Relationship Between Attention-Deficit/Hyperactivity Disorder Symptoms And Behavioral Lifestyle Among Preschoolers

Objective To describe the current situation of outdoor activities,screen time,diet and sleep habits of preschoolers,and furthermore,to explore the relationship between attention-deficit/hyperactivity disorder(ADHD)symptoms and behavioral lifestyle.Methods Totally 16 439 preschool aged 3-6 years in 91 kindergartens in Maanshan were investigated.The behavioral lifestyle and sociodemographic characteristics of preschoolers were collected through questionnaire survey.ADHD symptoms were assessed by the 10-item Chinese version of the Conners' abbreviated symptom questionnaire(C-ASQ).A total of 15 291 valid questionnaires were retained for analysis,and the effective response rate was 93.0%.A lifestyle index was formed from ten domains,as follows: outdoor activities,TV viewing on weekday and weekend,play other electronic devices on weekday and weekend,picky-eater,favorite flavor,sleep time,falling asleep on weekday and weekend.Descriptive analyses were performed on preschoolers' sociodemographic characteristics,outdoor activities,screem time,dietary habits,sleeping habits and so on.The Pearson chi-square tests were used to compare the proportions of the independent variables versus dependent variables.Logistic regression analyses were used to analyze the possible factors affecting outdoor activities,screem time,dietary habits,sleeping habits,and furthermore explore the effects of behavioral lifestyle on preschoolers' attention-deficit/hyperactivity disorder symptoms.Results There are 8 218 boys(53.7%)and 7 073(46.3%).The mean age of the participating students was 4.45 years(SD=1.04).The reported rates of preschool children with little outdoor activities and less than 1 h/d of average outdoor activities per day were 8.5% and 12.7%,respectively.The percentages of watching TV more than 2h/d in study day and playing electronic products more than 1h/d were 33.8% and 23.4% respectively.The reporting rates of watching TV(> 2h/d)and playing electronic products(> 1h/d)on weekends were 64.7% and 39.2% respectively.28.4%,10.1%,31.8% and 27.9% of them were picky,meal time > 30 min,greasy / salty / sweet and meat-loving,respectively.9.4% and 21.7% sleep after 22:00 on study day and weekend respectively.Different characteristics of preschool children outdoor activities,screen time,dietary habits,sleep conditions were also different;the difference was statistically significant(P < 0.05).The total score of the behavioral lifestyle index is 10,and with a mean values of 2.64 scores [standard deviation(SD)=1.78].After adjusted for demographic information and outdoor exercise time,mealtimes,food types and naps,the average autonomous group(2 to 3 scores)and high autonomous group(?4 scores)of behavioral lifestyle index were significantly associated with increased risk of ADHD symptoms(OR=1.78,95%CI: 1.50~2.12;OR=2.82,95%CI: 2.37~3.35).Conclusion The occurrence of ADHD symptoms is related to the daily behavioral lifestyle,and the association intensity of ADHD symptoms increased with the increase of unhealthy lifestyle index.It's a hint that prompt interventions to promote active living and healthy eating will play an important role in preventing and reducing the onset of ADHD in preschoolers.