Trajectories of Executive Functions and ADHD Symptoms in Preschoolers and the Role of Negative Parental Discipline.

In the present study, we investigated whether the longitudinal growth trajectories of executive functions (EF) and Attention-Deficit/Hyperactivity Disorder (ADHD) symptoms are related. In addition, we investigated whether negative discipline moderated these longitudinal relations. The sample consisted of predominantly clinically referred preschoolers (N = 248, age 42-66 months at Time 1; 79.0% boys). Assessment occurred three times: at baseline, at 9 months, and at 18 months. EF was assessed with five EF tasks. ADHD symptoms (Child Behavior Checklist 1.5-5) were reported by parents. Groups of medium to high and low negative discipline were based on mother- and father-reports (Parenting Practices Inventory). Growth curve models showed that EF generally increased and ADHD symptoms generally decreased over time. Parallel process models showed that there was no relation between the change in EF and the change in ADHD symptoms over time, suggesting no co-development. However, higher EF at baseline was related to lower ADHD symptoms at baseline. This was irrespective of whether children were exposed to high or low negative discipline. Overall, the results suggest that, while EF and ADHD symptoms are related, they develop independently across the preschool years.

Mother-Child Interactions and Externalizing Behavior Problems in Preschoolers over Time: Inhibitory Control as a Mediator.

Previous research has shown links between parenting and externalizing behavior problems in young children over time. Associations between inhibitory control, one of the executive functions, and externalizing behavior problems are widely established as well. Yet, the role of inhibitory control in the maintenance and change of externalizing behavior problems over time remains unclear. We examined whether inhibitory control could explain the link between mother-child interactions measured on a moment-to-moment timescale and preschoolers' externalizing behavior problems as reported by teachers. With a sample of 173 predominantly clinically referred preschoolers (76.9% boys) we tested a longitudinal model proposing that affective dyadic flexibility and maternal negative affect predict as well as interact in predicting hyperactive/impulsive behavior and aggressive behavior, with preschoolers' inhibitory control as a mediator. Our results provide support for this model for preschoolers' hyperactive/impulsive behavior, but not for aggressive behavior. Hence, inhibitory control is identified as a mechanism linking the content and structure of mother-child interactions to preschoolers' hyperactivity and impulsivity over time.

The Child Behavior Checklist Dysregulation Profile in Preschool Children: A Broad Dysregulation Syndrome.

OBJECTIVE: Children with concurrent impairments in regulating affect, behavior, and cognition can be identified with the Anxious/Depressed, Aggressive Behavior, and Attention Problems scales (or AAA scales) of the Child Behavior Checklist (CBCL). Jointly, these scales form the Dysregulation Profile (DP). Despite persuasive evidence that DP is a marker for severe developmental problems, no consensus exists on the preferred conceptualization and operationalization of DP in preschool years. We addressed this concern by testing and validating the factor structure of DP in a group of predominantly clinically referred preschool children. METHOD: Participants were 247 children (195 boys and 52 girls), aged 3.5 to 5.5 years. Children were assessed at baseline and 18 months later, using parent and teacher reports, a clinical interview with parents, behavioral observations, and neuropsychological tasks. RESULTS: Confirmatory factor analysis showed that a bifactor model, with a general DP factor and 3 specific factors representing the AAA scales, fitted the data better than a second-order model and a one-factor model for both parent-reported and teacher-reported child problem behavior. Criterion validity analyses showed that the DP factor was concurrently and longitudinally associated with markers of dysregulation and clinically relevant criteria, whereas the specific factors representing the AAA scales were more differentially related to those criteria. CONCLUSION: DP is best conceptualized as a broad syndrome of dysregulation that exists in addition to the specific syndromes as represented by the AAA scales. Implications for researchers and clinicians are discussed.

Executive functions in preschool children with ADHD and DBD: an 18-month longitudinal study.

In this longitudinal study, we examined the stability of the association between executive functions and externalizing behavior problems, and the developmental change of executive functions in a predominately clinically diagnosed preschool sample (N = 200). Inhibition and working memory performance were assessed three times in 18 months. Across time, poorer inhibition performance in young children was associated with attention deficit hyperactivity disorder (ADHD) and disruptive behavior disorders (DBD), and poorer working memory performance was associated with ADHD. Inhibition and working memory performance increased over time, especially in the early preschool period. The improvement of inhibition performance was more pronounced in the clinically diagnosed children compared to the TD children.

Stability and change of ODD, CD and ADHD diagnosis in referred preschool children.

Longitudinal studies have shown that preschool children's diagnosis of Oppositional Defiant Disorder (ODD), Conduct Disorder (CD) and Attention-Deficit/Hyperactivity Disorder (ADHD) are likely to persist into school age. However, limited attention has been paid to instability of diagnosis. The aim of the present study, therefore, was to investigate both stability and change of ODD, CD and ADHD diagnosis in children aged 3.5-5.5 years. For diagnosing these disorders, a semi-structured diagnostic parent interview, i.e., the Kiddie-Disruptive Behavior Disorder Schedule (K-DBDS), was used at the first assessment and at follow-up assessments (9 and 18 months). Five diagnostic stability groups (chronic, partial remission, full remission, new onset, no diagnosis) were compared with regard to impairment and number of symptoms. Participants were referred preschool children with externalizing behavioral problems (N = 193; 83% male) and typically developing (TD) children (N = 58; 71% male). Follow-up assessments allowed to distinguish children belonging to the chronic group of ODD, CD or ADHD from those belonging to one of the remission groups. In addition, there was a substantial number of children with a new onset diagnosis. In conclusion, as a complement to studies showing stability of ODD, CD and ADHD diagnosis into school age, present findings point to changes of diagnosis in the preschool and early school period. Diagnostic reassessments therefore are needed in this age group.

Clinical usefulness of the Kiddie-Disruptive Behavior Disorder Schedule in the diagnosis of DBD and ADHD in preschool children.

The aim of the present study was to investigate the clinical usefulness of a semi-structured diagnostic parent interview, i.e., the Kiddie-Disruptive Behavior Disorder Schedule (K-DBDS), in preschool children. For Oppositional Defiant Disorder (ODD), to define symptoms two coding methods were compared, i.e., one based on the threshold "often" and the other based on the frequency of behaviors in combination with the presence of clinical concern. For Attention-Deficit/Hyperactivity Disorder (ADHD), to define symptoms, two coding methods were compared, i.e., one with and one without consideration of pervasiveness across contexts. Participants were referred preschool children with externalizing behavioral problems (N = 193; 83% male) and typically developing (TD) children (N = 58; 71% male). The referred children were given a diagnosis of either ODD/CD (N = 39), or ADHD (N = 58) or comorbid ODD/CD+ADHD (N = 57) or no diagnosis (N = 39) based on best-estimate diagnosis. Receiver Operating Characteristic curve analyses showed that a cutoff score of four ODD symptoms using "often" as the threshold for frequency of behaviors led to a sensitivity of 87% and a specificity of 93%; the coding method which included the frequency of behaviors yielded a sensitivity of 56% and a specificity of 100%. For ADHD, a clinical cutoff score of five symptoms without the pervasiveness criterion yielded a sensitivity of 83% and a specificity of 98%; when the pervasiveness criterion was included sensitivity was 77% and specificity 98%. In the clinical assessment of ODD and ADHD in preschool children, the K-DBDS may be used with ODD symptom definition based on the threshold "often" and ADHD pervasiveness across contexts not included.

Clinical usefulness of observational assessment in the diagnosis of DBD and ADHD in preschoolers.

The aim of the present study was to investigate the clinical usefulness of an observational tool--the Disruptive Behavior Diagnostic Observation Schedule (DB-DOS)--in the diagnosis of disruptive behavior disorders (DBD) and attention deficit/hyperactivity disorder (ADHD) in preschoolers. We hypothesized that the DB-DOS may help support the presumption of a diagnosis generated by the information from parents and teachers (or other caregivers). Participants were referred preschool children with externalizing behavioral problems (N = 193; 83% male) and typically developing children (N = 58; 71% male). In view of the clinical validity study each child was given a diagnosis of either DBD (N = 40), or ADHD (N = 54) or comorbid (DBD + ADHD; N = 66) based on best-estimate diagnosis. The DB-DOS demonstrated good interrater and test-retest reliability for DBD and ADHD symptom scores. Confirmatory factor analysis demonstrated an excellent fit of the DB-DOS multidomain model of DBD symptom scores and a satisfactory fit of ADHD symptom scores. The DB-DOS demonstrated good convergent validity, moderate divergent validity, and good clinical validity on a diagnostic group level for DBD and ADHD symptom scores. The Receiver Operating Characteristic curve analyses revealed that for DBD the sensitivity and specificity are moderate and for ADHD good to excellent. The presumption of a diagnosis based on information from parents, teachers, and cognitive assessment was supported by the DB-DOS in 60% for DBD and 75% for ADHD. The DB-DOS can be used to help support a presumption of a DBD and/or ADHD diagnosis in preschool children.

Executive function deficits in preschool children with ADHD and DBD.

BACKGROUND: Impairments in executive functions (EF) are consistently associated with attention deficit hyperactivity disorder (ADHD) and to a lesser extent, with disruptive behavior disorder (DBD), that is, oppositional defiant disorder or conduct disorder, in school-aged children. Recently, larger numbers of children with these disorders are diagnosed earlier in development, yet knowledge about impairments in clinically diagnosed preschool children and the role of comorbidity is limited. Therefore, the aim of the current study was to examine EF in clinically referred preschool children with a clinical diagnosis of ADHD, DBD and ADHD + DBD. METHOD: Participants were 202 children aged 3.5-5.5 years, 61 with ADHD only, 33 with DBD only, 52 with comorbid ADHD + DBD and 56 typically developing children. Five EF tasks were administered. RESULTS: Confirmatory factor analysis showed that the two-factor model (inhibition and working memory) fit the data better than a one-factor model in this clinical sample. Preschoolers with ADHD displayed inhibition deficits, also after controlling for IQ. Likewise, preschoolers with DBD displayed impaired inhibition, but when IQ was controlled differences were carried mostly by the effect on the task where motivational demands were high (i.e. when tangible rewards were used). This pattern was also found in the interaction between ADHD and DBD; impaired inhibition in the comorbid group, however, was more severe than in the DBD group. Regarding working memory, few group differences were found. CONCLUSIONS: Clinically diagnosed preschool children with ADHD showed robust inhibition deficits, whereas preschool children with DBD showed impaired inhibition especially where motivational incentives were prominent. Severity of inhibition impairment in the comorbid group was similar to the ADHD group.