Drs. Shephard, Zuccolo, Prof. Polanczyk, Ms. Godoy, and Mr. Catão are with Faculdade de Medicina FMUSP, Universidade de São Paulo, Brazil; Drs. Shephard, Goodwin, Tye, and Prof. Bolton are with Institute of Psychiatry, Psychology & Neuroscience (IoPPN), King's College London, United Kingdom.
Drs. Shephard, Zuccolo, Prof. Polanczyk, Ms. Godoy, and Mr. Catão are with Faculdade de Medicina FMUSP, Universidade de São Paulo, Brazil.
J Am Acad Child Adolesc Psychiatry. 2022 Feb;61(2):187-226. doi: 10.1016/j.jaac.2021.03.016. Epub 2021 Apr 20.
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.
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.
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]).
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.
评估哪些早期神经认知和行为指标与注意力缺陷/多动障碍（ADHD）的发展相关，以及这些指标是否是目前早期干预的目标。
我们进行了两项系统评价和荟萃分析，以检验以下内容：（1）与家族性 ADHD 易感性、早期 ADHD 诊断/ADHD 症状升高以及/或儿童后期 ADHD 相关的生命早期（0-5 岁）神经认知和行为指标；（2）针对已确定的 ADHD 生物标志物或将其作为结果进行测量的 0-5 岁儿童的干预措施。计算了标准化均数差值（Hedges'g）和治疗前后变化值（SMD）。
共有 149 项研究（165095 名参与者）调查了 8 个神经认知和行为领域，符合第 1 部分的纳入标准。对 136 项研究的多水平随机效应荟萃分析显示，ADHD 与较差的认知（g=-0.46[95%CI:-0.59,-0.33]）、运动（g=-0.35[CI:-0.48,-0.21]）和语言（g=-0.43[CI:-0.66,-0.19]）发育、社会（g=0.23[CI:0.03,0.43]）和情绪（g=0.46[CI:0.33,0.58]）困难、早期调节（g=0.30[CI:0.18,0.43]）和睡眠（g=0.29[CI:0.14,0.44]）问题、感觉异常（g=0.52[CI:0.16,0.88]）、活动水平升高（g=0.54[CI:0.37,0.72]）和执行功能障碍（g=0.34[CI:0.05,0.64]至-0.87[CI:-1.35,-0.40]）存在显著关联。共有 32 项试验（28 项随机试验、4 项非随机试验、3848 名参与者）符合第 2 部分纳入标准，这些试验测试了针对已确定的 ADHD 生物标志物的早期干预措施。对 22 项研究的多水平随机效应荟萃分析显示，ADHD 症状（SMD=0.43[CI:0.22,0.64]）和工作记忆（SMD=0.37[CI:0.06,0.69]）方面的干预相关改善具有统计学意义。
当前或以后出现 ADHD 的 0-5 岁儿童可能会出现多种神经认知/行为功能障碍。早期干预措施显示对 ADHD 症状有一定的减轻效果，但它们对神经认知/行为障碍的影响仍需要进一步研究。
