Systematic Review and Meta-analysis: The Science of Early-Life Precursors and Interventions for Attention-Deficit/Hyperactivity Disorder

Author(s):Show less -

Shephard, Elizabeth ^{[1, 2]} ; Zuccolo, Pedro F. ^[1] ; Idrees, Iman ^[3] ; Godoy, Priscilla B. G. ^[1] ; Salomone, Erica ^[4] ; Ferrante, Camilla ^[4] ; Sorgato, Paola ^[4] ; Catao, Luis F. C. C. ^[1] ; Goodwin, Amy ^[2] ; Bolton, Patrick F. ^{[5, 2, 6]} ; Tye, Charlotte ^[2] ; Groom, Madeleine J. ^[3] ; V. Polanczyk, Guilherme ^[1]

Affiliation

^[1] Univ Sao Paulo, Fac Med FMUSP, Sao Paulo - Brazil

^[2] Kings Coll London, Inst Psychiat Psychol & Neurosci IoPPN, London - England

^[3] Univ Nottingham, Inst Mental Hlth, Nottingham - England

^[4] Univ Milano Bicocca, Milan - Italy

^[5] South London & Maudsley NHS Fdn Trust, London - England

^[6] Kings Coll London, Maudsley NIHR Biomed Res Ctr Mental Hlth, London - England

• Document type: Review article
• Source: JOURNAL OF THE AMERICAN ACADEMY OF CHILD AND ADOLESCENT PSYCHIATRY; v. 61, n. 2, p. 187-226, FEB 2022.
• Web of Science Citations: 3

Abstract

Objective: To evaluate which early neurocognitive and behavioral precursors are associated with the development of attention-deficit/hyperactivity disorder (ADHD) and whether these are currently targeted in early interventions. Method: We conducted 2 systematic reviews and meta-analyses of empirical studies to examine the following: (1) early-life (0-5 years) neurocognitive and behavioral precursors associated with familial likelihood for ADHD, an early ADHD diagnosis/elevated ADHD symptoms, and/or the presence of later-childhood ADHD; and (2) interventions delivered to children aged 0 to 5 years targeting the identified precursors or measuring these as outcomes. Standardized mean differences (Hedges' g) and pre-post-treatment change scores (SMD) were computed. Results: A total of 149 studies (165,095 participants) investigating 8 neurocognitive and behavioral domains met inclusion criteria for part 1. Multilevel random-effects meta-analyses on 136 studies revealed significant associations between ADHD and poorer cognitive (g = -0.46 {[}95% CIs: -0.59, -0.33]), motor (g = -0.35 {[}CIs: -0.48, -0.21]) and language (g = -0.43 {[}CIs: -0.66, -0.19]) development, social (g = 0.23 {[}CIs: 0.03, 0.43]) and emotional (g = 0.46 {[}CIs: 0.33, 0.58]) difficulties, early regulatory (g = 0.30 {[}CIs: 0.18, 0.43]) and sleep (g = 0.29 {[}CIs: 0.14, 0.44]) problems, sensory atypicalities (g = 0.52 {[}CIs: 0.16, 0.88]), elevated activity levels (g = 0.54 {[}CIs: 0.37, 0.72]), and executive function difficulties (g = 0.34 {[}CIs: 0.05, 0.64] to -0.87 {[}CIs: -1.35, -0.40]). A total of 32 trials (28 randomized, 4 nonrandomized, 3,848 participants) testing early interventions that targeted the identified precursors met inclusion criteria for part 2. Multi-level random-effects meta-analyses on 22 studies revealed significant intervention-related improvements in ADHD symptoms (SMD = 0.43 {[}CIs: 0.22, 0.64]) and working memory (SMD = 0.37 {[}CIs: 0.06, 0.69]). Conclusion: Children aged 0 to 5 years with current or later-emerging ADHD are likely to experience difficulties in multiple neurocognitive/behavioral functions. Early interventions show some effectiveness in reducing ADHD symptoms, but their effects on neurocognitive/behavioral difficulties require further study. (AU)

• FAPESP's process: 16/22455-8 - Early childhood interventions and trajectories of cognitive, social and emotional development
• Grantee: Guilherme Vanoni Polanczyk
• Support Opportunities: Research Projects - Thematic Grants
• FAPESP's process: 18/22396-7 - A multimodal neuroimaging investigation of changes in neural circuitry during early interventions for neurodevelopmental disorders
• Grantee: Elizabeth Shephard
• Support Opportunities: Scholarships in Brazil - Post-Doctoral
• FAPESP's process: 19/24819-5 - Understanding emotional processing in ADHD: an analysis of empirical electrophysiological data in preschool children
• Grantee: Luís Felipe Chagas Caldeira Catão
• Support Opportunities: Scholarships in Brazil - Scientific Initiation