Early ADHD diagnosis faces challenges, including a lack of thoroughly validated instruments and potential nosological limitations, delaying diagnosis and interventions that could mitigate negative outcomes. This multi-informant Delphi study sought consensus on behaviors/symptoms indicative of ADHD in preschool-age children, and investigated settings best suited for their observation, to support the development of a naturalistic observational scale for ADHD assessment in the preschool years. Four expert-panels participated: psychologists (Round 1, n=25; Round 2, n=14), pediatricians/child psychiatrists (Round 1, n=9; Round 2, n=6), parents of children with ADHD (Round 1, n=20; Round 2, n=6) and preschool teachers (Round 1, n =16; Round 2 n=6). Participants answered prompting questions on behavioral symptoms and observational procedures in Round 1. In Round 1 and 2, 44 behaviors/symptoms and eight observational settings were rated for their diagnostic relevance on a five-point Likert scale. Parents answered according to frequency and impairment on settings. Consensus was defined as >70% of the group rating an item as 4 or 5. Items close to consensus (i.e., >65% to 70%) in Round 1 were revised and rated in Round 2, alongside behaviors derived from open-ended responses, which were assigned symptom labels. Four observational contexts (e.g., “free play in a room with peers”) and 10 behaviors/symptoms (e.g., “quickly shifts from one activity to another,” “easily frustrated”) reached consensus across all groups. Additionally, 20 behaviors/symptoms reached consensus on a combination of groups. Of the consensual behaviors, 10 were adaptations (i.e., behaviors related to the symptom). Two inattention symptoms (“loses things” and “forgetful”) were not reported, and two hyperactivity/impulsivity symptoms (“difficulty playing quietly” and “talks excessively”) did not reach consensus. Finally, four consensual behaviors/symptoms did not fit within the bidimensional ADHD nosology. In conclusion, the relevance of observational settings depends on participants’ experience and type of contact with ADHD. Some consensual behaviors/symptoms were not endorsed by all groups, suggesting cross-situational variation. Finally, the lack of consensus on certain symptoms and the emergence of new behaviors/symptoms supports the investment in defining different assessment tools.

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ADHD,Early assessment,Preschoolers,Observation,Naturalistic