Assessment of attention-deficit hyperactivity disorder in preschoolers

Twenty-six preschoolers, 13 with Attention-Deficit Hyperactivity Disorder (ADHD), and 13 without ADHD, were assessed with respect to the following: Psychosocial Functioning, Attention, Impulsivity, and Hyperactivity. Two new behavioral coding systems, a new test of inhibitory control. and a new test of vigilance were specifically designed for preschoolers to measure activity, impulsivity, and attention. Preschoolers with ADHD were rated by their parents as significantly more stressful to manage, less reinforcing, more demanding, less adaptable to change, and less compatible with the parent. Although family functioning was rated to be within the average range for both groups, mothers of preschoolers with ADHD rated themselves as exhibiting more symptoms of depression, and a sense of reduced parental competence. During structured tasks, preschoolers with ADHD more often grabbed materials, and required more frequent directives from an examiner. During unstructured tasks the preschoolers with ADHD more often played with a set of "off-limits toys". Activity level, as well as squirming, did not reliably distinguish between the preschoolers with and without ADHD. Finally, preschoolers with ADHD, consistent with the school-age ADHD literature, committed significantly more errors of commission on a preschool vigilance task. Discussion focuses on the clinical validity of this protocol, the importance of assessing preschoolers with developmentally appropriate measures of attention and behavior, and of interpreting their profiles within a neurodevelopmental framework.