April 20, 2014

ADHD and Early Signs in Infants

APGAR Scores Are Quite Accurate in Predicting ADHD

I just read an article in the Journal of Pediatrics about ADHD and early signs in infants regarding the early detection of ADHD. According to the 13 year study, babies born with low scores on the APGAR test of newborn vitality are at higher risk to develop attention deficit hyperactivity disorder than infants with near-perfect scores. ADHD and early signs in infants might be detectable with the APGAR test which would allow for early treatment or behavior modification.

ADHD is a neuro-developmental condition that affects about 5% of children who are often born prematurely. ADHD or attention-deficit hyperactivity disorder is the only clinical term for disorders characterized by inattention, hyperactivity and impulsivity; However, ADD or attention deficit disorder is a term that has become increasingly popular among laypersons, the media, and even some professionals.  ADHD often is accompanied by one or more other conditions, we call this comorbidity.

This APGAR procedure was developed in 1952 and used around the world. APGAR is a 10-point scale that measures respiration, reflexes, skin color, pulse, and heart rate in the first minutes of life and may be repeated later if the score is and remains low. A study of 980,902 babies born in Denmark from 1988 to 2001 found that newborns with APGAR scores between 1 and 4 had a 75% higher risk of developing ADHD than babies with scores of 9 to 10. The risk of ADHD was 63% higher with scores of 5 to 6. The children were followed from age 3 through 2006, or until they were diagnosed with ADHD, whichever came first. ADHD cases totaled 8,234 and 82% were boys.

Objective of the Study – Causal or Correlation?

One question that must always be addressed in all research is: Are the effects causally related to the antecedent causes or are they mere coincidences? To examine whether low APGAR scores at 5 minutes are associated with increased risks of attention deficit hyperactivity disorder (ADHD). A nationwide population based cohort study was conducted of all 980,902 singletons born in Denmark from 1988 to 2001. All children were monitored from 3 years of age until a first International Classification of Diseases diagnosis of hyper-kinetic disorder, a first medication for ADHD, migration, death, or the end of 2006 whichever came first. Cox regression models were used to examine the association between APGAR scores at 5 minutes and ADHD.

The Results of The Study and The APGAR Test

APGAR scores were inversely associated with risk of ADHD (hazard ratio .92; 95% confidence interval [CI]: .88-.96, P trend < .001). Compared with children with APGAR scores of 9 or 10 at 5 minutes, the risk for ADHD was 75% higher in children with APGAR scores of 1 to 4 (hazard ratio 1.75; 95% CI: 1.15-2.11) and 63% higher for those with AGAR scores of 5 to 6 (95% CI: 1.25-2.11). The conclusions drawn from this study were that a low APGAR score was associated with an increased risk of ADHD in childhood. Low APGAR scores and ADHD may share common causes or a low APGAR score reflects at least one causal pathway leading to ADHD.

Caveat: Researchers were unable to make an independent diagnosis of ADHD because identification of patients is prohibited under the Danish health system. Although ADHD was diagnosed using international classification criteria, there may have been some variation in the interpretation.


Sign 0 Points 1 Point 2 Points


Activity (Muscle Tone) Absent Arms and Legs Flexed Active Movement
Pulse Absent Below 100 bpm Above 100 bpm
Grimace (Reflex Irritability) No Response Grimace Sneeze, cough, pulls away
Appearance (Skin Color) Blue-gray, pale all over Normal, except for extremities Normal over entire body
Respiration Absent Slow, irregular Good, crying

Scores of 3 and below are generally regarded as critically low, 4 to 6 fairly low, and 7 to 10 generally normal. A low score on the 1 minute test may show that the neonate requires medical attention but is not necessarily an indication that there will be long term problems, particularly if there is an improvement by the stage of the 5 minute test. If the APGAR score remains below 3 at later times such as 10, 15, or 30 minutes, there is a risk that the child will suffer longer term neurological damage. There is also a small but significant increase of the risk of cerebral palsy. The purpose of the APGAR test is to determine quickly whether a newborn needs immediate medical care; it was not designed to make long-term predictions on a child’s health.

A score of 10 is uncommon due to the prevalence of transient cyanosis, and is not substantially different from a score of 9. Transient cyanosis is common, particularly in babies born at high altitude. A study comparing babies born in Peru near sea level with babies born at very high altitude (4340 m) found a significant difference in the first but not the second APGAR score. Oxygen saturation also was lower at high altitude.

Several studies have linked low APGAR scores with neurological diseases such as epilepsy, cerebral palsy, mental retardation; and might signal ADHD and Early Signs in Infants, researchers said. Read more on ADHD and Early Signs in Infants

This article about ADHD and early signs in infants is for informational purposes only and not diagnosing or treating any illness
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