Abstract
Evidence of continuities between preschool hyperactivity and adult mental health problems highlights the potential value of targeting early identification and intervention strategies. However, specific risk factors are currently unclear. This large-scale prospective longitudinal study aimed to identify which hyperactive preschoolers are at the greatest long-term risk of poor mental health. One hundred and seventy children (89 females) rated as hyperactive by their parents, and 88 non-hyperactive controls (48 females) were identified from a community sample of 4215 3-year-olds. Baseline data relating to behavioral/emotional problems and background characteristics were collected. Follow-up mental health and functional impairment outcomes were collected between 14 and 25 years of age. At age 3 years, males and females in the hyperactive group had similarly raised levels of hyperactivity and other behavior problems. In adolescence/young adulthood, these individuals showed elevated symptoms of ADHD, conduct disorder, mood disorder, anxiety and autism, as well as functional impairment. Preschool hyperactivity was strongly predictive of poor adolescent/adult outcomes for males across domains with effects being specifically driven by hyperactivity. For females, the effects of preschool hyperactivity were smaller and dropped to non-significant levels when other preschool problems were taken into account. Environmental risk factors also differed between the sexes, although these may also have been mediated by genetic risk. In conclusion, these results demonstrate marked sex differences in preschool predictors of later adolescent/adult mental health problems. Future research should include a measure of preschool inattention as well as hyperactivity. The findings highlight the potential value of tailored approaches to early identification strategies.
Highlights
Prospective longitudinal studies confirm that the developmental processes that determine adult mental health have their roots in early childhood [1, 2]
There is compelling evidence that early, premorbid, behavioral markers of long-term risk for mental health problems are present in the preschool years—even in children as young as 15-montholds [3]
Lahey et al found that meeting ADHD criteria in preschool was highly predictive of continued ADHD symptoms and functional impairment at school age [14], while Bufferd et al demonstrated that preschool hyperactivity in children aged 3 years predicted a diagnosis of oppositional defiant disorder (ODD) at age 6 years [13]
Summary
Prospective longitudinal studies confirm that the developmental processes that determine adult mental health have their roots in early childhood [1, 2]. In a 6-year longitudinal study of hyperactive preschool children, parent-reported hyperactivity and impulsivity ratings were higher for females versus males at baseline, but showed greater decline in symptoms over time [16] These results suggest that growing up female and hyperactive, in some way, is associated with reduced risk of a poor outcome compared with growing up male and hyperactive. The current study had three specific goals: (1) to compare the long-term risk of mental health problem in groups of hyperactive and non-hyperactive preschoolers selected from a large community sample and test whether these risks affect males and females differently; (2) to establish whether these effects are independent of other preschool behavioral characteristics; and (3) to identify factors that predict poor outcomes in the group of hyperactive preschoolers (i.e., which hyperactive preschoolers go on to have problems?)
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