Attention Deficit/Hyperactivity Disorder in Preschool-Age Children: Issues and Concerns

Abstract

The diagnosis of attention deficit/hyperactivity disorder (ADHD) in children has been steadily increasing over the past 10 years. ADHD is associated with numerous health, behavioral, social, and academic outcomes. The use of medication is common for the treatment of ADHD. However, the evidence base for pharmacological and non-pharmacological treatments for children younger than 6 years of age is limited. Both short-term and long-term studies of efficacy and safety of all interventions are needed in this population, especially the use of psychotropic medications. Understanding the long-term effects of psychotropic medication on the developing brains of preschoolers has important implications for outcomes into adulthood. Nonpharmacologic evidence-based interventions are available and should serve as the first line of treatment in this population. Future research needs include further evidence regarding specific curricula, dose, duration, delivery methods, and staff training to ensure optimal intervention outcomes.

Prevalence of Prescribed Attention-Deficit Hyperactivity Disorder Medications and Diagnosis among Canadian Preschoolers and School-Age Children: 1994–2007

“…In either case, future monitoring of the trends in the prevalence of medication intake by preschoolers is needed, as the efficacy of medication is rarely tested on this population. 31,62…”

“…[28][29][30] As few control trials have been conducted on this specific population, the efficacy of medication on preschoolers' ADHD behaviour and the short-and long-term impact on these children's brain and global development are still unknown. 29,[31][32][33] Moreover, the controversy around the ADHD diagnosis 34,35 is particularly lively when it comes to preschoolers, as the line between normal and pathological behaviour may be quite difficult to draw, especially as no specific diagnosis tools exist for this population. 31,32,36 Regarding sex-specific prevalence, it is well known that boys have always had a greater prevalence of ADHD and prescribed medications than girls.…”

“…29,[31][32][33] Moreover, the controversy around the ADHD diagnosis 34,35 is particularly lively when it comes to preschoolers, as the line between normal and pathological behaviour may be quite difficult to draw, especially as no specific diagnosis tools exist for this population. 31,32,36 Regarding sex-specific prevalence, it is well known that boys have always had a greater prevalence of ADHD and prescribed medications than girls. However, the steepest increase over time in ADHD 5 and in prescribed medications was observed in the latter group.…”

Parent Training for Preschool ADHD in Routine, Specialist Care: A Randomized Controlled Trial

“…Behavioral parent training (PT) is recommended as the first-line treatment for pre-school ADHD 1 and is often favored by parents over medication 2 . Medication appears less effective in the treatment of preschool ADHD, compared to the effects of medication for school-aged children with ADHD, and is associated with more adverse effects 2 . A recent systematic review supported the classification of behavioural PT as a well-established treatment for preschool children with ADHD 3 .…”

The Interplay Between Prenatal Adversity, Offspring Dopaminergic Genes, and Early Parenting on Toddler Attentional Function

“…Importantly, the general recommendation is that for preschool children showing signs of ADHD parent training should be the first line of treatment, and medication introduced only in case when parent training is not effective (Daley et al, 2009 ; Pelham et al, 2016 ). Thus, the literature suggests that parents have a key role in the development of their children’s attention skills (Gauvain, 2001 ; Davis and Williams, 2011 ). Attentional competencies develop through dynamic and continuous interactions between the child and their physical and social surroundings (Vygotsky, 1978 ; Landry et al, 2002 ).…”