University of Oulu

Robinson, R., Girchenko, P., Pulakka, A. et al. ADHD symptoms and diagnosis in adult preterms: systematic review, IPD meta-analysis, and register-linkage study. Pediatr Res 93, 1399–1409 (2023).

ADHD symptoms and diagnosis in adult preterms: systematic review, IPD meta-analysis, and register-linkage study

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Author: Robinson, Rachel1; Girchenko, Polina1; Pulakka, Anna2;
Organizations: 1University of Helsinki, Helsinki, Finland
2Finnish Institute for Health and Welfare, Helsinki, Finland
3Faculty of Social Sciences, Tampere University, Tampere, Finland
4Department of Neonatology, University of Bonn, Bonn, Germany
5Children’s Hospital, University of Helsinki and Helsinki University Hospital, Helsinki, Finland
6Royal Women’s Hospital, Melbourne, VIC, Australia
7University of Melbourne, Melbourne, VIC, Australia
8Murdoch Children’s Research Institute, Melbourne, VIC, Australia
9Turner Institute for Brain and Mental Health, School of Psychological Sciences, Monash University, Clayton, VIC, Australia
10Department of Paediatrics, University of Otago, Christchurch, New Zealand
11University of Canterbury, Christchurch, New Zealand
12Department of Clinical and Molecular Medicine, Norwegian University of Science and Technology, Trondheim, Norway
13Department of Physiotherapy, Oslo Metropolitan University, Oslo, Norway
14University College London, London, UK
15University of Leicester, Leicester, UK
16University of Warwick, Coventry, UK
17Department of Neuroscience, Psychology and Behaviour, School of Psychology, University of Leicester, Leicester, UK
18PEDEGO Research Unit, MRC Oulu, Oulu University Hospital and University of Oulu, Oulu, Finland
Format: article
Version: published version
Access: open
Online Access: PDF Full Text (PDF, 0.8 MB)
Persistent link:
Language: English
Published: Springer Nature, 2022
Publish Date: 2023-11-09


Background: This study examined differences in ADHD symptoms and diagnosis between preterm and term-born adults (≥18 years), and tested if ADHD is related to gestational age, birth weight, multiple births, or neonatal complications in preterm borns.

Methods: (1) A systematic review compared ADHD symptom self-reports and diagnosis between preterm and term-born adults published in PubMed, Web of Science, and PROQUEST until April 2021; (2) a one-stage Individual Participant Data(IPD) meta-analysis (n= 1385 preterm, n = 1633 term; born 1978–1995) examined differences in self-reported ADHD symptoms[age 18–36 years]; and (3) a population-based register-linkage study of all live births in Finland (01/01/1987–31/12/1998; n = 37538 preterm, n = 691,616 term) examined ADHD diagnosis risk in adulthood (≥18 years) until 31/12/2016.

Results: Systematic review results were conflicting. In the IPD meta-analysis, ADHD symptoms levels were similar across groups (mean z-score difference 0.00;95% confidence interval [95% CI] −0.07, 0.07). Whereas in the register-linkage study, adults born preterm had a higher relative risk (RR) for ADHD diagnosis compared to term controls (RR = 1.26, 95% CI 1.12, 1.41, p < 0.001). Among preterms, as gestation length (RR = 0.93, 95% CI 0.89, 0.97, p < 0.001) and SD birth weight z-score (RR = 0.88, 95% CI 0.80, 0.97, p < 0.001) increased, ADHD risk decreased.

Conclusions: While preterm adults may not report higher levels of ADHD symptoms, their risk of ADHD diagnosis in adulthood is higher.

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Series: Pediatric research
ISSN: 0031-3998
ISSN-E: 1530-0447
ISSN-L: 0031-3998
Volume: 93
Issue: 5
Pages: 1399 - 1409
DOI: 10.1038/s41390-021-01929-1
Type of Publication: A2 Review article in a scientific journal
Field of Science: 3124 Neurology and psychiatry
3123 Gynaecology and paediatrics
Funding: This work was supported by funding from the European Union Horizon 2020 Grant # 733280 for RECAP, the European Commission NORFACE Dynamics of Inequality Across the Life course Grant #724363 (University of Warwick No. 462.16.100; University of Helsinki 462.16.101) for PremLife, Academy of Finland Grant #315690, 323910, 128459, 12848591, 1312670, 1324596, 330206, NHMRC (Australia) Grant #1153176; #1104300, #1176077, MRFF (Australia) #1141354, The Foundation for Pediatric Research (Finland), Sigrid Juselius Foundation; Signe and Ane Gyllenberg Foundation; Novo Nordisk Foundation. Open Access funding provided by University of Helsinki including Helsinki University Central Hospital.
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