Systematic Review and Meta-analysis: The Science of Early-Life Precursors and Interventions for Attention-Deficit/Hyperactivity Disorder - 20/01/22
, Pedro F. Zuccolo, PhD 1, Iman Idrees, MSc 4, Priscilla B.G. Godoy, MSc 1, Erica Salomone, PhD 5, Camilla Ferrante, MSc 5, Paola Sorgato, MSc 5, Luís F.C.C. Catão, MD Candidate 1, Amy Goodwin, PhD 2, Patrick F. Bolton, PhD, FRCPsych 2, 3, Charlotte Tye, PhD 2, Madeleine J. Groom, PhD 4, Guilherme V. Polanczyk, MD, PhD 1Drs. Shepard and Zuccolo are co-first authors of this work.
Résumé |
Objective |
To evaluate which early neurocognitive and behavioral precursors are associated with the development of attention-deficit/hyperactivity disorder (ADHD) and whether these are currently targeted in early interventions.
Method |
We conducted 2 systematic reviews and meta-analyses of empirical studies to examine the following: (1) early-life (0-5 years) neurocognitive and behavioral precursors associated with familial likelihood for ADHD, an early ADHD diagnosis/elevated ADHD symptoms, and/or the presence of later-childhood ADHD; and (2) interventions delivered to children aged 0 to 5 years targeting the identified precursors or measuring these as outcomes. Standardized mean differences (Hedges’ g) and pre-post-treatment change scores (SMD) were computed.
Results |
A total of 149 studies (165,095 participants) investigating 8 neurocognitive and behavioral domains met inclusion criteria for part 1. Multi-level random-effects meta-analyses on 136 studies revealed significant associations between ADHD and poorer cognitive (g = −0.46 [95% CIs: −0.59, −0.33]), motor (g = −0.35 [CIs: −0.48, −0.21]) and language (g = −0.43 [CIs: −0.66, −0.19]) development, social (g = 0.23 [CIs: 0.03, 0.43]) and emotional (g = 0.46 [CIs: 0.33, 0.58]) difficulties, early regulatory (g = 0.30 [CIs: 0.18, 0.43]) and sleep (g = 0.29 [CIs: 0.14, 0.44]) problems, sensory atypicalities (g = 0.52 [CIs: 0.16, 0.88]), elevated activity levels (g = 0.54 [CIs: 0.37, 0.72]), and executive function difficulties (g = 0.34 [CIs: 0.05, 0.64] to −0.87 [CIs: −1.35, −0.40]). A total of 32 trials (28 randomized, 4 nonrandomized, 3,848 participants) testing early interventions that targeted the identified precursors met inclusion criteria for part 2. Multi-level random-effects meta-analyses on 22 studies revealed significant intervention-related improvements in ADHD symptoms (SMD = 0.43 [CIs: 0.22, 0.64]) and working memory (SMD = 0.37 [CIs: 0.06, 0.69]).
Conclusion |
Children aged 0 to 5 years with current or later-emerging ADHD are likely to experience difficulties in multiple neurocognitive/behavioral functions. Early interventions show some effectiveness in reducing ADHD symptoms, but their effects on neurocognitive/behavioral difficulties require further study.
Le texte complet de cet article est disponible en PDF.Key words : attention-deficit/hyperactivity disorder (ADHD), early-life precursors, neurocognition, early intervention, prevention
Plan
| E. Shephard is supported by a postdoctoral fellowship from the São Paulo Research Foundation (FAPESP; ref: 18/22396-7). L.F.C. Catão is supported by a scientific initiation bursary from FAPESP (ref: 19/24819-5). C. Tye is supported by the Tuberous Sclerosis Association and the National Institute for Health research (NIHR) Biomedical Research Centre at South London and Maudsley NHS Foundation Trust and King's College London. The views expressed are those of the authors and not necessarily those of the NHS, the NIHR, or the Department of Health and Social Care. Prof. Polanczyk is supported by FAPESP (grant 2016/22455-8) and the National Council for Scientific and Technological Development (CNPq; grant 310582/2017-2). |
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| This article is part of a special series devoted to the subject of child and adolescent attention-deficit/hyperactivity disorder (ADHD). The series covers a range of topics in the area including genetics, neuroimaging, treatment, and others. The series was edited by Guest Editor Jonathan Posner, MD, along with Deputy Editor Samuele Cortese, MD, PhD. |
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| This work has been prospectively registered: display_record.php?ID=CRD42020165286. |
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| Author Contributions Conceptualization: Shephard, Bolton, Tye, Groom, Polanczyk Data curation: Shephard, Zuccolo Formal analysis: Shephard, Zuccolo, Idrees, Godoy, Salomone, Ferrante, Sorgato, Catão, Goodwin, Tye, Groom, Polanczyk Methodology: Shephard, Zuccolo, Bolton, Groom, Polanczyk Project administration: Shephard, Zuccolo Supervision: Polanczyk Visualization: Shephard Writing – original draft: Shephard, Zuccolo, Bolton, Tye, Groom, Polanczyk Writing – review and editing: Shephard, Zuccolo, Idrees, Godoy, Salomone, Ferrante, Sorgato, Catão, Goodwin, Bolton, Tye, Groom, Polanczyk |
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| The authors are grateful to the authors of publications who responded to their requests for summary data for the computation of effect sizes. |
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| Disclosure: Prof. Polanczyk has been in the past 3 years a member of the advisory boards of Shire/Takeda and Medice and a speaker for Shire/Takeda, Novo Nordisk, and Aché. He has received travel expenses for continuing education support from Shire/Takeda and royalties from Editora Manole. Drs. Shephard, Zuccolo, Salomone, Goodwin, Prof. Bolton, Drs. Tye and Groom, Mss. Idrees, Godoy, Ferrante, Sorgato, and Mr. Catão have reported no biomedical financial interests or potential conflicts of interest. |
Vol 61 - N° 2
P. 187-226 - février 2022 Retour au numéro
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