The Challenges of Diagnosing ADHD in the Very Young

William T. Basco, Jr., MD, MS


July 03, 2014

Study Findings

To meet the definition of ADHD at the follow-up visit, the children had to score in the positive range on 2 of the parent rating scales and the teacher rating scale. Approximately three quarters (88 or 73%) of the 120 eligible children with ADHD provided follow-up data. Demographic characteristics of these children did not differ from those of the children who were not available for follow-up. The mean age at initial diagnosis was 68 months, with 8.5% living below the poverty level. During the enrollment assessment, 3.3% of the children were diagnosed with a behavioral disorder, 17.5% were diagnosed with a learning disorder, 8.3% were diagnosed with a mood disorder, and 65% were diagnosed with a developmental disability. After 7 years of follow-up, 70.4% of the children still met ADHD criteria.

Several factors were associated with stability of the ADHD diagnosis. At the patient level, the presence of externalizing symptoms, internalizing symptoms, and a lower nonverbal composite score at the enrollment assessment were all associated with a higher odds of retaining the ADHD diagnosis. Familial factors that were associated with retaining the ADHD diagnosis included a parental history of psychopathology as well as having a lower income. Among the 26 children who no longer met the criteria for a diagnosis of ADHD at the follow-up evaluation, 15 had obtained new diagnoses. Two had been diagnosed with anxiety disorders, 10 with autism spectrum disorders, and 3 with a new learning disorder.


Several points are worth emphasizing here. First, these children underwent a full developmental, medical, and psychological assessment at enrollment, so the diagnosis of ADHD was very rigorous. It does not mean that clinicians can make an office-based diagnosis of ADHD in children younger than 7 years old and be certain that their patients will be appropriately diagnosed more than 70% of the time! The new diagnoses that appeared among 17% of the children initially diagnosed with ADHD also emphasizes how difficult it is to make a proper diagnosis in these very young children. The results indirectly emphasize the need to complete as comprehensive an evaluation as possible in these young children and then follow them carefully for emergence of new symptoms or signs that might point to alternative diagnoses.



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