Table 3.
Prevalence of Developmental Health, Functioning, Other Mental, Behavioral, or Developmental Disorders and Intervention/Support Indicators by Preschool Expulsion Among Children With ADHD, NS-DATA 2014
| Expelled in Preschool |
||||
|---|---|---|---|---|
| Yes |
No |
|||
| % (95% CI) | % (95% CI) | PR (95% CI) | p | |
|
| ||||
| Developmental health | ||||
| Early concerns, prior to ADHD diagnosis | ||||
| First concerns younger than 5 yra | 90.9 (76.9–96.7) | 54.4 (51.3–57.8) | 1.7 (1.5–1.9) | <0.01 |
| Concerns about school behavior | 95.5 (85.6–98.7) | 79.8 (77.0–82.3) | 1.2 (1.1–1.3) | <0.01 |
| Concerns about home behavior | 72.3 (56.9–83.8) | 63.2 (60.0–66.3) | 1.1 (0.9–1.4) | 0.18 |
| Concerns about behavior with friends | 72.8 (56.6–84.6) | 55.7 (52.4–58.9) | 1.3 (1.1–1.6) | 0.01 |
| Concerns about grades, tests, assignments | 61.1 (45.2–74.8) | 74.5 (71.6–77.2) | 0.8 (0.6–1.1) | 0.11 |
| Symptoms at their worstb | ||||
| Severe ADHD symptoms | 73.0 (59.6–83.2) | 47.5 (44.2–50.7) | 1.5 (1.3–1.8) | <0.01 |
| ADHD presentationc | ||||
| Combined | 35.9 (22.9–51.4) | 23.9 (21.1–26.9) | 1.5 (1.0–2.1) | 0.03 |
| Hyperactive/impulsive | 2.8 (1.7–6.7)k | 4.5 (3.3–6.0) | 0.6 (0.2–1.6) | 0.33 |
| Inattentive | 29.4 (17.4–45.1) | 27.7 (24.8–30.7) | 1.1 (0.6–1.7) | 0.81 |
| Subthreshold | 31.8 (19.7–47.0) | 43.9 (40.7–47.2) | 0.7 (0.5–1.1) | 0.16 |
| Other mental, behavioral, or developmental disorders | ||||
| Any MBDDd | 83.3 (70.7–91.2) | 66.5 (63.4–69.4) | 1.3 (1.1–1.4) | <0.01 |
| Disruptive behaviore | 37.5 (24.3–52.8) | 23.1 (20.4–26.1) | 1.6 (1.1–2.4) | 0.02 |
| Emotional disordersf | 57.2 (42.3–70.9) | 37.1 (34.0–40.3) | 1.5 (1.2–2.0) | <0.01 |
| Anxiety | 29.9 (17.7–45.9) | 17.9 (15.6–20.5) | 1.7 (1.02–2.8) | 0.04 |
| Depression | 14.1 (6.8–27.1)k | 19.6 (17.1–22.4) | 0.7 (0.4–1.5) | 0.40 |
| OCD | 32.1 (18.8–49.1) | 13.8 (11.6–16.3) | 2.3 (1.4–3.9) | <0.01 |
| PTSD | 11.4 (4.6–25.5) | 7.0 (5.5–8.9) | 1.6 (0.7–4.0) | 0.28 |
| Developmental, learning, or language disordersg | 58.8 (43.7–72.3) | 47.7 (44.4–50.9) | 1.2 (0.9–1.6) | 0.11 |
| Intervention and support | ||||
| School-based support | 88.7 (79.1–94.2) | 78.8 (75.9–81.3) | 1.1 (1.03–1.2) | 0.01 |
| Classroom management | 80.3 (68.2–88.5) | 57.3 (54.0–60.5) | 1.4 (1.2–1.6) | <0.01 |
| IEP or 504 plan | 63.1 (47.4–76.4) | 52.5 (49.2–55.7) | 1.2 (0.9–1.5) | 0.14 |
| Peer intervention | 47.4 (32.7–62.7) | 27.7 (24.8–30.8) | 1.7 (1.2–2.4) | <0.01 |
| Social skills training | 61.5 (46.5–74.7) | 36.5 (33.4–39.7) | 1.7 (1.3–2.2) | <0.01 |
| Cognitive-behavioral therapy | 29.1 (16.9–45.3) | 17.9 (15.4–20.6) | 1.6 (1.0–2.7) | 0.07 |
| Parent training | 41.5 (27.8–56.6) | 28.6 (25.8–31.7) | 1.5 (1.0–2.1) | 0.05 |
| Impact on functioning | ||||
| Expulsion in later gradesh | 13.0 (6.3–24.9)k | 11.8 (9.7–14.2) | 1.1 (0.5–2.3) | 0.75 |
| School difficultiesi | ||||
| Overall school performance | 61.4 (46.8–74.2) | 45.2 (41.9–48.5) | 1.4 (1.1–1.7) | 0.01 |
| Writing | 67.2 (52.7–79.1) | 49.8 (46.5–53.1) | 1.3 (1.1–1.7) | 0.01 |
| Reading | 41.2 (27.1–57.0) | 40.1 (36.9–43.3) | 1.0 (0.7–1.5) | 0.88 |
| Math | 45.6 (31.1–60.8) | 44.0 (40.8–47.2) | 1.0 (0.7–1.5) | 0.84 |
| Handwriting | 60.0 (45.1–73.3) | 40.5 (37.3–43.8) | 1.5 (1.1–1.9) | <0.01 |
| Organized activitiesj | 51.1 (36.0–65.9) | 28.5 (25.6–31.6) | 1.8 (1.3–2.5) | <0.01 |
| Social impact | ||||
| Parental relationships | 36.5 (23.1–52.3) | 21.2 (18.6–24.0) | 1.7 (1.1–2.6) | 0.01 |
| Sibling relationships | 39.4 (24.6–56.4) | 30.3 (27.2–33.6) | 1.3 (0.8–2.0) | 0.23 |
| Peer relationships | 38.4 (24.9–54.0) | 27.6 (24.8–30.7) | 1.4 (0.9–2.1) | 0.11 |
| Work and financial impact | ||||
| Work stoppage | 16.5 (9.2–27.8)k | 13.8 (11.6–16.4) | 1.2 (0.7–2.1) | 0.55 |
| Work reduction | 32.6 (20.4–47.8) | 19.0 (16.6–21.8) | 1.7 (1.1–2.7) | 0.02 |
| Financial impact | 26.7 (17.2–39.0) | 20.8 (18.2–23.7) | 1.3 (0.8–2.0) | 0.26 |
ADHD, attention-deficit/hyperactivity disorder; IEP, individualized education program; MBDD, mental, behavioral, or developmental disorders; NS-DATA, National Survey of the Diagnosis and Treatment of ADHD and Tourette Syndrome; OCD, obsessive-compulsive disorder; PTSD, post-traumatic stress disorder.
Age at first concern younger than 5 yr.
Severe versus mild/moderate ADHD symptoms at their worst.
Combined: 6 or more hyperactive/impulsive and 6 or more inattentive symptoms. Hyperactive/impulsive: 6 or more hyperactive/impulsive symptoms but less than 6 inattentive symptoms. Inattentive: 6 or more hyperactive/impulsive symptoms but less than 6 hyperactive/impulsive symptoms. Subthreshold: less than 6 symptoms on both scales. Symptoms reported for the 6-month period before the survey.
Child ever received a diagnosis of conduct disorder, oppositional defiant disorder, autism spectrum disorder, intellectual disability, learning disorder, language disorder, OCD, PTSD, anxiety, bipolar disorder, and/or depression.
Child ever received a diagnosis of conduct disorder and/or oppositional defiant disorder.
Child ever received a diagnosis of OCD, PTSD, anxiety, bipolar disorder, and/or depression.
Childreceived a diagnosis of autism spectrum disorder, intellectual disability, learning disorder, and language disorder.
Child was also expelled in grades K-12.
Based on child’s behavior when not taking medication for ADHD or other difficulties with emotions, behavior, or concentration.
Includes only children who participated in organized activities (95% of unweighted sample).
The relative standard error for this estimate is between 30% and 40%; estimate should be interpreted with caution.