Multi-rater developmental trajectories of hyperactivity\u2013impulsivity and inattention symptoms from 1.5 to 17\xa0years: a population-based birth cohort study

Francis Vergunst,Richard E Tremblay,Daniel Nagin,Michel Boivin,Cédric Galera,Sylvana M Côté,Frank Vitaro

doi:10.1007/s00787-018-1258-1

Abstract

The developmental course of hyperactivity–impulsivity and inattention symptoms from infancy to adolescence has not been documented in a population sample. The aim of this study was to describe the developmental course of hyperactivity–impulsivity and inattention symptoms from 1.5 to 17 years using multiple informants, and to identify perinatal risk factors associated with following elevated (high-risk) trajectories. Using a population-based birth cohort (n = 1374), symptom ratings from mothers (1.5–8 years), teachers (6–13 years) and participant self-reports (10–17 years) were combined using group-based multi-trajectory modeling to identify informants’ convergence in identifying high-symptom trajectories of hyperactivity–impulsivity and inattention over time. Perinatal risk factors associated with high-symptom trajectories were identified using stepwise logistic regression. The study found that symptoms of hyperactivity–impulsivity broadly declined from 1.5 to 17 years while symptoms of inattention remained constant. 21.4% of participants followed elevated trajectories of hyperactivity–impulsivity and 20.2% followed elevated trajectories of inattention; 11.6% followed elevated trajectories of both types of symptoms concurrently. Risk factors for high-risk trajectories of hyperactivity–impulsivity were low maternal education, prenatal alcohol exposure, non-intact family, maternal depression, and low child IQ; for high-risk inattention they were prenatal street drug exposure, early motherhood, low maternal education, maternal depression and low child IQ. Risk factors for trajectories of high-risk hyperactivity–impulsivity and inattention concurrently were low maternal education, maternal depression, and low child IQ. The combination of longitudinal assessments from multiple informants (i.e., mother, teacher, participant-reports) provides a new way to characterize hyperactivity–impulsivity and inattention phenotypes over time.

Highlights

Attention-deficit/hyperactivity disorder (ADHD) is an etiologically complex neurodevelopmental condition associated with significant negative long-term outcomes
The developmental trajectories of hyperactivity–impulsivity and inattention symptoms are shown in Figs. 1 and 2
This is the first study to describe the course of hyperactivity–impulsivity and inattention symptoms from 1.5 to 17 years in a representative population sample [10], to generate symptom trajectories using an innovative multiinformant approach, and to identify a range of risk factors independently associated with high-symptom trajectories from infancy to adolescence

Summary

Introduction

Attention-deficit/hyperactivity disorder (ADHD) is an etiologically complex neurodevelopmental condition associated with significant negative long-term outcomes. An important obstacle for studies of this kind is the absence of an accepted methodology that allows a single rater to assess symptoms from infancy through adolescence. The present study uses data from a population sample followed from infancy (age 5 months) to adolescence (age 17 years) to identify groups of children following distinct developmental trajectories of hyperactivity–impulsivity and inattention symptoms. Symptom ratings were obtained from three sources—mothers, teachers, and participantreports—determined by the child’s social and educational contexts (pre-school, elementary school, high school). As children become adolescents, self-rated assessments become a reliable source of behavioral information [5, 6]. Symptom ratings from multiple informants are important for clinical practice and research as they can help to accurately identify the clinical phenotype of the child [7, 8]

Methods

Results

Discussion

Conclusion