68.2 TREATMENT GUIDELINES FOR PHARMACOLOGICAL MANAGEMENT OF DISRUPTIVE BEHAVIORS AND ADHD

Abstract

There is a high comorbidity between ADHD and disruptive behavior problems in young children. The AAP recommends behavioral parent training and/or behavioral therapy as a first-line treatment of preschool-aged children with ADHD. Based on literature review, behavioral therapy in young children is the most efficacious in the treatment of ADHD symptomatology, particularly when it is comorbid with disruptive behaviors; however, if it fails or is inadequate in managing symptomatology, stimulant medications are considered. Dextroamphetamine is FDA approved for the treatment of ADHD in children aged 3 years and older, vs methylphenidate, which has a warning to not be used in children younger than 6 years old. Data on medication use in this patient population are limited and risk assessment is complex due to lack of full appreciation of potential long-term side effects and consequences on the developing brain. It is also unclear which children would respond better to therapy and which ones would respond better to medication management. There are also no guidelines regarding combined treatment, medication plus therapy, for children with severe symptomatology. This presentation will focus on a literature review of studies discussing various treatment modalities for disruptive behaviors in young children with ADHD. We will discuss challenges of combined treatment: psychotherapy and medication management. We will focus on available literature on the use of psychotropic medications in children aged 2 to 7 years. We will review available treatment guidelines and offer provisional guidelines, based on available literature on when to use behavior treatment alone vs in combination with medication. Participants will learn treatment recommendations for young children with ADHD and disruptive behaviors. They will gain an understanding of the pros and cons of using medications in this patient population. They will have an opportunity to present their challenging cases and ask questions. First-line treatment of disruptive behaviors in kids with ADHD is with behavioral therapies. Data on medication use are very limited in this patient population.