ADHD affects school performance as early as 2nd grade

A study claims that ADHD can negatively affect a child's performance in school as early as the 2nd grade.

Attention-deficit/hyperactivity disorder can harm a child's academic performance and social skills as early as the second grade, a new Australian study contends.

Children between 6 and 8 years old who were tested and scored high for ADHD symptoms were more likely to get lower grades in elementary school and have trouble fitting in with other kids, compared with children without ADHD, the study authors reported.

Kids with ADHD also were more likely to have other mental health or developmental disorders, including anxiety, depression and autism, according to the study.

"Already at this stage, which is relatively young, it's very clear the children have important functional problems in every domain we registered," said study lead author Dr. Daryl Efron, a developmental-behavioral pediatrician with the Royal Children's Hospital Melbourne. "On every measure, we found the kids with ADHD were performing far poorer than the control children."

The researchers also said they discovered that about 80 percent of the young children with ADHD symptoms had not been diagnosed with the disorder, a finding called "striking" by Dr. David Fassler, a clinical professor of psychiatry at the University of Vermont College of Medicine.

"For this reason, I would fully agree with the authors' conclusion that the results of the study underscore the need for earlier recognition and treatment of ADHD in young children," Fassler said.

The study, published online Sept. 29 in the journal Pediatrics, is one of the first reports from the Children's Attention Project, a long-term examination of ADHD funded by the Australian government.

The researchers tested nearly 400 children between 6 and 8 years of age at 43 Melbourne schools, identifying 179 with ADHD and another 212 without ADHD who will serve as a "control group." These children will be observed throughout their academic careers.

By the second grade, the children with ADHD were already struggling. They were more likely to score below-average in reading and mathematics, and more likely to have problems connecting socially with their peers, the researchers said.

For example, 33 percent of kids with ADHD were reading below average and 46 percent had math skills below average. For non-ADHD kids, only about 6 percent were reading below average and nearly 15 percent had below-average math skills, the researchers found.

And the ADHD children were more likely to have other mental health or developmental problems -- such as anxiety, obsessive-compulsive disorder, depression, mania and autism, said Efron, who's also a senior lecturer at the University of Melbourne.

"Some people think it's only when kids get older you can pick up these comorbidities [overlapping health issues]. But we've shown you can pick them up at this early stage if you are looking for them," he said.

What's more, these problems seem to accumulate in some kids with ADHD, with 30 percent having two such impairments and 24 percent having three. By comparison, about 6 percent of non-ADHD kids had two such impairments, and about 1 percent had three, according to the study.

The investigators found that boys and girls with ADHD were equally impaired by the disorder.

"There hasn't been that much research into girls with ADHD, so we don't know that much," Efron said. "When we do see girls, in my experience, they are as impaired as the boys. But it is a novel research finding."

In another study published in the same issue of Pediatrics, researchers presented disappointing results for a drug that some had hoped would ease the insomnia experienced by many children with ADHD.

The drug, eszopiclone, failed to help children aged 6 to 17 with their ADHD-related insomnia. Both low and high doses of the drug proved ineffective, the researchers found.

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Children with ADHD perform worse than peers in second grade

A study shows that children with ADHD perform below their peers as early as second grade.

Children with attention-deficit/hyperactivity disorder (ADHD) perform well below their peers who do not have ADHD on multiple functional domains as early as grade 2, a new community-based study shows.

Daryl Efron, MD, Murdoch Children's Research Institute, Melbourne, Australia, and colleagues found that children with ADHD between 6 and 8 years of age were 11.0 times more likely to meet criteria for externalizing disorders than non-ADHD control children (P < .001).

They were also almost 3 times more likely than control individuals to meet criteria for internalizing disorders (P = .02).

On both reading and math computation, "striking" differences in academic performance were again observed between children who had ADHD and control children, equating to nearly a full standard deviation for both literacy and numeracy, the researchers report.

Children with ADHD were also more likely than control children to have problems with their peers according to both parent and teacher reports.

Yet prior to study enrollment, only 17% of children in the ADHD group had been diagnosed with ADHD, and only 13% were taking a medication for it.

"In their second year of school, children who had ADHD performed worse than controls across all functional domains, yet only a minority had been formally diagnosed with ADHD," investigators write.

"Findings highlight the need for earlier diagnosis and intervention."

The study was published online September 29 in Pediatrics.

High Comorbidity Burden

Participants were recruited from 43 elementary schools in metropolitan Melbourne, Australia.

The Conners 3 ADHD Index was distributed to parents of all second grade children in participating schools. Teachers completed the same measure.

Children were defined as screening negative for ADHD if their score on the ADHD Index was less than the 75th percentile (boys) or less than the 80th percentile (girls) by both parent and teacher reports and there was no parent-reported diagnosis of ADHD.

Each positive screen was randomly matched on sex and school to a negative screen.

ADHD Index cases were confirmed, and the presence of mental health comorbidities was assessed using the National Institute of Mental Health's Diagnostic Interview Schedule for Children, Version IV, conducted face-to-face with parents.

Children were classified as having an internalizing disorder if they met criteria for separation anxiety disorder; social phobia; generalized anxiety disorder; posttraumatic stress disorder; obsessive-compulsive disorder; hypomania; or manic episode.

Children were classified as having an externalizing disorder if they met criteria for oppositional defiant disorder or conduct disorder.

Academic achievement was assessed using the word reading and math computation subtests of the Wide Range Achievement Test 4, and social functioning was assessed by using the 5-item parent- and teacher-reported peer problems scale of the Strengths and Difficulties Questionnaire.

A total of 179 children with ADHD and 212 children without were compared across the various functional domains. Among those with ADHD, 93 had the combined ADHD subtype; 64, the inattentive subtype; and 22, the hyperactive subtype.

The most prevalent comorbid mental health disorder in children with ADHD was oppositional defiant disorder, affecting 54.2% of the group.

Children with ADHD were also significantly more likely than control children to have multiple impairments (P < .001).

The authors note that only 11% of children with ADHD had no functional impairments, compared with 57% of non-ADHD control children.

Children with ADHD "had a high burden of mental health comorbidities, were performing markedly worse academically, and had poorer peer relations," the investigators write.

"Our findings suggest that comorbidities are identifiable by early primary school age if symptoms are inquired about systematically."

"This is important," they add, "as children who have ADHD and comorbidities respond optimally to a combination of medication and behavioral interventions."

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