New research suggests predictors of adolescent ADHD and conduct disorder can be identified—and intercepted—in school-age children. According to a recent study,1 it is crucial to identify and remedy “bad” behavior and low academic performance during kindergarten. If these 2 modifiable factors occur together in a young child and are allowed to persist, the odds that the child will display severe symptoms of comorbid ADHD and conduct disorder are 8 to 1.
It is well-known that children with comorbid ADHD and conduct disorder engage in more delinquency behaviors than their peers. Such children may grow up to be at high risk for criminal activity and further psychopathology.2 Indeed, they ultimately display behavioral profiles similar to adult psychopaths. Although school psychologists are increasingly being called upon to intervene, they lack needed data on how to identify youths most at risk for ADHD/conduct disorder symptomatology in adolescence.
To provide that data, Morgan and colleagues,1 followed 7456 children from kindergarten to 8th grade and devised heretofore unavailable risk estimates of moderate or severe ADHD/conduct disorder symptomatology using multinomial logistic regression analyses of data from the Early Childhood Longitudinal Study, Kindergarten Class of 1998–1999, a survey of children, parents, and teachers maintained by the US Department of Education National Center for Education Statistics.
The study population consisted of those kindergarten children still participating in the survey at the end of 8th grade for whom 8th-grade ADHD and conduct disorder rating scale data were available. The cohort was divided into 3 groups: those without ADHD/conduct disorder symptomatology (90% of the study population); those with moderate (6%); and those and with severe symptomatology (4%).
Rating scales—which were independently completed at the culmination of 8th grade by the children’s parents and math and English teachers—were modeled after the DSM-5 criteria for ADHD and conduct disorder. Assessments included behavior history, academic achievement, socioeconomic factors, environmental risks, birth and maternal data, and whether the child was subject to a lack of routine.
The study found that kindergarteners who frequently displayed ADHD/conduct disorder-like behaviors could be expected to display those behaviors to a moderate (odds ratio [OR] = 2.37) or severe (OR = 3.63) degree by adolescence. Those children who were socioeconomically underprivileged or punished by spanking were significantly more likely to display severe ADHD/conduct disorder symptoms in 8th grade (OR 4.51 for lowest socioeconomic status and 2.24 for spanking; P ≤ .001).
Low academic achievement also significantly increased the risk of both moderate and severe ADHD/conduct disorder symptoms (OR range 2.98 to 3.58; P ≤ .001). In addition, children reared by mothers who had emotional problems or were substance abusers also were at significant risk for severe symptomology in adolescence (OR 2. 07; P ≤ .01).
According to the researchers, these findings should guide early screening and school-based psychological interventions for comorbid ADHD/conduct disorder. Identification and correction of poor behavior and academic functioning within the first year that a child enters the school system—kindergarten—is crucial to reducing that child’s risk for adolescent ADHD/conduct disorder.
1. Morgan PL, Li H, Cook M, et al. Which kindergarten children are at greatest risk for attention-deficit/hyperactivity and conduct disorder symptomatology as adolescents? Sch Psychol Q. 2015 Jul 20. [Epub ahead of print]
2. Lichtenstein P, Halldner L, Zetterqvist J, et al. Medication for attention deficit-hyperactivity disorder and criminality. N Engl J Med. 2012;367:2006-2014.