Risk Factors and a Prediction Model for ADHD Symptoms in Chinese Preschool Children

This study aimed to systematically analyze risk factors for attention-deficit/hyperactivity disorder (ADHD) symptoms in preschool children and to develop a prediction model for early screening, thereby providing a scientific tool for the early identification of ADHD. A total of 15,529 preschool children from 32 kindergartens in Guizhou Province, China, were included in this study. Among them, 1,340 children (8.6%) screened positive for ADHD symptoms via the Conners Abbreviated Symptom Questionnaire (C-ASQ). The least absolute shrinkage and selection operator (Lasso) regression and multivariable Logistic regression analysis were employed to identify independent risk factors for ADHD symptoms and to construct a nomogram. The predictive performance of the nomogram was evaluated using the receiver operating characteristic (ROC) curve, calibration curve, and the Hosmer-Lemeshow test. Lasso and multivariable logistic regression analyses identified nine independent predictors for ADHD symptoms: sex, degree of fondness for the child, birth order, consistency of parenting beliefs, sleep quality, age at first use of electronic devices, cumulative duration of electronic device use, duration of parent-child interaction, and duration of moderate-intensity physical activity. The nomogram based on these variables demonstrated moderate predictive performance, with an area under the curve (AUC) of 0.70, sensitivity of 0.62, and specificity of 0.67. The calibration curve and Hosmer-Lemeshow test ( p  > 0.05) confirmed its clinical applicability. Sex, degree of fondness for the child, birth order, consistency of parenting beliefs, sleep quality, age at first use of electronic devices, cumulative duration of electronic device use, duration of parent-child interaction, and duration of moderate-intensity physical activity were identified as independent predictors of ADHD symptoms in preschool children. Furthermore, the nomogram prediction model demonstrated certain discriminative ability for ADHD symptoms and may serve as an auxiliary tool in early screening to help identify high-risk children.