Treatment of Preschoolers with Attention-Deficit/Hyperactivity Disorder
- 763 Downloads
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.
KeywordsADHD Preschool Psychosocial Parenting
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.
Papers of particular interest, published recently, have been highlighted as: • Of importance
- 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
- 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.
- 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
- 19.Barkley RA: Hyperactive Children: A Handbook for Diagnosis and Treatment. New York: Guilford; 1981.Google Scholar
- 23.Forehand and McMahon’s Helping the Noncompliant Child: A Clinician’s Guide to Parent Training. New York: Guilford; 1981.Google Scholar
- 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.
- 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.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.
- 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
- 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
- 53.Shonkoff J, Phillips DA, eds: From Neurons to Neighborhoods. Washington, DC: National Academy of Sciences; 2000.Google Scholar