ADHD in the preschool years is sometimes misunderstood by stakeholders, stemming from various limitations, such as children’s young age and potential current nosological limitations, preventing early diagnosis and interventions that could mitigate future difficulties. This qualitative study aims to explore protective and risk factors for an adaptative development of preschool children with ADHD, using thematic analysis applied to the bioecological model, and five key stakeholders perspectives: 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 on their 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 Bioecological mode of human development The most cited themes by participants were the Microsystem (n= 84; f=353) and the Exosystem (n=83; f=271), while the most cited subthemes were Parenting/Caregiving styles (n=51; f=91), Emotional/Behavioral difficulties (n=49; f=76) and Diagnostic difficulties and practices (n=49; f=62). By number of segments, Knowledge and training (n=47; f=86) and (Neuro)development and associated difficulties (n=45; f=80) also appear as main factors. The findings reflect the need to go beyond parental training in behavior management, with interventions that address comorbidities and associated difficulties. This study provides intervention targets at all levels of the bioecological model, while Knowledge and training should be universal. Importantly, more research is needed on ADHD diagnosis in the preschool years, as highlighted by the overwhelming majority of clinicians, and a high number of preschool teachers and adults with ADHD.

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ADHD,preschoolers,bioecological model,qualitative study