Attention deficit hyperactivity disorder (ADHD) is a common neurobehavioral disorder of childhood that can result in significant functional impairment, and if not adequately treated can lead to impaired quality of life. Pharmacotherapy is considered the first-line treatment for ADHD in children and adolescents. We review both recent literature and seminal studies regarding the pharmacological treatment of ADHD in children and adolescents. There is ample evidence for the efficacy and safety of both stimulants and non-stimulants in the treatment of ADHD. We review important aspects of evaluation and assessment and discuss first-line pharmacological treatments and as well as when to consider using alternative pharmacological agents. Treatment approaches to manage frequently seen comorbid disorders with ADHD are also covered.

Objective: The aim of this study was to report preliminary data regarding effectiveness and tolerability of atomoxetine in 3-to 5-year-old preschool children with attention-deficit=hyperactivity disorder (ADHD). Methods: Nine boys and 3 girls (mean age ¼ 5.0 AE 0.72 years) diagnosed with ADHD were treated with atomoxetine in an open-label pilot study. Atomoxetine was gradually titrated to a maximum dose of 1.8 mg=kg per day.Results: There was a significant effect of time from baseline to end point on the parent-rated hyperactivity= impulsivity Swanson Nolan and Pelham (SNAP-IV-HI) subscale ratings (F[9, 11] ¼ 6.32, p < 0.0001). The mean difference between the baseline and end-point parent SNAP-IV-HI scores was 10.2 AE 7.3 ( p ¼ 0.0005). The rate of positive response (defined as at least a 30% reduction in the end-point parent SNAP-IV-HI scores and a Clinical Global Impressions-Improvement [CGI-I] rating of Much Improved or Very Much Improved) was 75%. The Children's Global Assessment Scale scores improved significantly over time [F(9, 11) ¼ 6.24 p < 0.001]. The mean end-point daily dose of atomoxetine was 1.59 AE 0.3 mg=kg. A high proportion (66.7%) of the preschoolers experienced side effects with atomoxetine. Side effects of defiance, tantrums, aggression, and irritability were most disconcerting to parents, and gastrointestinal complaints were the most commonly reported adverse effects. One child was terminated from the study due to ''chest ache.'' There were no changes in weight, height, or cardiovascular measures.Conclusion: This open-label pilot study provides preliminary evidence of effectiveness and tolerability of atomoxetine for treating ADHD in preschool children, although double-blind, randomized, placebo-controlled studies are needed to confirm this.

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