Preschool Attention-deficit/hyperactivity Disorder Research Articles

Are Planning, Working Memory, and Inhibition Associated With Individual Differences in Preschool ADHD Symptoms?

The association between executive function (EF; planning, working memory, and inhibition) and individual differences in symptoms of attention deficit hyperactivity disorder (ADHD) was explored in a sample of preschool children. One hundred sixty children (between the ages of 3 years, 0 months and 5 years, 6 months), selected so as to oversample high ADHD scorers, performed 3 tasks previously shown to measure planning (Tower of London), working memory (Noisy Book) and inhibition ("Puppet Says..."). EF measures were reliable (k > .77) and were correlated with IQ (rs > .38) and age (rs > .59). Once IQ and age were controlled, planning and working memory (r = .41) were correlated. Planning and working memory were not correlated with inhibition (rs < .20). There was no association between ADHD and working memory or planning (rs < .12). There was a significant negative association between ADHD and conduct problems and inhibition (r = -.30 and r = -.25, respectively). Only the link with ADHD persisted after the effects of other factors were controlled for in a multiple regression. Specific deficits in inhibitory control rather than general EF deficits are associated with ADHD in the preschool period. This association is linear in nature, supporting the idea that ADHD is better seen as a continuum rather than a discrete category. This association provides evidence for Barkley's (1997) view that ADHD is underpinned by inhibitory deficits in the preschool period.

Does Maternal ADHD Reduce the Effectiveness of Parent Training for Preschool Children's ADHD?

To assess the impact of maternal attention-deficit/hyperactivity disorder (ADHD) symptoms on the effectiveness of a parent training (PT) program for preschool ADHD. Eighty-three 3-year-old children with ADHD and their mothers selected from two community cohorts living in Hampshire, England (1992-93 and 1995-96, respectively), completed an 8-week PT program. ADHD symptoms and a number of other parent and child factors, including adult ADHD symptoms, were measured prior to the start of treatment (week 1: T1), immediately after treatment (week 8: T2), and at 15 weeks follow-up (week 23: T3). Mothers were divided into three groups on the basis of their scores (T1) on the Adult AD/HD Rating Scale (high, medium, low). Children of mothers in the high-ADHD group displayed no improvement after PT, whereas the levels of ADHD symptoms of the children of mothers in either the medium or low ADHD groups reduced substantially (F(4,60) = 3.13, p < .05). This association persisted after other child and maternal factors were controlled for in multiple regression analyses (beta > .30, p < .05). High levels of maternal ADHD symptoms limit the improvement shown by children with ADHD after a program of PT. This effect was unrelated to other aspects of maternal mental health and child functioning. The treatment of parental ADHD may be a prerequisite for the success of psychosocial interventions for childhood ADHD.

Preschool attention deficit hyperactivity disorder: a review of prevalence, diagnosis, neurobiology, and stimulant treatment.

The clinical use of stimulant medications for 3- to 6-year-old preschool children who meet diagnostic criteria for attention deficit hyperactivity disorder (ADHD) is becoming more common. A systematic computerized literature search extending back to 1970 identified nine controlled studies of stimulant treatment and two controlled trials of stimulant side effects in preschool ADHD children. Treatment benefits are reported for eight of nine (89%) controlled stimulant trials involving a total of 206 preschool subjects. In comparison with school-aged ADHD youth, there may be a greater variability of stimulant response in ADHD preschoolers. Domains assessing cognition, interpersonal interactions, and hyperactive-impulsive behavior are noted to improve on drugs relative to placebos. Side effects in this age range are generally reported as mild. ADHD preschool children may experience slightly more and different types of stimulant-induced side effects compared with older children. High rates of behavior reported as stimulant side effects are found for children receiving a placebo, necessitating a baseline evaluation for medication side effects before stimulants are initiated. Despite the lack of research assessing stimulant effects on the very young and developing brain and the need for more controlled medication trials in this age range, this review of the extant literature finds stimulants to meet evidence based criteria as beneficial and safe for carefully diagnosed ADHD preschool children aged 3 years and older.

Parent-Based Therapies for Preschool Attention-Deficit/Hyperactivity Disorder: A Randomized, Controlled Trial With a Community Sample

To evaluate two different parent-based therapies for preschool attention-deficit/hyperactivity disorder (ADHD) in a community sample. Three-year-old children displaying a preschool equivalent of ADHD (n = 78) were randomly assigned to either a parent training (PT; n = 30), a parent counseling and support (PCO&S; n = 28), or a waiting-list control group (n = 20). The PT group received coaching in child management techniques. The PC&S group received nondirective support and counseling. Measures of child symptoms and mothers' well-being were taken before and after intervention and at 15 weeks follow-up. ADHD symptoms were reduced (F2,74 = 11.64; p < .0001) and mothers' sense of well-being was increased by PT relative to both other groups (F2,74 = 10.32; p < .005). Fifty-three percent of children in the PT group displayed clinically significant improvement (chi 2 = 4.08; p = .048). PT is a valuable treatment for preschool ADHD. PC&S had little effect on children's behavior. Constructive training in parenting strategies is an important element in the success of parent-based interventions. Psychostimulants are not a necessary component of effective treatment for many children with preschool ADHD.

Parent Training Management of Preschool ADHD

Parent training (PT) and parent counseling and support (PC&S) techniques were compared in the management of a community sample of preschool 3-year-old children with attention-deficit/hyperactivity disorder (ADHD) followed in the Department of Psychology, University of Southampton, UK.

Assessment of Attention-Deficit Hyperactivity Disorder in Preschoolers

Twenty-six preschoolers, 13 with Attention-Deficit Hyperactivity Disorder (ADHD), and 13 without ADHD, were assessed with respect to the following: Psychosocial Functioning, Attention, Impulsivity, and Hyperactivity. Two new behavioral coding systems, a new test of inhibitory control, and a new test of vigilance were specifically designed for preschoolers to measure activity, impulsivity, and attention. Preschoolers with ADHD were rated by their parents as significantly more stressful to manage, less reinforcing, more demanding, less adaptable to change, and less compatible with the parent. Although family functioning was rated to be within the average range for both groups, mothers of preschoolers with ADHD rated themselves as exhibiting more symptoms of depression, and a sense of reduced parental competence. During structured tasks, preschoolers with ADHD more often grabbed materials, and required more frequent directives from an examiner. During unstructured tasks the preschoolers with ADHD more often played with a set of “off-limits toys”. Activity level, as well as squirming, did not reliably distinguish between the preschoolers with and without ADHD. Finally, preschoolers with ADHD, consistent with the school-age ADHD literature, committed significantly more errors of commission on a preschool vigilance task. Discussion focuses on the clinical validity of this protocol, the importance of assessing preschoolers with developmentally appropriate measures of attention and behavior, and of interpreting their profiles within a neurodevelopmental framework.

Methylphenidate for ADHD in Preschoolers

The effectiveness of methylphenidate (MPH), 0.3 and 0.5 mg/kg 2x daily, in the treatment of 31 children, aged 4 to 6 years, with attention-deficit hyperactivity disorder (ADHD) was investigated by a double-blind, placebo-controlled study at the University of Ottawa, Canada.