Finding the Tools for Effective Early Intervention for Preschool Attention-Deficit/Hyperactivity Disorder

Abstract

T he rapid development across all developmental domains in early childhood offers opportunities for early intervention to mitigate risks and promote healthy development. Existing data are clear that early intervention promotes healthy brain development and positive caregiving environments and lowers the costs associated with high-risk child, family, and community factors. A growing empirical literature moves beyond risk factors to characterize clinically impairing early childhood mental health problems, including attention-deficit/hyperactivity disorder (ADHD), and examine the efficacy of treatments. The Preschool ADHD Treatment Study (PATS) was the first large, multisite, multiphase, randomized, controlled trial of medication for very young children with any psychiatric disorder. PATS examined the effect of immediate-release methylphenidate for moderate to severe ADHD in children 3.0 to 5.5 years old. The rigorous PATS intervention included parent management training (PMT), blinded identification of each child’s optimal dose, and a placebo-controlled phase. The PATS demonstrated the superiority of methylphenidate over placebo in treating ADHD in preschoolers. However, the PATS results also highlighted the need for rigorous evaluation of the downward extension of state-of-the-art school-age treatments to preschoolers. The study demonstrated that, in preschoolers with ADHD who did not respond to parent training, methylphenidate showed a smaller effect size, higher rates of adverse effects, and higher peak plasma concentrations than those seen in school-age children. Essentially, preschoolers are different. A clinical take-home message from the PATS seemed to be that, although methylphenidate is the best studied treatment for preschool ADHD, this first-line treatment for school-age ADHD is an