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Pharmacologic Intervention for Attention-Deficit Hyperactivity Disorder in Preschoolers

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Abstract

Pharmacologic intervention for attention-deficit hyperactivity disorder (ADHD) in preschool children is a controversial issue. Non-pharmacologic interventions (psychosocial and restricted dietary interventions) have been shown to benefit oppositional, non-compliant, aggressive and disruptive, as well as hyperactive and inattentive behaviors in preschoolers with ADHD and other disruptive behavior disorders. However, not all families have access to non-pharmacologic interventions or prefer them. The Preschool ADHD Treatment Study recently provided evidence of benefit with immediate-release methylphenidate; however, effect sizes were small to moderate and preschoolers had a high rate of adverse effects and a unique adverse effect profile. Furthermore, no information is available about long-term safety and effects of psychopharmacologic agents on the rapidly developing brains of preschoolers. Based on current evidence and guidelines, a careful trial with psychopharmacologic agents is indicated to treat ADHD in preschoolers if there is no improvement with behavior therapy and the preschoolers continue to exhibit significantly impaired hyperactive and inattentive symptoms. Preschoolers should be monitored closely for adverse effects and tried off medications after 6 months to assess the need for ongoing psychopharmacologic intervention. Further research is needed to identify predictors and moderators of response to guide individualized/optimal treatment options for ADHD in preschoolers.

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Acknowledgments

The authors thank the children, parents, and staff of the Infant and Preschool Psychiatry Clinic, and Ms. Rachele Peterson for her help with the literature search and preparation of the bibliography. Dr. J. Ghuman has received past funding from the NIMH for a K-23 career development grant, and from Bristol-Myers Squibb for a clinical trial in autistic disorder. She currently receives funding from the Health Resources and Services Administration–Maternal and Child Health (HRSA-MCH) for a training grant for the University of Arizona Leadership Education in Neurodevelopmental Disabilities Training Program (AZLEND). Dr. H. Ghuman has no biomedical financial interests or conflict of interest. No funding was received to prepare this manuscript.

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  1. Child and Adolescent Psychiatry, University of Arizona, Room AHSC 7304, 1501 N. Campbell Ave, Tucson, AZ, 85724-5002, USA

    Jaswinder K. Ghuman & Harinder S. Ghuman

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  1. Jaswinder K. Ghuman
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  2. Harinder S. Ghuman
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Correspondence to Jaswinder K. Ghuman.

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Ghuman, J.K., Ghuman, H.S. Pharmacologic Intervention for Attention-Deficit Hyperactivity Disorder in Preschoolers. Pediatr Drugs 15, 1–8 (2013). https://doi.org/10.1007/s40272-012-0001-5

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