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When preschool children have ADHD

Stimulant medication is effective for treatment of preschool children with ADHD, but it’s associated with a high rate of adverse events.

Results of small studies have reported benefits from methylphenidate (MPH) for treating core ADHD behaviors in preschool children. Now, results of the Preschool ADHD Treatment Study (PATS), a NIMH-funded, six-center, randomized trial of the efficacy and safety of MPH in preschool children, have been reported in four articles.

Investigators enrolled 303 children (age range, 3–5.5 years) who met DSM-IV criteria for combined-type ADHD in an intensive 10-week behavioral therapy program with their parents. Children whose behaviors had not improved after behavioral therapy and whose parents agreed to a medication trial entered a 5-week, placebo-controlled, double-blind trial in which 165 children were randomized to receive placebo or 1.25 mg, 2.5 mg, 5.0 mg, or 7.5 mg of immediate-release MPH three times daily. Outcomes were measured with standardized ADHD questionnaires completed by parents and teachers. Compared with controls, children who received the 2.5 mg, 5.0 mg, and 7.5 mg doses of MPH had significant reductions in ADHD symptoms (P<0.01, P<0.001, P<0.001, respectively). The mean effective total daily dose of MPH was 14.2 (+/−8.1) mg/day.

After the controlled phase, 140 children entered a 10-month open-label maintenance trial. By the end of the maintenance phase, the mean effective total daily dose …