Parent behavior training treats preschoolers at risk for ADHD

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1. Parent behavior training (PBT) showed efficacy in treatment of preschoolers at risk for Attention Deficit Hyperactivity Disorder (ADHD). 

2. Methylphenidate showed less efficacy and greater adverse effects than PBT; first-line treatment with stimulants is not recommended in this age group. 

Study Rundown: Interventions at the preschool level are being studied for children with at or risk for ADHD in an effort to begin treatment and achieve behavioral improvements before entering school. This comparative effectiveness review examined 55 studies enrolling children younger than 6 years with known ADHD or disruptive behaviors putting the child at risk for ADHD. Three interventions – PBT, methylphenidate treatment, and combined home/school care interventions – were assessed for their effect on behavior. PBT consisted of parental training on effective discipline methods while developing a strong parent and child relationship. Each intervention was given an overall strength of evidence (SOE) score by two independent raters. PBT showed the greatest efficacy, with methylphenidate treatment being less effective. Combined home/school care interventions showed inconsistent results in terms of efficacy. Additionally, the study highlighted several adverse effects of methylphenidate, which included somatic concerns, irritability, and growth decline. Adverse effects of PBT were not found.

Click to read the study, published today in Pediatrics

In Depth: this comparative effectiveness review examined 55 studies enrolling children under 6 years with known ADHD or disruptive behaviors associated with ADHD risk. PBT, methylphenidate treatment, and combined home/school care programs were assessed by two independent raters, who produced a strength of evidence (SOE) score according to treatment evidence guidelines. Higher SOE indicated a stronger evidence base in favor of the intervention. Eight high-quality studies investigating PBT were included, with a high SOE for improved behavior. One high-quality study with methylphenidate-based intervention was included and yielded a lower SOE. Adverse somatic concerns, irritability, and decreased growth rates were of concern with methylphenidate use in preschool-age participants. Combined home/school care programs revealed inconsistent efficacy results. This review was limited by the small number of high-quality studies included for SOE analysis from among the 55 original studies and the lack of direct PBT versus methylphenidate comparison studies.

By Neha Joshi, Devika Bhushan, and Leah H. Carr

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