Preschool regulatory problems and attention-deficit/hyperactivity and cognitive deficits at school age in children born at risk: different phenotypes of dysregulation?

Early Hum Dev. 2014 Aug;90(8):399-405. doi: 10.1016/j.earlhumdev.2014.05.001. Epub 2014 Jun 2.


Background: Early regulatory problems (RP), i.e., excessive crying, feeding, and sleeping difficulties, have been reported to be predictors of cognitive and attention-deficit/hyperactivity problems. However, previous studies had limitations such as small sample size or retrospective design.

Aim: To investigate whether persistent RP from infancy until preschool age are precursors of ADHD problems and cognitive deficits at school age.

Study design: A prospective study from birth to 8.5years of age.

Subjects: 1120 infants born at risk.

Measures: RP were assessed at 5months (i.e., excessive crying, feeding, and sleeping problems), 20, and 56months (i.e., eating and sleeping problems) via parent interviews and neurological examination. At 8.5years of age, IQ was assessed by a standard test (K-ABC), and ADHD problems by direct observations in the test situation and by the Mannheimer Parent Interview (MPI, DSM-IV diagnosis of ADHD).

Results: 23.8% of the sample born at risk had RP at least at two measurement points until preschool age. Persistent RP predicted lower IQ (β=-.17; 95% CI (-.21; -.10)), behaviour problems (β=-.10; 95% CI (-.15; -.03)), attention (OR 2.43; 95% CI (1.16; 5.09)) and hyperactivity problems (OR 3.10; 95% CI (1.29; 7.48)), and an ADHD diagnosis (OR 3.32; 95% CI (1.23; 8.98)) at school age, even when controlled for psychosocial and neurological confounders.

Conclusions: Early persistent RP increased the odds of ADHD and associated problems at school age, indicating a cascade model of development, i.e., infant behaviour problems provide the starting point of a trajectory of dysregulation through time.

Keywords: Attention-deficit/hyperactivity disorder; Crying problems; Dysregulation; Feeding problems; Sleeping problems.

Publication types

  • Research Support, Non-U.S. Gov't

MeSH terms

  • Attention Deficit Disorder with Hyperactivity / etiology*
  • Child
  • Child Behavior Disorders / etiology
  • Child, Preschool
  • Cognition Disorders / etiology
  • Female
  • Humans
  • Infant
  • Infant Behavior*
  • Infant, Newborn
  • Intelligence Tests
  • Male
  • Parents
  • Prospective Studies
  • Risk Factors
  • Sleep Initiation and Maintenance Disorders / etiology*