Clinical diagnosis and management of attention deficit hyperactivity disorder in preschool children

Abstract

To provide an overview of clinical advances and research findings related to attention deficit hyperactivity disorder (ADHD) in preschool children, with an emphasis on assessment and management. The American Academy of Pediatrics has just released new clinical practice guidelines for the diagnosis and management of ADHD. These guidelines are broader in scope, now extending down to preschool children (ages 4 and 5 years). With respect to diagnosis, the American Psychiatric Association has recently proposed modifications to the Diagnostic and Statistical Manual of Mental Disorders (DSM-IV); the current draft version of DSM-V includes changes to the diagnosis criteria for ADHD. With respect to treatment of preschool children with ADHD, studies continue to support the efficacy of behavioral interventions. Regarding pharmacotherapy, a large, recently completed, placebo-controlled study of methylphenidate for preschool ADHD identified some age-related medication differences. ADHD can be reliably diagnosed in preschool children. Behavior therapy remains the recommended first-line treatment approach; pharmacotherapy is sometimes indicated as a treatment adjunct, or, less commonly, a treatment alternative.