Screening for attention-deficit/hyperactivity disorder (ADHD): can high-risk children be identified in first grade?

Child Care Health Dev. 2013 Mar;39(2):268-76. doi: 10.1111/j.1365-2214.2012.01382.x. Epub 2012 Apr 20.


Aim: Recent studies have demonstrated the beneficial long-term effects of an indicated parent support programme for acting out behaviour in pre-school children with attention-deficit/hyperactivity disorder (ADHD) traits. In this study we wanted to assess different thresholds for screening with the Conners scale for hyperactive-inattentive behaviours in first grade for ADHD in grade four.

Method: The study population consisted of 422 first graders (6- to 7-year-olds) in one municipality in Stockholm County who were screened with Conners 10-item scale and followed up by ADHD assessment in grade four. Sensitivity, specificity, likelihood ratios, and positive predictive value (PPV) of the screening by parents and teachers in first grade for being diagnosed with ADHD in fourth grade were calculated.

Results: The prevalence of pervasive and situational ADHD was 5.7% and 5.9% respectively. A score ≥ 10 on the Conners scale in first grade in teachers' reports identified 63% [95% confidence interval (CI): 43-79] of children diagnosed with pervasive ADHD in grade four (P < 0.001) with a PPV of 29% and a positive likelihood ratio (LR+) of 6.72. Parental reports of a score ≥ 10 yielded a lower sensitivity (29%; 95% CI: 15-49), PPV of 20% and LR+ of 4.24 for pervasive ADHD. The best predictor was a combination of parent and teacher scores ≥ 10 with a PPV of 50% and LR+ of 16.63. Associations with situational ADHD were weak with LR+ of 1.81 and 2.49, respectively, for teachers' and parental scores ≥ 10.

Conclusions: This study indicates a strong association between a teacher's report of a score ≥ 10 on the Conners scale in first grade and pervasive ADHD in grade four, while parental reports were less predictive.

Publication types

  • Evaluation Study
  • Research Support, Non-U.S. Gov't

MeSH terms

  • Attention Deficit Disorder with Hyperactivity / diagnosis*
  • Attention Deficit Disorder with Hyperactivity / epidemiology
  • Attention Deficit Disorder with Hyperactivity / etiology
  • Child
  • Early Diagnosis
  • Educational Status
  • Faculty
  • Female
  • Humans
  • Male
  • Mass Screening / methods
  • Parents
  • Predictive Value of Tests
  • Psychiatric Status Rating Scales
  • Risk Factors
  • School Health Services
  • Sensitivity and Specificity
  • Sex Factors
  • Sweden / epidemiology