The Challenges of Diagnosing ADHD in the Very Young

William T. Basco, Jr., MD, MS


July 03, 2014

Attention-Deficit/Hyperactivity Disorder in Young Children: Predictors of Diagnostic Stability

Law EC, Sideridis GD, Prock LA, Sheridan MA
Pediatrics. 2014;133:659-667

Study Summary

This study sought to improve upon what is known about the stability of a diagnosis of attention-deficit/hyperactivity disorder (ADHD) made in children younger than 7 years of age. This study addressed the limitations of some previous studies by completing medical, developmental, and psychological assessments of the children as part of their initial evaluation for ADHD. This complete combination of evaluations at diagnosis had not been examined in previous studies. The children (n = 120) were aged 3 years to 6 years, 11 months at the time of diagnosis. The children were consecutively evaluated at a single developmental assessment clinic in Boston from 2003 to 2008. The follow-up was completed at a mean of 7 years after initial diagnosis. Children with autism, genetic syndromes, or other neurologic conditions that would affect assessment were excluded. At enrollment and diagnosis, each child was evaluated by a pediatric developmental-behavioral specialist and a pediatric psychologist who completed the developmental assessment and also reviewed school records and obtained objective ratings of child behavior through rating scales. The diagnosis of ADHD was only made after the clinical team had evaluated all of the data during a group meeting.

The follow-up assessment was completed in person, and parents completed multiple evaluation instruments. Parents were also asked to describe their child's behavior on and off medication, if the child was on medication. At both enrollment and follow-up assessments, data were collected on ADHD symptoms, global assessments of the children, as well as assessments of aggression and social communication. The investigators also collected information on behavioral therapy, school services the child may have received, and medication prescribing and use in the interval between the enrollment and follow-up visits. They obtained genetic information from the families. The children's teachers also completed ADHD evaluation scales.


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