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Current Psychiatry Reports

, Volume 12, Issue 5, pp 374–381 | Cite as

Treatment of Preschoolers with Attention-Deficit/Hyperactivity Disorder

Article

Abstract

This article reviews the current treatment literature for attention-deficit/hyperactivity disorder (ADHD) in preschoolers. Parent training studies show consistent behavioral improvements reported by teachers and observers as well as parents, with evidence of clinically significant improvement in ADHD symptoms for up to 2 years. Few other behavioral interventions have been evaluated, although data from a large psychosocial, multimodal intervention are forthcoming. There is evidence to support the benefit of immediate-release stimulant medication for up to 1 year; however, effects do not seem to be as large, and some of the side effects may be greater than for school-age children. With regard to nonstimulants such as atomoxetine, there are literally no controlled outcome data for children with ADHD who are younger than 5 years of age. Overall, a great deal remains to be learned about the safety and efficacy of pharmacotherapy in this age group. Fortunately, results of several large intervention studies will be available soon to better inform clinical practice.

Keywords

ADHD Preschool Psychosocial Parenting 

Notes

Disclosure

Dr. Murray attended an advisory committee meeting held by Ortho-McNeil Janssen Scientific Affairs (OMJSA); has served as a consultant for OMJSA, Incredible Years, and Communities in Schools (Durham, NC); has had travel/accommodation expenses covered or reimbursed by OMJSA; served on the Incredible Years committee for the North Carolina Prevent Child Abuse Alliance; and received payment for development of several educational presentations from local Area Health Education Consortiums.

References

Papers of particular interest, published recently, have been highlighted as: • Of importance

  1. 1.
    Angold A, Erkanli A, Egger HL, Costello EJ: Stimulant treatment for children: a community perspective. J Am Acad Child Adolesc Psychiatry 2000, 39:975–984.CrossRefPubMedGoogle Scholar
  2. 2.
    Keenan K, Wakschlag LS: More than the terrible twos: the nature and severity of behavior problems in clinic-referred preschool children. J Abnorm Child Psychol 2000, 28:33–46.CrossRefPubMedGoogle Scholar
  3. 3.
    DuPaul GJ, McGoey KE, Eckert TL, VanBrakle J: Preschool children with attention-deficit/hyperactivity disorder: impairments in behavioral, social, and school functioning. J Am Acad Child Adolesc Psychiatry 2001, 40:508–515.CrossRefPubMedGoogle Scholar
  4. 4.
    Posner K, Melvin GA, Murray D, et al.: Clinical presentation of ADHD in preschool children: the Preschool ADHD Treatment Study (PATS). J Child Adolesc Psychopharmacol 2007, 17:547–562.CrossRefPubMedGoogle Scholar
  5. 5.
    Egger HL, Angold A: The Preschool Age Psychiatric Assessment (PAPA): a structured parent interview for diagnosing psychiatric disorders in preschool children. In A Handbook of Infant and Toddler Mental Health Assessment. Edited by Delcarmen R, Carter A. New York: Oxford University Press; 2004:223–246.Google Scholar
  6. 6.
    Cunningham CE, Boyle MH: Preschoolers at risk for attention-deficit hyperactivity disorder and oppositional defiant disorder: family, parenting, and behavioral correlates. J Abnorm Child Psychol 2002, 30:555–569.CrossRefPubMedGoogle Scholar
  7. 7.
    Sonuga-Barke EJS, Daley D, Thompson M, et al.: Preschool ADHD: exploring uncertainties in diagnostic validity and utility, and treatment efficacy and safety. Expert Rev Neurother 2003, 3:465–476.CrossRefPubMedGoogle Scholar
  8. 8.
    Connor DF, Edwards G, Fletcher KE, et al.: Correlates of comorbid psychopathology in children with ADHD. J Am Acad Child Adolesc Psychiatry 2003, 42:193–200.CrossRefPubMedGoogle Scholar
  9. 9.
    McGee R, Partridge F, Williams S, et al.: A twelve-year follow-up of preschool hyperactive children. J Am Acad Child Adolesc Psychiatry 1991, 30:224–232.CrossRefPubMedGoogle Scholar
  10. 10.
    Pierce EW, Ewing LJ, Campbell SB: Diagnostic status and symptomatic behavior of hard-to-manage preschool children in middle school and early adolescence. J Clin Child Psychol 1999, 28:44–57.CrossRefPubMedGoogle Scholar
  11. 11.
    Campbell SB, Spieker S, Burchinal M, et al.: Trajectories of aggression from toddlerhood to age 9 predict academic and social functioning through age 12. J Child Psychol Psychiatry 2006, 47:791–800.CrossRefPubMedGoogle Scholar
  12. 12.
    Schwebel DC, Speltz ML, Jones K, et al.: Unintentional injury in preschool boys with and without early onset of disruptive behavior. J Pediatr Psychol 2002, 27:727–737.CrossRefPubMedGoogle Scholar
  13. 13.
    National Institutes of Health: Diagnosis and treatment of attention deficit hyperactivity disorder. National Institutes of Health Consensus Development Conference Statement. November 16–18, 1998. Available at http://consensus.nih.gov/1998/1998AttentionDeficitHyperactivityDisorder110html.htm. Accessed July 20, 2010.
  14. 14.
    Gleason MM, Egger HL, Emslie GJ, et al.: Psychopharmacological treatment for very young children: contexts and guidelines. J Am Acad Child Adolesc Psychiatry 2007, 46:1532–1572CrossRefPubMedGoogle Scholar
  15. 15.
    • LaForett, DR, Murray DW, Kollins SH: Psychosocial treatments for preschool-aged children with attention-deficit/hyperactivity disorder (ADHD). Ment Retard Dev Disabil Res Rev 2008, 14:300–310. This article reviews parent training, classroom management, and multimodal treatments that have been evaluated in preschoolers with ADHD and disruptive behavior in the context of the developmental and contextual needs of this population.Google Scholar
  16. 16.
    Egger HL, Angold A: Common emotional and behavioral disorders in preschool children: presentation, nosology, and epidemiology. J Child Psychol Psychiatry 2006, 47:313–337.CrossRefPubMedGoogle Scholar
  17. 17.
    Task Force on Research Diagnostic Criteria: Infancy and Preschool: Research diagnostic criteria for infants and preschool children: the process and empirical support. J Am Acad Child Adolesc Psychiatry 2003, 42:1504–1512.CrossRefGoogle Scholar
  18. 18.
    APA Presidential Task Force on Evidence-Based Practice: Evidence-based practice in psychology. Am Psychol 2006, 61:271–285.CrossRefGoogle Scholar
  19. 19.
    Barkley RA: Hyperactive Children: A Handbook for Diagnosis and Treatment. New York: Guilford; 1981.Google Scholar
  20. 20.
    Eyberg S, Boggs SR, Algina J: Parent-child interaction therapy: a psychosocial model for the treatment of young children with conduct problem behavior and their families. Psychopharmacol Bull 1995, 31:83–91.PubMedGoogle Scholar
  21. 21.
    Sonuga-Barke EJS, Thompson M, Abikoff H, et al.: Nonpharmacological interventions for preschoolers with ADHD. The case for specialized parent training. Infants Young Child 2006, 19:142–153.CrossRefGoogle Scholar
  22. 22.
    Pisterman S, McGrath P, Firestone JT, et al.: Outcome of parent-mediated treatment of preschoolers with attention deficit disorder with hyperactivity. J Consult Clin Psychol 1989, 57:628–635.CrossRefPubMedGoogle Scholar
  23. 23.
    Forehand and McMahon’s Helping the Noncompliant Child: A Clinician’s Guide to Parent Training. New York: Guilford; 1981.Google Scholar
  24. 24.
    Barkley RA, Shelton TL, Crosswait C, et al.: Multi-method psycho-educational intervention for preschool children with disruptive behavior: preliminary results at post-treatment. J Child Psychol Psychiatry 2000, 41:319–332.CrossRefPubMedGoogle Scholar
  25. 25.
    Sanders MR: Triple P Positive Parenting Program: towards an empirically validated multilevel parenting and family support strategy for the prevention of behavior and emotional problems in children. Clin Child Fam Psychol Rev 1999, 2:71–90.CrossRefPubMedGoogle Scholar
  26. 26.
    Bor W, Sanders MR, Markie-Dadds C: The effects of the Triple P—Positive Parenting Program on preschool children with co-occurring disruptive behavior and attentional/hyperactive difficulties. J Abnorm Child Psychol 2002, 30:571–587.CrossRefPubMedGoogle Scholar
  27. 27.
    Gallagher N: Effects of parent-child interaction therapy on young children with disruptive behavior disorders. Available at http://www.wbpress.com/index.php?main_page=product_book_info&products_id=232 . Accessed July 21, 2010.
  28. 28.
    Eyberg S, Funderburk BW, Hembree-Kigin TL, et al.: Parent-child interaction therapy with behavior problem children: one and two year maintenance of treatment effects in the family. Child Fam Behav Ther 2001, 23:1–20.CrossRefGoogle Scholar
  29. 29.
    Funderburk BW, Eyberg SM, Newcomb K, et al.: Parent-child interaction therapy with behavior problem children: maintenance of treatment effects in the school setting. Child Fam Behav Ther 1998, 20:17–38.CrossRefGoogle Scholar
  30. 30.
    McNeil CB, Eyberg S, Eisenstadt TH, et al.: Parent-child interaction therapy with behavior problem children: generalization of treatment effects to the school setting. J Clin Child Psychol 1991, 20:140–151.CrossRefGoogle Scholar
  31. 31.
    Sonuga-Barke EJS, Daley D, Thompson M, et al.: Parent-based therapies for preschool attention-deficit/hyperactivity disorder: a randomized, controlled trial with a community sample. J Am Acad Child Adolesc Psychiatry 2001, 40:402–408.CrossRefPubMedGoogle Scholar
  32. 32.
    Sonuga-Barke EJS, Thompson M, Daley D, et al.: Parent training for attention-deficit/hyperactivity disorder. Is it as effective when delivered as routine rather than as specialist care? Br J Clin Psychol 2004, 43:449–457.CrossRefPubMedGoogle Scholar
  33. 33.
    McGoey KE, DuPaul GJ: Token reinforcement and response cost procedures: reducing the disruptive behavior of preschool children with ADHD. Sch Psychol Q 2000, 15:330–343.CrossRefGoogle Scholar
  34. 34.
    Shelton TL, Barkley RA, Crosswait C, et al.: Multimethod psychoeducational intervention for preschool children with disruptive behavior: two year post-treatment follow-up. J Abnorm Child Psychol 2000, 28:253–266.CrossRefPubMedGoogle Scholar
  35. 35.
    Webster-Stratton C: The Incredible Years: a training series for the prevention and treatment of conduct problems in young children. In Psychosocial Treatment Research of Child and Adolescent Disorders. Edited by Hibbs ED, Jensen PS. Washington, DC: American Psychological Association; 2005:507–555.Google Scholar
  36. 36.
    National Registry of Evidence-based Programs and Practices: Intervention summary: Incredible Years program. Available at http://www.nrepp.samhsa.gov/programfulldetails.asp?PROGRAM_ID=131. Accessed April 2010.
  37. 37.
    Webster-Stratton C, Reid MJ, Hammond M: Preventing conduct problems, promoting social competence: a parent and teacher training partnership in Head Start. J Clin Child Psychol 2001, 30:283–302.CrossRefPubMedGoogle Scholar
  38. 38.
    Webster-Stratton C, Reid MJ, Hammond M: Social skills and problems solving training for children with early-onset conduct problems. Who benefits? J Child Psychol Psychiatry 2001, 33:105–124.Google Scholar
  39. 39.
    Webster-Stratton C, Reid MJ, Hammond M: Treating children with early-onset conduct problems: intervention outcomes for parent, child and teacher training. J Clin Child Adolesc Psychol 2004, 33:105–124.CrossRefPubMedGoogle Scholar
  40. 40.
    Webster-Stratton C, Reid MJ, Stoolmiller M: Preventing conduct problems and improving school readiness: evaluation of the Incredible Years teacher and child training programs in high-risk schools. J Child Psychol Psychiatry 2008, 49:471–488.CrossRefPubMedGoogle Scholar
  41. 41.
    Wolraich ML, Lindgren S, Stromquist A, et al.: Stimulant medication use by primary care physicians in the treatment of attention deficit hyperactivity disorder. Pediatrics 1990, 86:95–101.PubMedGoogle Scholar
  42. 42.
    Zito JM, Safer DJ, DosReis S, et al.: Trends in the prescribing of psychotropic medications to preschoolers. JAMA 2000, 283:1025–1030.CrossRefPubMedGoogle Scholar
  43. 43.
    Rappley MD, Mullan PB, Alvarez FJ, et al.: Diagnosis of attention deficit/hyperactivity disorder and use of psychotropic medication in very young children. Arch Pediatr Adolesc Med 1999, 153:1039–1045.PubMedGoogle Scholar
  44. 44.
    Kollins SK, Greenhill L, Swanson J, et al.: Rationale, design, and methods of the Preschool ADHD Treatment Study (PATS). J Am Acad Child Adolesc Psychiatry 2006, 45:1275–1283.CrossRefPubMedGoogle Scholar
  45. 45.
    Greenhill LL, Posner K, Vaughan BS, Kratochvil CJ: Attention deficit hyperactivity disorder in preschool children. Child Adolesc Psychiatr Clin N Am 2008, 17:347–366.CrossRefPubMedGoogle Scholar
  46. 46.
    Greenhill L, Kollins SK, Abikoff H, et al.: Efficacy and safety of immediate-release methylphenidate treatment for preschoolers with ADHD. J Am Acad Child Adolesc Psychiatry 2006, 45:1284–1293.CrossRefPubMedGoogle Scholar
  47. 47.
    Wigal T, Greenhill L, Chuang S, et al.: Safety and tolerability of methylphenidate in preschool children with ADHD. J Am Acad Child Adolesc Psychiatry 2006, 45:1294–1304.CrossRefPubMedGoogle Scholar
  48. 48.
    Ghuman JK, Riddle MA, Vitiello B, et al.: Comorbidity moderates response to methylphenidate in the Preschoolers With Attention-Deficit/Hyperactivity Disorder Treatment Study (PATS). J Child Adolesc Psychopharmacol 2007, 17:563–580.CrossRefPubMedGoogle Scholar
  49. 49.
    • Vitiello B, Abikoff HB, Chuang SZ, et al.: Effectiveness of methylphenidate in the 10-month continuation phase of the Preschoolers with ADHD Treatment Study (PATS). J Child Adolesc Psychopharmacol 2007, 17:593–603. This empiric article provides results of the 10-month, open-label treatment phase of the PATS study, the largest randomized study of immediate-release methylphenidate in a clinically diagnosed sample.CrossRefPubMedGoogle Scholar
  50. 50.
    Swanson J, Greenhill L, Wigal T, et al.: Stimulant-related reduction of growth rates in the PATS. J Am Acad Child Adolesc Psychiatry 2006, 45:1304–1313.CrossRefPubMedGoogle Scholar
  51. 51.
    Kratochvil CJ, Vaughan BS, Mayfield-Jorgensen ML, et al.: A pilot study of atomoxetine in young children with attention-deficit/hyperactivity disorder. J Child Adolesc Psychopharmacol 2007, 17:175–185.CrossRefPubMedGoogle Scholar
  52. 52.
    Pelham WE, Fabiano GA: Evidence-based psychosocial treatment for ADHD: an update. J Clin Child Adolesc Psychol 2008, 37:184–214.CrossRefPubMedGoogle Scholar
  53. 53.
    Shonkoff J, Phillips DA, eds: From Neurons to Neighborhoods. Washington, DC: National Academy of Sciences; 2000.Google Scholar
  54. 54.
    Lahey BB, Pelham WE, Loney J, et al.: Three-year predictive validity of DSM-IV attention deficit/hyperactivity disorder in children diagnosed at 4–6 years of age. Am J Psychiatry 2004, 161:2014–2020.CrossRefPubMedGoogle Scholar
  55. 55.
    Hoagwood K, Burns BJ, Kiser L, et al.: Evidence-based practice in child and adolescent mental health services. Psychiatr Serv 2000, 52:1179–1189.CrossRefGoogle Scholar
  56. 56.
    Leslie LK, Wolraich ML: ADHD service use patterns in youth. J Pediatr Psychol 2007, 32:695–710.CrossRefPubMedGoogle Scholar

Copyright information

© Springer Science+Business Media, LLC 2010

Authors and Affiliations

  1. 1.Department of PsychiatryDuke University Medical CenterDurhamUSA

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