Preschool children with ADHD face barriers, with 79 per cent not ready for school
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Preschool children with ADHD face barriers, with 79 per cent not ready for school

by Freya Lucas

July 23, 2019

A recent study conducted by Stanford University School of Medicine researchers has found that 79 per cent of preschool-aged children with attention-deficit hyperactivity disorder (ADHD) were not ready for school, compared with 13 per cent of neurotypical peers.


While several previous studies have addressed the academic challenges of school-aged children living with the disorder, the recent Stanford study is among the first to comprehensively examine school readiness in young children with ADHD.


Published online 21 July 2019, in the Pediatrics journal, the study sought to explore and investigate whether children with ADHD start school behind their peers.


Senior author Dr Irene Loe said researchers were “pretty surprised at the proportion of children within the ADHD group who were not school-ready,” describing the comparison of 79 per cent of children with ADHD having impaired school readiness compared with 13 per cent of children in a control group as “a really high number”.


The main symptoms of ADHD — inattention, hyperactivity and impulsivity — can be normal in toddlers, and these behaviours sometimes persist into the preschool years even in children who will not ultimately meet the diagnostic criteria for ADHD, making the disorder difficult to diagnose in preschoolers, Dr Loe said, adding “A lot of these children are not identified until they’re really having a lot of trouble in the school setting.”


For the study, 93 children aged four and five years of age, nearly all of whom had attended or were currently enrolled in preschool, and some were enrolled in kindergarten, were studied. 


Some of the group, 45 children, had previously been diagnosed with ADHD or were identified by their parents as having significant levels of ADHD symptoms. The comparison group consisted of 48 children without ADHD. The researchers tested all the children to confirm their levels of ADHD symptoms.


Five areas of the children’s functioning were explored through tests and parent questionnaires: physical well-being and motor development; social and emotional development; approaches to learning; language development; and, cognition and general knowledge. 


“Approaches to learning” included measures of executive function, which is a person’s ability to prioritise actions and tasks and exercise self-control to regulate behaviour and meet long-term goals.


Children were considered impaired in an area of functioning if their assessment scores in that area were more than one standard deviation worse than the mean score for their age. They were considered unready for school if they were impaired in two or more of the five areas of functioning measured in the study.


While the children with ADHD were no more likely than their peers to show impairment in the area of cognition and general knowledge, they were much more likely than their peers to struggle in all four other areas measured.


It was important to note, researchers said, that the cognition and general knowledge area includes IQ and, importantly, knowledge people traditionally associate with kindergarten readiness, such as being able to identify letters, numbers, shapes and colours.

Children with ADHD were 73 times more likely than children without ADHD to be impaired in approaches to learning; more than seven times as likely to have impaired social and emotional development; six times as likely to have impaired language development; and, three times as likely to have impaired physical well-being and motor development.

Because their terms of assessment were broader than other school-readiness measures researchers have used in the past, Dr Loe said, they opened up avenues for future research. 


“We looked at many aspects of the child more comprehensively,” she said, adding that approaches to learning or executive function as a component of school readiness has been especially under-studied.


The findings, Dr Loe hopes, will support general paediatricians to figure out how they can flag children who might be at risk for school failure, setting them up for a more positive experience when transitioning to school. 


Families, she said, also need better access to behavioural therapy for preschoolers with ADHD, which is not always available or covered by insurance, even though it is recommended as the first-line ADHD treatment for this age group.


“Thinking about how we can provide services for young children with ADHD or who are at high risk for the diagnosis is really important,” she said.


The study was funded by the Maternal and Child Health Bureau, which is part of the U.S. Department of Health and Human Services; 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 and Stanford’s Department of Pediatrics, who also supported the work.

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