Articles
ADHD in Swedish 3- to 7-Year-Old Children

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ABSTRACT

Objective

To study characteristics of attention-deficit/hyperactivity disorder (ADHD) in a representative group of clinically impaired young children in Sweden with the disorder.

Method

One hundred thirty-one children with ADHD (aged 3–7 years) were examined, and their parents were interviewed. Independent parent questionnaire data (Child Behavior Checklist, ADHD Rating Scale-IV, Conners) were collected. For comparison 131 children without ADHD were matched for age, gender, parents’ marital status, child's adoption status, and social class.

Results

Children with ADHD had extremely high ADHD symptom levels—on average four to eight times higher than the comparison group. Sociodemographic correlates of ADHD symptoms were more pronounced in parent questionnaire data than in parent interview data, underscoring the importance of diagnostic interview when dealing with clinical issues. Very few of the children with ADHD (6%) appeared “normal” with regard to attention/activity level at clinical examination.

Conclusions

Clinic children with a diagnosis of DSM-IV ADHD have typical and impairing symptoms already before starting school. The variance of ADHD in this age group appears to be accounted for by primary psychosocial factors only to a limited degree. It would seem reasonable to establish supportive and treatment measures for these young children so that the psychosocial and academic problems shown by so many individuals with ADHD later in their development might be reduced.

Section snippets

METHOD

Children (n = 262), 3 to 7 years of age, were studied in detail in a prospective, controlled, longitudinal survey of intervention effects in ADHD. There were 49 three-year-olds, 62 four-year-olds, 65 five-year-olds, 39 six-year-olds, and 47 seven-year-olds. Swedish children, at the time of this study, started school at age 7 years. The 7-year-olds were included in the study before or upon starting school. The study groups comprised 131 children (101 boys, 30 girls) with ADHD and 131 children

Characteristics of the ADHD Group According to Parent Interview

The mean number of ADHD symptoms shown by each child was 12.2 (SD 2.1). Children with ADHD had higher rates of symptoms on the hyperactivity-impulsivity factor than on the attention dysfunction factor (6.8, SD 2.2 versus 5.4, SD 2.0;p < .01) according to parent interview.

Characteristics of Children With ADHD at Clinical Observation

The rate of observed problems at clinical evaluation of the child is shown in Table 1. Only 6% of the 131 children with ADHD were judged to be problem-free at clinical examination. Collapsed problem scores ranged from 0 to 8. A

DISCUSSION

This is among the first systematic, controlled, relatively large-scale studies of preschool children with ADHD. Previous studies have been retrospective. The present results should therefore be of particular interest to clinicians and researchers working with young children.

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    This work was supported by grants from the Swedish Council for Social Research ( grant 97-0223), Swedish Foundation for Health Care Sciences and Allergy Research ( grant V97-320), and Swedish MRC ( grant K2000-21X-11251-06C) to Christopher Gillberg.

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