Impact of early school-based screening and intervention programs for ADHD on children's outcomes and access to services: follow-up of a school-based trial at age 10 years.
OBJECTIVE
To investigate the impact of early school-based screening and educational interventions on longer-term outcomes for children at risk for attention-deficit/hyperactivity disorder (ADHD) and the predictive utility of teacher ratings.


METHODS
A population-based 5-year follow-up of a randomized, school-based intervention.


METHODS
Schools in England.


METHODS
Children between 4 and 5 years of age with high teacher-rated hyperactivity/inattention scores. Follow-up data were collected on 487 children in 308 schools.


METHODS
Following screening, using a 2 x 2 factorial design, schools randomly received an educational intervention (books about ADHD for teachers), the names of children with high hyperactivity/inattention scores between ages 4 and 5 years (identification), both educational intervention and identification, or no intervention.


METHODS
Parent-rated hyperactivity/inattention, impairment in classroom learning, and access to specialist health services for mental health or behavioral problems.


RESULTS
None of the interventions were associated with improved outcomes. However, children receiving the identification-only intervention were twice as likely as children in the no-intervention group to have high hyperactivity/inattention scores at follow-up (adjusted odds ratio, 2.11; 95% confidence interval, 1.12-4.00). Regardless of intervention, high baseline hyperactivity/inattention scores were associated with high hyperactivity/inattention and specialist health service use at follow-up.


CONCLUSIONS
We did not find evidence of long-term, generalizable benefits following a school-based universal screening program for ADHD. There may be adverse effects associated with labeling children at a young age.
Sayal
Kapil
K
Section of Developmental Psychiatry, University of Nottingham, Queen's Medical Centre, Nottingham, England. kapil.sayal@nottingham.ac.uk
Owen
Victoria
V
White
Kate
K
Merrell
Christine
C
Tymms
Peter
P
Taylor
Eric
E
D001289:Attention Deficit Disorder with Hyperactivity / Q000175:diagnosis* / Q000453:epidemiology / Q000628:therapy; D002648:Child; D002675:Child, Preschool; D004739:England / Q000453:epidemiology; D005260:Female; D005500:Follow-Up Studies; D006297:Health Services Accessibility; D006801:Humans; D008137:Longitudinal Studies; D008297:Male; D008403:Mass Screening / Q000458:organization & administration*; D011446:Prospective Studies; D012044:Regression Analysis; D012307:Risk Factors; D012572:School Health Services / Q000458:organization & administration*