Clinician observations of preschoolers' behavior help to predict ADHD at school age

Don't rely on one source of information about your preschoolers' inattention or hyperactivity. Rather, consider how your child behaves at home as well as information from his or her teacher and a clinician.

This advice comes from Sarah O'Neill, of The City College of New York, based on research she conducted at Queens College (CUNY), in an article published in Springer's Journal of Abnormal Child Psychology.

The study examines how well parent, teacher, and clinician ratings of preschoolers' behavior are able to predict severity and diagnosis of attention deficit hyperactivity disorder (ADHD) at age six.

Characterized by developmentally inappropriate levels of inattention, hyperactivity, and impulsivity, ADHD is one of the most frequently diagnosed childhood psychiatric disorders.

Although many studies focusing on school-aged children have shown that parents and teachers—rather than clinician observations alone—are more likely to assess ADHD accurately, scant evidence exists to support similar conclusions with preschoolers.

To fill this gap in the research, O'Neill and colleagues followed a group of 104 hyperactive and/or inattentive three- and four-year-olds for a period of two years. Both parents and teachers rated the preschoolers' behaviour.

In addition, clinicians, who were blind to parent and teacher reports, completed ratings of preschoolers' behavior during a psychological testing session.

By the time the children reached age six, more than half (53.8 percent) had been diagnosed with ADHD.

The likelihood of such a diagnosis increased when all three informants had rated the child as high on symptoms at age three or four.

Furthermore, after analyzing the reports separately, the research team found that parents' reports were critical, particularly when combined with either teacher or clinician reports.

Teacher reports alone were not as useful, and the research team ascribed the relative inability of educators' reports to predict a child's ADHD status over time to possible situational variables.

Preschoolers may initially have difficulty adjusting to the structured classroom setting, but this disruptive behavior is time-limited to the transition to school.

Teachers' perceptions of "difficult" behaviour may also be affected by factors such as classroom setting and size as well as their expectations of children's behaviour.

As a result of the study findings, O'Neill and her team emphasize the importance of using information from multiple informants who have seen the child in different settings.

Parent reports of preschoolers' behaviour appear to be crucial, but these alone are not sufficient. Augmenting the parent report with that of the teacher and/or clinician is necessary.

Also important are clinician observations of preschoolers during psychological testing, which are predictive of an ADHD diagnosis and its severity over time.

Being able to identify children at risk for poorer outcomes may help educators and clinicians to plan appropriate interventions.

"Consider a preschool child's behaviour in different contexts," O'Neill emphasized. "Although parents' reports of preschoolers' inattention, hyperactivity, or impulsivity are very important, ideally we would not rely solely on them. At least for young children, the clinician's behavioural observations appear to hold prognostic utility."

More information: O'Neill, S. et al. (2013). Reliable Ratings or Reading Tea Leaves: Can Parent, Teacher, and Clinician Behavioral Ratings of Preschoolers Predict ADHD at Age Six? Journal of Abnormal Child Psychology. DOI: 10.1007/s10802-013-9802-4

Playground peers can predict adult personalities

Even on the playground, our friends know us better than we know ourselves.

New research has revealed that your childhood peers from grade school may be able to best predict your success as an adult.

Lisa Serbin of the Department of Psychology at Concordia University and Alexa Martin-Storey, a recent Concordia graduate and a current post-doctoral student at the University of Texas -- both members of the Concordia-based Centre for Research in Human Development -- recently published a study online, which reveals that childhood peer evaluation of classmate personalities can more accurately predict adulthood success than self-evaluation at that age.

"This study, known as the Concordia Longitudinal Risk Project, was started in 1976 by my colleagues in the Department of Psychology, Alex Schwartzman and Jane Ledingham, who is now at the University of Ottawa," says Serbin.

"Over two years, Montreal students in grades 1, 4 and 7 completed peer evaluations of their classmates and rated them in terms of aggression, likeability and social withdrawal. The students also did self-evaluations."

Over the next twenty years, these children were closely followed as researchers used the exhaustive longitudinal study to track their progress into adulthood.

A follow-up survey was conducted between 1999 and 2003 with nearly 700 of the participants from the initial study.

The survey included measurement of adult personality traits, such as levels of neuroticism, extroversion, openness, agreeableness and conscientiousness.

"We were able to compare peer and self-perceptions of the childhood behaviours to these adult personality factors," says Martin-Storey.

"We found the evaluations from the group of peers were much more closely associated with eventual adult outcomes than were their own personality perceptions from childhood.

This makes sense, since children are around their peers all day and behaviours like aggressiveness and likeability are extremely relevant in the school environment."

For example, children who perceived themselves as socially withdrawn exhibited less conscientiousness as adults.

On the other hand, kids whose peers perceived them as socially withdrawn grew up to exhibit lower levels of extraversion, the latter being a more accurate association.

Peer-perceived likeability also predicted a more accurate outcome, associating the personality trait with higher levels of agreeableness and conscientiousness, and lower levels of neuroticism than those who thought of themselves as likeable.

Overall, the findings supported the use of peer rather than self-ratings of childhood personalities in the prediction of adulthood success.

"Adult personality traits are associated with a lot of important life factors, such as health, mental health and occupational satisfaction," says Serbin.

"The information from our study could be used to promote better longitudinal outcomes for children by helping kids and parents develop effective mechanisms for addressing aggressive or socially withdrawn behaviours and promoting more pro-social behaviour."