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

• Published in: Journal of the American Academy of Child and Adolescent Psychiatry Vol. 61; no. 2; pp. 187 - 226
• Main Authors: Shephard, Elizabeth, Zuccolo, Pedro F., Idrees, Iman, Godoy, Priscilla B.G., Salomone, Erica, Ferrante, Camilla, Sorgato, Paola, Catão, Luís F.C.C., Goodwin, Amy, Bolton, Patrick F., Tye, Charlotte, Groom, Madeleine J., Polanczyk, Guilherme V.
• Format: Journal Article
• Language: English
• Published: United States Elsevier Inc 01.02.2022; Elsevier BV
• Subjects: Attention Deficit Disorder with Hyperactivity - therapy; Attention deficit hyperactivity disorder; attention-deficit/hyperactivity disorder (ADHD); Behavior; Child; Child, Preschool; Childhood; Children; Clinical trials; Cognition; Cognitive ability; Early intervention; early-life precursors; Executive Function; Humans; Hyperactivity; Infant; Infant, Newborn; Intervention; Longitudinal studies; Medical diagnosis; Memory, Short-Term; Meta Analysis; neurocognition; Precursors; Preschool Children; prevention; Reviews; Short term memory; Social development; Systematic review; Young Children; attention-deficit/hyperactivity disorder (ADHD); neurocognition; early intervention; prevention; early-life precursors
• ISSN: 0890-8567; 1527-5418
• DOI: 10.1016/j.jaac.2021.03.016

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. 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. A total of 149 studies (165,095 participants) investigating 8 neurocognitive and behavioral domains met inclusion criteria for part 1. Multi-level 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]). 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.