Predicting ADHD-related symptoms in primary school children from developmental characteristics assessed at the preschool health examination. Results of IPSUM, a prospective cohort study at German Steiner schools


  • Christiane Diefenbach
  • Michael S. Urschitz et al.


Background: Children with attention-deficit/hyperactivity disorder (ADHD) and ADHD-related symptoms perform poorer at school and have lower educational attainment. Early identification, diagnosis, and appropriate treatment may avoid poorer educational outcomes in these children. We investigated whether developmental characteristics assessed prior to school entry independently predict ADHD-related symptoms later in primary school.

Methods: A multi-centre prospective cohort study including 1,345 children (mean age at study entry: 6.1 years; 50 % girls) from 87 German Steiner schools (Waldorf schools) was conducted. Developmental characteristics were assessed by a standardized preschool health examination addressing six domains: gross and fine motor skills, cognitive/sensory skills, auditory memory, anthropometric measures, and second dentition. ADHD-related symptoms were obtained with the hyperactivity/inattention subscale of the Strengths and Difficulties Questionnaire (SDQ) at three time points: prior to school entry by parent reports and in 2nd and 4th grade by teacher reports. Relationships between developmental characteristics and ADHD-related symptoms were evaluated by multivariable linear mixed model analysis and adjusted for baseline symptoms and potential co-predictors.

Results: Scores on the cognitive/sensory skills subscale were negatively related to scores on the SDQ hyperactivity/inattention subscale. Regarding the single items of this subscale, independent associations for three of seven subscale items were observed.

Conclusions: Developmental characteristics such as cognitive/sensory skills assessed prior to school entry may independently predict teacher-reported ADHD-related symptoms later in primary school. Performance ratings of these skills may contribute to an early identification of children at risk for developing ADHD and related educational problems later in school.






Empirical Research / Beiträge zur empirischen Forschung / Peer Reviewed Articles