Preschool ADHD and Medication ... More Study Needed?!

By Posey, W. Mark; Bassin, Sarah A. et al. | Journal of Early Childhood and Infant Psychology, Annual 2009 | Go to article overview

Preschool ADHD and Medication ... More Study Needed?!


Posey, W. Mark, Bassin, Sarah A., Lewis, Ashley, Journal of Early Childhood and Infant Psychology


The purpose of this work is to provide an examination of the diagnosis

of ADHD, the efficacy of the medication use for controlling ADHD

symptoms, and the concerns with medication use for ADHD in

preschool populations. Thus, the perceived validity of the ADHD

diagnosis in preschool children is reviewed. The evidence base

to support efficacy of medication use for ADHD in preschoolers

is discussed. Consideration is given to arguments for and against

medication use in this population. Suggestions for future research are

presented.

More than 70 years ago, Bradley (1937) reported on the behavioral effects of stimulants. These medications produced a calming effect and also improved compliance and academic performance. Bradley continued to publish studies showing positive outcomes for children using this type of treatment (e.g., Bradley & Bowen, 1941). Since that time Swanson et al. (1993) noted that there have been 250 reviews and more than 3,000 articles on stimulant effects. For example, Jensen and colleagues (1999) have reported that only one-eighth of the children who met the criteria of attention deficit hyperactivity disorder (ADHD) received adequate stimulant treatment. In contrast, 72% of school-aged children prescribed stimulants in rural North Carolina did not meet criteria for ADHD (Angold, Erkanli, Egger, & Costello, 2000). Still, the stability and validity of the ADHD diagnosis is high from 4 years of age throughout elementary school (Lahey et al., 2004). While discussing how ADHD manifests itself differently in school-age children and preschoolers, Dopfner and colleagues state that "on the basis of this data one can start to make an argument about the utility of the preschool ADHD construct" (Dopfner, Rothenberger, & Sonuga-Barke, 2004, p. 132). The Preschoolers with Attention-Deficit/Hyperactivity Disorder Treatment Study (PATS) was sponsored by the National Institute of Mental Health (NIMH) and several universities (i.e., University of California, Irvine; Duke University Medical Center; Columbia University; New York University Child Study Center; University of California, Los Angeles; and Johns Hopkins University). The PATS was not designed to look at whether ADHD is a valid diagnosis, but rather to address the efficacy and safety of short-term use of methylphenidate (MPH). The PATS included preschoolers aged 3 to 5 years who were diagnosed with ADHD. Several studies have been published based on the PATS data (e.g., Greenhill et al., 2006; Kollins et al., 2006).

The focus of the PATS suggests that the notion of whether ADHD is a valid diagnosis in early childhood is more settled than what to do when the diagnosis is obtained. The present paper begins with reasons why diagnosing ADHD in the preschool child has been challenging. Second, it reviews medication and the preschool child. Third, it addresses issues related to medication efficacy in the treatment of ADHD. Focus is given specifically to medication concerns resulting from the use of stimulant and nonstimulant psychotropic drugs on preschool children. The goal is to identify research trends while describing areas where additional research is warranted.

Diagnosing ADHD in Preschoolers and Children

Two mainstream scientific consensus statements address the diagnosis and treatment of ADHD: one organized by Russell Barkley (Barkley et al., 2002) and one sponsored by the National Institutes of Health (NIH, 1998). The statement organized by Barkley (and 74 other prominent scientists) addresses misinformation about ADHD covered in the mainstream media. Barkley et al. state that the American Medical Association (AMA), the American Psychiatric Association (APA), the American Academy of Child and Adolescent Psychiatry (AACAP), and the American Academy of Pediatrics (AAP), among others, all recognize ADHD as a valid disorder that can be diagnosed in children as young as 3 years of age. …

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