Development matters: Characterizing patterns of emergent ADHD risk through a neurodevelopmental framework

Attention deficit/hyperactivity disorder (ADHD) is a prevalent and impairing early childhood disorder that presents notable challenges to normative development in academic, social, and behavioral domains. A growing body of scientific literature supports the validity of identifying ADHD at preschool age when developmentally based assessments are employed. Of note, identification of concerning attention dysregulation, before frank disorder presents, could ameliorate the negative developmental cascades associated with ADHD and related impairment. Thus, the current project applies methods of conservatively identifying early vulnerability to ADHD by seeking to determine when stable patterns of attention (dys)regulation occur across the transition to toddlerhood (~12-34 months), drawing on novel measures capturing the typical:atypical spectrum of neurodevelopmental and behavioral indicators of attention (dys)regulation: parent survey and standardized clinical observation. The project engages a community-based sample of children recruited at their first annual well-child visits and oversampled for psychopathology risk (i.e., irritability). Initial examination of outcomes at later time points indicates that the sample is well-characterized for ADHD symptoms with prevalence matching other community samples. Under this award, the candidate will train in innovative methods of risk characterization (including latent class analysis) and predictive hierarchical modeling, to generate a multi-level (measurement) model of data collected at 12 months, validating these measures clinically with developmentally based ADHD outcomes at 24 and 36 months. Building from this, predictive model-based weights of each measure (based on the added value of each in the models) will inform a clinical decision-making algorithm that specifies which measures are needed, and for whom. All models treat outcomes dimensionally, building on the work of key project collaborators. Meanwhile, semi-structured in-depth interviews with stakeholders take a stakeholder-engaged, caregiver-centered approach to revising clinically translatable measures (specifically the survey and observation tools) for use with ethnically/racially diverse families. This mixed-methods approach seeks to characterize neurodevelopmental vulnerability to ADHD at the earliest point in the developmental sequence, establishing an empirically grounded, equitable approach to assessment and conceptualization of ADHD risk at infant age.