Preschool ADHD treatment

Brigette S. Vaughan, Joan M. Daughton, Christopher J Kratochvil

Research output: Chapter in Book/Report/Conference proceedingChapter

Abstract

Introduction Preschool psychopharmacology is nearly entirely off-label [1], and the use of psychopharmacological interventions essentially exposes a young child to agents whose potential risks and benefits may not be entirely known. In addition to potentially unintended central nervous system (CNS) and other adverse effects, children display more rapid hepatic and renal metabolisms which may change the dosing and administration strategy for psychopharmacological intervention in this age group. Few studies examine the effects of psychiatric medications on preschool-aged children, and even fewer offer data on long-term outcomes. The limited support of pharmacotherapy as a safe and efficacious treatment for young children with attention-deficit hyperactivity disorder (ADHD) no doubt provides the rationale for recommending behavioral therapy as the initial intervention for these patients, or at a minimum, as a key part of a comprehensive treatment plan. The lack of US Food and Drug Administration (FDA) approval for many of the ADHD pharmacotherapies for use in the preschool age group, however, does not suggest that available approved medications cannot be used. It does, however, emphasize the importance of a careful and thorough assessment of the young child, and cautious determination of the degree of impairment and the need for treatment. This risk–benefit analysis is a crucial aspect of treatment planning. If pharmacotherapy is ultimately determined to be warranted, the prescribing clinician is obligated to provide a detailed and collaborative informed consent process. Epidemiology One epidemiological study found that 12% of preschool-aged children met criteria for an impairing Diagnostic and Statistical Manual of Mental Disorders (DSM)-IV disorder [2], with 9% meeting criteria for a behavioral disorder. Carter et al. also found that 21.6% of children entering formal schooling (kindergarten or first grade) met criteria for an impairing DSM-IV disorder [3]. In school-age children, ADHD has a 5.7% worldwide prevalence [4–6], while epidemiological surveys of community samples have reported 2–6% of preschoolers meet full criteria for ADHD [7–9]. Symptoms of the disorder are very common in the preschool population. Two studies have reported that 59–86% of 2- to 6-year-olds referred to psychiatric clinics have at least some symptoms of the disorder [9, 10]. A careful assessment by a skilled clinician is necessary to differentiate “true” ADHD from other disorders with overlapping symptoms, or even from “normal” development.

Original languageEnglish (US)
Title of host publicationAttention-Deficit Hyperactivity Disorder in Adults and Children
PublisherCambridge University Press
Pages318-326
Number of pages9
ISBN (Electronic)9781139035491
ISBN (Print)9780521113984
DOIs
StatePublished - Jan 1 2015

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Attention Deficit Disorder with Hyperactivity
Diagnostic and Statistical Manual of Mental Disorders
Preschool Children
Drug Therapy
Psychiatry
Therapeutics
Age Groups
Off-Label Use
Drug Approval
Psychopharmacology
Informed Consent
Epidemiologic Studies
Epidemiology
Central Nervous System
Kidney
Food
Liver
Population

ASJC Scopus subject areas

  • Medicine(all)

Cite this

Vaughan, B. S., Daughton, J. M., & Kratochvil, C. J. (2015). Preschool ADHD treatment. In Attention-Deficit Hyperactivity Disorder in Adults and Children (pp. 318-326). Cambridge University Press. https://doi.org/10.1017/CBO9781139035491.026

Preschool ADHD treatment. / Vaughan, Brigette S.; Daughton, Joan M.; Kratochvil, Christopher J.

Attention-Deficit Hyperactivity Disorder in Adults and Children. Cambridge University Press, 2015. p. 318-326.

Research output: Chapter in Book/Report/Conference proceedingChapter

Vaughan, BS, Daughton, JM & Kratochvil, CJ 2015, Preschool ADHD treatment. in Attention-Deficit Hyperactivity Disorder in Adults and Children. Cambridge University Press, pp. 318-326. https://doi.org/10.1017/CBO9781139035491.026
Vaughan BS, Daughton JM, Kratochvil CJ. Preschool ADHD treatment. In Attention-Deficit Hyperactivity Disorder in Adults and Children. Cambridge University Press. 2015. p. 318-326 https://doi.org/10.1017/CBO9781139035491.026
Vaughan, Brigette S. ; Daughton, Joan M. ; Kratochvil, Christopher J. / Preschool ADHD treatment. Attention-Deficit Hyperactivity Disorder in Adults and Children. Cambridge University Press, 2015. pp. 318-326
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