Screening for attention-deficit/hyperactivity disorder (ADHD): can high-risk children be identified in first grade

Child: Care, Health, and Development, 05/04/2012

Holmberg K et al. – This study indicates a strong association between a teacher's report of a score >10 on the Conners scale in first grade and pervasive attention–deficit/hyperactivity disorder (ADHD) in grade four, while parental reports were less predictive.


  • The study population consisted of 422 first graders (6- to 7-year-olds) in one municipality in Stockholm County who were screened with Conners 10-item scale and followed up by ADHD assessment in grade four.
  • Sensitivity, specificity, likelihood ratios, and positive predictive value (PPV) of the screening by parents and teachers in first grade for being diagnosed with ADHD in fourth grade were calculated.


  • The prevalence of pervasive and situational ADHD was 5.7% and 5.9% respectively.
  • A score >10 on the Conners scale in first grade in teachers' reports identified 63% [95% confidence interval (CI): 43–79] of children diagnosed with pervasive ADHD in grade four (P < 0.001) with a PPV of 29% and a positive likelihood ratio (LR+) of 6.72.
  • Parental reports of a score >10 yielded a lower sensitivity (29%; 95% CI: 15–49), PPV of 20% and LR+ of 4.24 for pervasive ADHD.
  • The best predictor was a combination of parent and teacher scores >10 with a PPV of 50% and LR+ of 16.63.
  • Associations with situational ADHD were weak with LR+ of 1.81 and 2.49, respectively, for teachers' and parental scores >10.

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