Journal of consulting and clinical psychology



This paper explores three published articles that scrutinized the effectiveness of the Diagnostic Statistic Manuel-4th edition, predictive criteria for Attention- Deficit/Hyperactivity Disorder within preschool-age children. The articles however, disagreed on methodology, yet concurred on DSM-IV predictive validity among preschool-age. Lahey et al. (2004) suggest that even though discretion may be required, most of the preschool children who met full criteria for Attention- Deficit/Hyperactivity Disorder continued manifesting the symptoms and associating ailments during elementary school years. Other articles used different approaches and methodologies, yet still help support main point. This paper examines Lahey et al.'s investigation in relation to other two research articles to DSM-IV criteria for Attention- Deficit/Hyperactivity Disorder predictive validity among preschool-age children.

Keywords: Attention- Deficit/Hyperactivity Disorder, Diagnostic Statistic Manual 4th edition

DSM-IV Predictive Validity for Attention-Deficit/Hyperactivity Disorder in Preschool-age Children

The population of children diagnoses with Attention- Deficit /Hyperactivity Disorder (ADHD) has spread in recent years. Many educators, clinicians, and researchers have obvious concerns about this growing problem. However, many of the existing experiential findings have reckoned on measures designed for older children. Greater social and academic ailments, exceptional education placement, and accidentally injuries correlated with children who met DSM-IV symptom criteria for ADHD (Lahey, B.B., Pelham, W.E., Loney, J., Kipp, H., Ehrhardt, A., Lee, S.S., Willcut, E.G., Hartung, L.M., Chronis, A. & Massetti, G., 2004). Nevertheless the power of the current Diagnostic and Statistical Manual, 4th edition (DSM-IV) definition of ADHD has not been thoroughly analyzed for preschool-age children (Tandon,M.,Si,X.,Belden,A.,&Luby,J., 2009).

Lahey et al. (2004) scrutinized the predictive validity of the DSM-IV definition criterion for ADHD among preschool-age. This paper examines Lahey et al.'s analysis, as well as Harvey et al.'s & Tandon et al.'s supporting researches to suggest that the DSM-IV criteria for ADHD can be acceptable and effective within preschool-age children.

In 1995, Lahey et al. (2004) began an investigation that researches the soundness of ADHD in children diagnoses at 4-6 years-old. Concerns for how ADHD affects an estimated of 3% to 10% school age children helped develop this study. Preschool-age was a paramount concern due to evolving social skills problems and the recent growth of psychoactive content within children who met DSM-IV symptom criteria for ADHD (Lahey et al., 2004).

Lahey et al. (2004) addressed two prominent inquiries. First, if ADHD have predictive, cogency when assessing 4-6 year-old children in longitudinal period. Second, if DSM-IV definition for ADHD functioned as an early indicator when assessing these children in a longitudinal period. The investigation focused their sample around 4-6 year-old children who met DSM-IV definition criteria for ADHD. The sample consisted originally of 310 qualified participants, which were later, divided into comparison group (children that did not meet DSM-IV criteria for ADHD) and probands (children that met full criteria for ADHD). Vetting procedures reduced the sample to 255 (Lahey et al. 2004).

The result in this study demonstrated that 4-6 year-old children who met full criteria for ADHD would likely continue meeting criteria for ADHD. Children would also continue displaying basic ailments comparing to comparison group. Therefore, this finding strongly supported the predictive cogency of the DSM-IV definition for ADHD among preschool-age children (Lahey et al., 2004). The present research percentages were 31% of situational ADHD children met full diagnostic criteria for ADHD and was more impaired than the comparison group, in waves 2-4 compared with 3.1% of the comparison group. The findings also suggested that children who met symptom criteria for impairment in wave 1 will eventually meet full diagnostic criteria for ADHD (Lahey et al., 2004). Strong evidence support that those children who met full criteria will continue displaying deficiency over time.

One limitation to the study is the impairment measure used, instead of the indicative criterion; however, the authors suggested that further research must be developed regarding this issue. Another limitation to the study is the use of only one functional interpretation for "cross-situational impairment". The use of only one interpretation may have affected the study. Lahey at al. (2004) suggested that further research needed to be done in regards to this criterion.

Similarly, Harvey et al.'s (2009) scrutinized the predictability of early preschool measures to determine future identification of ADHD, oppositional defiant disorder (ODD), and conduct disorder (CD). In the research report by Harvey et al. (2009) three prominent queries were addressed. First, if the DSM-IV-based diagnostic interview had predictive cogency when identifying later ADHD and ODD/CD behavior among preschool children. Second, the additional predictive control mothers', fathers' and teachers' can include (if any) on rating scales and direct observation. Third, the most appropriate time (3-years or late preschool age) to predict future detection when using the diagnostic interview and parent rating scales. Harvey et al. (2009) developed a 4-year longitudinal study of preschool children who met the criteria definition for ADHD. A sample of 199 children from a total of 1,752 enrolled in the study at time 1. The research used a variety of measures: diagnostic interview (completed by parents at Time 1, 2, and 3), Hyperactivity Attention Problems and Aggression Subscale of the BASC (completed by parents and teachers at Time 1, 2, and 3), Videotaped assessment of child behavior at Time 1, and Clinicians Diagnostic completed at time 4 (Harvey et al., 2009).

Harvey et al. (2009) provided pertinent information regarding the consistency of preschool ADHD manifestations. These findings stated that the DSM-IV based diagnostic interview combined with others standardized rating scales may be useful in identifying at-risk preschool. Harvey et al. (2009) findings were consistent with Lahey et al. (2004) research. One limitation to this study is that judgment should always be used when inferring and analyzing children with ADHD manifestations, especially in distractive or inattentive behavior. Second, differential attrition may have biased estimates of OPP, (although this information does not concern this paper). Third, clinician-based diagnoses could have influenced by administration measures during Time 4. Finally, the lack of teacher reports at age 4 and 5 (Harvey et al. 2009). Despite these limitations, results confirmed the strength of preschool ADHD criteria, as well as DSM-IV predictive validity, yet Harvey et al. (2009) suggested future investigation.

Consequently, Tandon, et al. (2009) addressed the issue by using a performance-based benchmark analysis. Three hypotheses addressed the investigation. First, Tandon et al. (2009) predicted that preschoolers diagnosed with DSM-IV ADHD would have decreased overall accuracy scores in the visual attention execution evaluation. Second, preschoolers with ADHD inattentive subtype would have greater omission errors than the other subtypes, and third, those with ADHD-hyperactive/impulsive subtype would have greater commission error than the other subtype. The core of the study was to determine whether attentional impairments in preschoolers with DSM-IV ADHD could be observed (Tandon et al., 2009). The diagnostic test group consisted on 304 demographically diverse group of preschooler, categorized into 3, 4, and 5 year old age groups that either met DSM-IV ADHD criteria or did not.

The findings indicated ailments only in 4.0-4.11 year-old diagnostic with DSM-IV ADHD. Tandon et al. (2009) findings also supported the main topic of this paper. The current DSM-IV criteria for ADHD seemed to be an age valid measure for 4 year-old preschoolers. However, these findings were not detected in either 3 or 5 year-old children. A limitation of this study is that there is a possibility that the 5 year old evaluation was more difficult than the 4 year old evaluation. Another limitation to the study is that it is not longitudinal. Findings based on preschoolers current scores rather than later scores (Tandon el at., 2009).

All in all, the results indicate that the DSM-IV definition for ADHD can be used as a predictive measure in preschool-age children (Harvey et al., 2009; Lahey et al., 2004 & Tandon et al., 2009). It can be assumed from these three literatures review that the DSM-IV definition description is appropriate for the identification of at-risk 4 year-old preschoolers, while earlier diagnosis (younger than 4 years-old) remains somewhat unclear.

Addressing the complete preschool-age population requires further investigation; it requires a thorough mobility not just from concerned parents and educators, but scholar researchers that will develop inductive studies regarding this issue. It is crucial to understand that the main purpose of identifying at-risk preschoolers is not to "label" them; on the contrary, the identification of at-risk preschoolers will help develop early interventions strategies and parenting skills focused on the child's proper develop of social, emotional, and academic skills.

Are the articles scholarly?

Scholarly articles are original research written to enhance scholarly study field. Capella scholar learners must learn how to identify and choose relevant scholarly articles. Scholarly articles can be distinguished by analyzing authors' credentials, purpose, audience, terminology, structure, and format.

All articles chosen were scholarly articles. Each title acted as a brief summary of the article content. The article also used technical field vocabulary as well as inductive, reasoning information. Articles required that readers had the highest level of Bloom Taxonomy, in order to evaluate and interpreted the data. Authors' credentials were also provided either at the beginning of the article (supporting article) or the end (main and supporting article). Each article established a researcher as point of contact regarding the research.

Furthermore, the purpose of all the articles was to present research findings. The articles audience was field scholar researchers, as well as scholar students. Structure and composition of the articles were also scholarly. The articles provided an abstract, formulated the problem, objectives or hypothesis, methodologies, graphics that showed the data, results, limitations or further experimental proposal, conclusion, as well as references.

In conclusion when fully analyzing the overall structure and critical information presented in each article, learners can conclude that the articles presented in this literature review are scholar articles.


  • Harvey, E., Youngwirth, S., Thakar, D., & Errazuriz, P. (2009). Predicting attention-deficit/hyperactivity disorder and oppositional defiant disorder from preschool diagnostic assessments. Journal of Consulting and Clinical Psychology, 77(2), 349-354. doi:10.1037/a0014638
  • Lahey, B. B., Pelham, W. E., Loney, J., Kipp, H., Ehrhardt, A., Lee, S. S., et al. (2004). Three-year predictive validity of DSM-IV attention-deficit/hyperactivity disorder in children diagnosed at 4-6 years of age. American Journal of Psychiatry, 161, 2014-2020.
  • Tandon,M.,Si,X.,Belden,A.,&Luby,J..(2009). Attention-Deficit/Hyperactivity Disorder in Preschool Children: An Investigation of Validation Based on Visual Attention Performance.Journal of Child and Adolescent Psychopharmacology,19(2),137-46.

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