Are preschoolers with signs of ADHD ready for school? A new study suggests they’re far from prepared.

A small sample of children with symptoms of moderate to severe ADHD scored markedly lower than comparable children on 8 of 10 measures of readiness for primary education in a study published in Pediatrics.

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“Preschool-aged children with parent- or clinician-reported ADHD symptoms are likely to have impaired school readiness. These children require early identification and intervention,” Hannah T. Perrin, MD, of Stanford University and associates wrote.

There’s sparse research into the prevalence of ADHD symptoms in preschoolers, but the Centers for Disease Control and Prevention reports that nearly half of children aged 4-5 years with the condition got no behavioral therapy from 2009 to 2010. About 25% received only medical treatment.

Dr. Perrin and colleagues recruited 93 children aged 4-6 years from the community. Their parents, who were compensated, took the Early Childhood Inventory-4 (ECI-4) questionnaire. It revealed that 80% (n = 45) of those diagnosed with ADHD had scores considered signs of moderate or severe ADHD symptom severity based on the parent ratings. Those with lower scores made up the comparison group (n = 48).

The groups were similar, about 60% male and more than 50% white; neither difference between groups was statistically significant. However, those in the comparison group were much more likely to have non-Latino/non-Hispanic ethnicity; 61% in ADHD group vs. 91% in comparison group, P = .001.

The children were tested for school readiness through several measures in two 1- to 1.5-hour sessions.

The researchers reported that 79% of children in the ADHD group were not ready for school (impaired) vs. 13% of the comparison group. (odds ratio, 21, 95% confidence interval, 5.67-77.77, P = .001).

“We found that preschool-aged children with ADHD symptoms demonstrated significantly worse performance on 8 of 10 school readiness measures,” the authors added, “and significantly greater odds of impairment in four of five domains and overall school readiness.”

Dr. Perrin and associates cautioned that the findings rely on a convenience sample, are based on parent – but not teacher – input, do not include Spanish speakers, and do not follow children over the long term.

Going forward, they wrote, “family dynamics and social-emotional functioning should be assessed for each preschool-aged child with ADHD symptoms, and appropriate therapeutic interventions and community supports should be prescribed to enhance school readiness.”

The study authors had no disclosures. Study funders include the Maternal and Child Health Bureau, the Katharine McCormick Faculty Scholar Award, Stanford Children’s Health and Child Health Research Institute Pilot Early Career Award, and the National Institutes of Health.

SOURCE: Perrin HT et al. Pediatrics. 2019 Aug. doi: 10.1542/peds.2019-0038.