ADHD in toddlers. These behaviors can persist into preschool even in children who do not meet the criteria for ADHD diagnosis. This makes it difficult for preschoolers to diagnose ADHD. Loe stated that many of these children are not diagnosed until they are really having trouble in school settings.
The study involved 93 children who were all 4 or 5 years of age. Nearly all of the children were either enrolled or had attended preschool. Some were also enrolled at kindergarten. 45 children were included in the ADHD group. These children had either been previously diagnosed with ADHD or had their parents identify them as having ADHD symptoms. The comparison group comprised 48 children who were not diagnosed with ADHD. All the children were tested by researchers to confirm their ADHD symptoms.
The tests were administered to parents, and five areas of functioning were measured by the researchers: motor development, mental health, approaches to learning and language development. Also cognition and general knowledge. “Approaches for learning” included measures to assess executive function. This is a person’s ability to prioritize tasks and to exercise self-control to manage behavior and reach long-term goals.
Children were considered impaired in a particular area of functioning if they scored more than one standard deviation lower than the average score for their age. They were considered unready to attend school if they were impaired or unable to perform in at least one of the five functional areas measured in the study.
4 out of 5 areas have difficulty
The study found that ADHD children were not more likely than their peers, to exhibit impairments in the areas of cognition or general knowledge. This includes IQ and, more importantly, the knowledge that people associate with kindergarten readiness such as being able identify letters, numbers and colors.
Children with ADHD were more likely than their peers that they would struggle in any of the four areas. They were 73x more likely than children with ADHD to be impaired in learning approaches; they were six times more likely to have impaired language and social development; and three to four times more likely to have impaired motor and physical development.
Loe stated that the assessment was more comprehensive than any other school-readiness measures previously used. “We looked at many different aspects of the child,” Loe said. She also noted that approaches to learning or executive functions as a component school readiness have been under-studied.
These findings suggest that preschoolers with ADHD symptoms may be easier to identify and help.
Loe said that general pediatricians should be able “to help flag children who may be at risk of school failure.” She added that families need better access to behavioral therapy in preschoolers with ADHD. Although it is recommended as the first-line treatment, it is not always covered by insurance.
She stated, “Thinking of how we can offer services for young children who have ADHD or are at high-risk for the diagnosis is really important.”
Loe is a member of the Stanford Maternal & Child Health Research Institute. The research is also co-authored by Nicole Heller, a former Stanford clinical research coordinator.
The study was funded by the Maternal and Child Health Bureau which is part of U.S. Department of Health and Human Services. It also received a Katharine Mccormick Faculty Scholar Award, a Stanford Children’s Health and Child Health Research Institute Pilot Early Career Award, and the National Institutes of Health (grants UL1 TR0001085).