While ADHD is more easily identified in school-aged children, diagnoses in younger children can be more challenging because the disorder is often confused with other disruptive behaviour like temper tantrums. This has triggered the need for more research into the effectiveness of different interventions and treatment for preschoolers at risk for ADHD.
Researchers, from The Hospital for Sick Children (SickKids) and McMaster Evidence-Based Practice Center reviewed over 50 studies and found that parental behaviour training (PBT) is the most safe and effective treatment for preschool-aged children at risk of ADHD. The review is published in the April 1 online edition of Pediatrics.
The other treatment interventions examined were psychostimulant drugs (specifically Ritalin or methylphenidate), and a combination of behaviour training for parents in the home, and training for teachers in the classroom setting.
“We’re always looking for the best way to treat children with ADHD. Physicians often refer to previous research showing that psychostimulant medications are a safe and effective treatment for school-aged children with ADHD as a guide for treatment decisions in younger children,” says Dr. Alice Charach, Head of the Neuropsychiatry Team at SickKids “This review aimed to evaluate and compare different treatment interventions for children under six years of age who are at risk of ADHD specifically, and determine what our first line of action should be. We found that parent behaviour training should be the first intervention used for this age group.”
The review found that parental behaviour training should be used as the primary form of treatment based on its many benefits, and medication should only be used as a secondary treatment option.
Charach, who is also Associate Professor in the Department of Psychiatry at the University of Toronto, adds that parent behaviour training interventions not only improved disruptive behaviour in preschool-aged children with ADHD, but also improved parenting skills.
Parents sometimes prefer parental behaviour training over medication, stemming from the concern that preschool-aged children are susceptible to the adverse effects from medications. It is important to note that while parent behaviour training is not associated with any adverse effects, the review did find that many parents did not complete the full intervention due to the time commitment and cost.
The next step, says Charach, will be to make parent behaviour training more easily accessible by tailoring intervention techniques to specific families and subgroups, as well as looking at assisting kindergarten personnel with similar behaviour training. After attempting parental behaviour training, children should then have follow-up assessment to determine if further intervention should be considered.
This research was supported by the United States Agency for Healthcare Research and Quality as part of the Effective Health Care Program.