Objective: To determine the prevalence of teacher-rated ADHD symptoms in Italian first-graders.

Methods: 1891 first-graders aged 6.6-7.4 years were evaluated using a 34-item DSM-IV-referenced ADHD teacher rating questionnaire which included all the 18 DSM-IV ADHD diagnostic criteria, some Oppositional-Defiant Disorder (ODD), Conduct Disorder (CD), depression and anxiety symptoms, and questions about the child's social and scholastic impairment.

Results: Criteria for ADHD were met in 7.1% (n=135) of the subjects (10.4% males and 3.8% females), 3.5% with the Inattentive subtype, 2.3% with the Hyperactive/Impulsive subtype and 1.3% with a Combined subtype. Internalizing (depression and/or anxiety) symptoms were reported in 25.9% of the subjects with ADHD symptoms, 17% showed externalizing symptoms (ODD or CD), and 12.6% showed both. Comorbid symptoms were 10 times more frequent than in subjects without ADHD symptoms. Inattentive subtype and scholastic impairment were more frequent in females, Hyperactive/Impulsive subtype and social impairment were more frequent in males.

Conclusions: Even though the real prevalence of ADHD in first graders is presumably lower than that found in the present study, this screening procedure might allow detecting those children who could benefit from referral for more comprehensive assessments.