ADHD symptoms and diagnosis in adult preterms: systematic review, IPD meta-analysis, and register-linkage study

Rachel Robinson; Polina Girchenko; Anna Pulakka; Kati Heinonen; Anna Lähdepuro; Marius Lahti-Pulkkinen; Petteri Hovi; Marjaana Tikanmäki; Peter Bartmann; Aulikki Lano; Lex W Doyle; Peter J Anderson; Jeanie L Y Cheong; Brian A Darlow; Lianne J Woodward; L John Horwood; Marit S Indredavik; Kari Anne I Evensen; Neil Marlow; Samantha Johnson; Marina Goulart de Mendonca; Eero Kajantie; Dieter Wolke; Katri Räikkönen

doi:10.1038/s41390-021-01929-1

ADHD symptoms and diagnosis in adult preterms: systematic review, IPD meta-analysis, and register-linkage study

Pediatr Res. 2023 Apr;93(5):1399-1409. doi: 10.1038/s41390-021-01929-1. Epub 2022 Jan 7.

Authors

Rachel Robinson¹, Polina Girchenko², Anna Pulakka³, Kati Heinonen^{2

4}, Anna Lähdepuro², Marius Lahti-Pulkkinen^{2

3}, Petteri Hovi³, Marjaana Tikanmäki³, Peter Bartmann⁵, Aulikki Lano^{2

6}, Lex W Doyle^{7

8

9}, Peter J Anderson^{9

10

11}, Jeanie L Y Cheong^{7

8

9}, Brian A Darlow¹¹, Lianne J Woodward¹², L John Horwood¹¹, Marit S Indredavik¹³, Kari Anne I Evensen^{13

14}, Neil Marlow¹⁵, Samantha Johnson¹⁶, Marina Goulart de Mendonca^{17

18}, Eero Kajantie^{2

3

6

19}, Dieter Wolke¹⁷, Katri Räikkönen²

Affiliations

¹ University of Helsinki, Helsinki, Finland. Rachel.robinson@helsinki.fi.
² University of Helsinki, Helsinki, Finland.
³ Finnish Institute for Health and Welfare, Helsinki, Finland.
⁴ Faculty of Social Sciences, Tampere University, Tampere, Finland.
⁵ Department of Neonatology, University of Bonn, Bonn, Germany.
⁶ Children's Hospital, University of Helsinki and Helsinki University Hospital, Helsinki, Finland.
⁷ Royal Women's Hospital, Melbourne, VIC, Australia.
⁸ University of Melbourne, Melbourne, VIC, Australia.
⁹ Murdoch Children's Research Institute, Melbourne, VIC, Australia.
¹⁰ Turner Institute for Brain and Mental Health, School of Psychological Sciences, Monash University, Clayton, VIC, Australia.
¹¹ Department of Paediatrics, University of Otago, Christchurch, New Zealand.
¹² University of Canterbury, Christchurch, New Zealand.
¹³ Department of Clinical and Molecular Medicine, Norwegian University of Science and Technology, Trondheim, Norway.
¹⁴ Department of Physiotherapy, Oslo Metropolitan University, Oslo, Norway.
¹⁵ University College London, London, UK.
¹⁶ University of Leicester, Leicester, UK.
¹⁷ University of Warwick, Coventry, UK.
¹⁸ Department of Neuroscience, Psychology and Behaviour, School of Psychology, University of Leicester, Leicester, UK.
¹⁹ PEDEGO Research Unit, MRC Oulu, Oulu University Hospital and University of Oulu, Oulu, Finland.

Abstract

Background: This study examined differences in ADHD symptoms and diagnosis between preterm and term-born adults (≥18 years), and tested if ADHD is related to gestational age, birth weight, multiple births, or neonatal complications in preterm borns.

Methods: (1) A systematic review compared ADHD symptom self-reports and diagnosis between preterm and term-born adults published in PubMed, Web of Science, and PROQUEST until April 2021; (2) a one-stage Individual Participant Data(IPD) meta-analysis (n = 1385 preterm, n = 1633 term; born 1978-1995) examined differences in self-reported ADHD symptoms[age 18-36 years]; and (3) a population-based register-linkage study of all live births in Finland (01/01/1987-31/12/1998; n = 37538 preterm, n = 691,616 term) examined ADHD diagnosis risk in adulthood (≥18 years) until 31/12/2016.

Results: Systematic review results were conflicting. In the IPD meta-analysis, ADHD symptoms levels were similar across groups (mean z-score difference 0.00;95% confidence interval [95% CI] -0.07, 0.07). Whereas in the register-linkage study, adults born preterm had a higher relative risk (RR) for ADHD diagnosis compared to term controls (RR = 1.26, 95% CI 1.12, 1.41, p < 0.001). Among preterms, as gestation length (RR = 0.93, 95% CI 0.89, 0.97, p < 0.001) and SD birth weight z-score (RR = 0.88, 95% CI 0.80, 0.97, p < 0.001) increased, ADHD risk decreased.

Conclusions: While preterm adults may not report higher levels of ADHD symptoms, their risk of ADHD diagnosis in adulthood is higher.

Impact: Preterm-born adults do not self-report higher levels of ADHD symptoms, yet are more likely to receive an ADHD diagnosis in adulthood compared to term-borns. Previous evidence has consisted of limited sample sizes of adults and used different methods with inconsistent findings. This study assessed adult self-reported symptoms across 8 harmonized cohorts and contrasted the findings with diagnosed ADHD in a population-based register-linkage study. Preterm-born adults may not self-report increased ADHD symptoms. However, they have a higher risk of ADHD diagnosis, warranting preventive strategies and interventions to reduce the presentation of more severe ADHD symptomatology in adulthood.

Publication types

Systematic Review
Meta-Analysis
Research Support, Non-U.S. Gov't

MeSH terms

Adolescent
Adult
Attention Deficit Disorder with Hyperactivity* / diagnosis
Attention Deficit Disorder with Hyperactivity* / epidemiology
Birth Weight
Female
Gestational Age
Humans
Infant, Newborn
Parturition
Pregnancy
Pregnancy, Multiple
Premature Birth* / prevention & control
Young Adult

Abstract

Publication types

MeSH terms

Grants and funding