Pharmacologic Intervention for Attention-Deficit Hyperactivity Disorder in Preschoolers

Abstract

Pharmacologic intervention for attention-deficit hyperactivity disorder (ADHD) in preschool children is a controversial issue. Non-pharmacologic interventions (psychosocial and restricted dietary interventions) have been shown to benefit oppositional, non-compliant, aggressive and disruptive, as well as hyperactive and inattentive behaviors in preschoolers with ADHD and other disruptive behavior disorders. However, not all families have access to non-pharmacologic interventions or prefer them. The Preschool ADHD Treatment Study recently provided evidence of benefit with immediate-release methylphenidate; however, effect sizes were small to moderate and preschoolers had a high rate of adverse effects and a unique adverse effect profile. Furthermore, no information is available about long-term safety and effects of psychopharmacologic agents on the rapidly developing brains of preschoolers. Based on current evidence and guidelines, a careful trial with psychopharmacologic agents is indicated to treat ADHD in preschoolers if there is no improvement with behavior therapy and the preschoolers continue to exhibit significantly impaired hyperactive and inattentive symptoms. Preschoolers should be monitored closely for adverse effects and tried off medications after 6 months to assess the need for ongoing psychopharmacologic intervention. Further research is needed to identify predictors and moderators of response to guide individualized/optimal treatment options for ADHD in preschoolers.

Investigating the Gut Microbiota Composition of Individuals with Attention-Deficit/Hyperactivity Disorder and Association with Symptoms

“…These pharmacological interventions are highly effective in controlling ADHD symptoms and have an approximate response rate of 70% [8]. However, medication treatment of ADHD is limited by low adherence, concerns about side effects, and absence of evidence for long-term efficacy [9,10]. Approximately 30% of individuals with ADHD do not respond to medication or are unable to tolerate the adverse effects [7].…”

Patterns and profiles of methylphenidate use both in children and adults

“…For children, the mean duration of treatment was longer for those initiating MPH therapy at a young age (6–11 years), while the highest dropout rate after one dispensing was observed for 1–5‐year‐old children (27%). Use of MPH for these preschool children has not been approved and is controversial due to the lack of pertinent data about its safety on the developing brain of these children, and on its efficacy in this population . One‐quarter of these preschool children dropped out after one prescription.…”

Investigating the Gut Microbiota Composition of Individuals with Attention-Deficit/Hyperactivity Disorder and Association with Symptoms

“…These pharmacological interventions are highly effective in controlling ADHD symptoms and have an approximate response rate of 70% [8]. However, medication treatment of ADHD is limited by low adherence, concerns about side effects, and absence of evidence for long-term efficacy [9,10]. Approximately 30% of individuals with ADHD do not respond to medication or are unable to tolerate the adverse effects [7].…”