Risk and protective factors for healthy development in preschool children with ADHD: A qualitative bioecological study of key stakeholders’ perspectives

Abstract

ADHD in preschoolers is sometimes misunderstood by stakeholders due to children’s young age, preventing early diagnosis and interventions. This qualitative study explores protective and risk factors for their healthy development using thematic analysis applied to the bioecological model, and perspectives from five stakeholder groups (N = 91, 90.1% female; Portuguese-speaking; aged from 19 to 69 years): parents of children with ADHD (n = 20), psychologists (n = 25), pediatricians/child psychiatrists (n = 9), preschool teachers (n = 16) and adults with ADHD (n = 21). Participants answered five open-ended questions about concerns regarding diagnosis and development, and facilitators and barriers to healthy development. A total of 951 excerpts (f) were coded and organized into five themes according to Bronfenbrenner’s bioecological model. The most cited themes were the Microsystem (n = 84; f = 353) and the Exosystem (n = 83; f = 271). Findings identify intervention targets across all levels of the bioecological model. Key subthemes include Parenting/Caregiving styles, Emotional/Behavioral difficulties, Diagnostic difficulties and practices and Knowledge and training. Stakeholders consistently viewed environmental support (such as school/family, healthcare and societal factors), multidisciplinary collaboration, and improved universal knowledge as more influential than ADHD symptoms alone in promoting healthy development. Interventions should go beyond parental training in behavior management to address comorbidities and associated difficulties. Importantly, more research on ADHD diagnosis in preschoolers is needed.