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Pharmacotherapy for Preschool Children with Attention Deficit Hyperactivity Disorder (ADHD): Current Status and Future Directions

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Abstract

In this review, we consider issues relating to the pharmacological treatment of young children with attention deficit hyperactivity disorder (ADHD). ADHD in preschool-age children has a profound impact on psychosocial function and developmental trajectory. Clinical studies on pharmacotherapies for ADHD in young children have expanded rapidly in the past 2 decades, providing some evidence of efficacy for both psychostimulant and non-psychostimulant medications. However, preschool children may be more susceptible to adverse effects of medications, including growth reduction and cardiovascular side effects. Many questions remain regarding the long-term safety and effectiveness of these interventions; thus more research is needed to help clinicians evaluate the risk–benefit ratio for preschoolers with ADHD. As this body of knowledge grows, providers should consider the level of impairment caused by current symptoms in the risk–benefit analysis. Families should be educated not just about potential effects of medication but known complications of untreated ADHD; parents will likely not fully appreciate the long-term psychological effects of chronic behavioral problems and underachievement on a young child. A blanket “wait and see” approach should be avoided, in order to prevent a permanent loss of self-esteem and motivation that may affect some children throughout their lifespan.

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Authors and Affiliations

  1. Department of Psychiatry and Behavioral Sciences, Duke University School of Medicine, Durham, NC, USA

    Jonathan R. Young, Adare Yanagihara, Rachel Dew & Scott H. Kollins

  2. Education, and Clinical Center (MIRECC), Mid-Atlantic Mental Illness Research, Durham Veterans Affairs Health Care System, Durham, NC, USA

    Jonathan R. Young

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JRY, AY, and RD have nothing to disclose. SHK has received research support and/or consulting fees from the following sources in the past 24 months: Akili Interactive, Arbor Pharmaceuticals, BehaVR, Bose, Ironshore Pharma, KemPharm, Neos, OnDosis, Otsuka, Rhodes, Sana Health, Tali Health, Tris Pharma. SHK has received equity from Akili Interactive and holds equity and is a co-founder of Behavioral Innovations Group.

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Dr. Young is supported by the Department of Veterans Affairs Office of Academic Affiliations Advanced Fellowship Program in Mental Illness Research and Treatment, the Medical Research Service of the Veterans Affairs Durham Health Care System, and the Department of Veterans Affairs Mid-Atlantic Mental Illness Research, Education, and Clinical Center (MIRECC). There are no other funding sources relevant to this work.

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Young, J.R., Yanagihara, A., Dew, R. et al. Pharmacotherapy for Preschool Children with Attention Deficit Hyperactivity Disorder (ADHD): Current Status and Future Directions. CNS Drugs 35, 403–424 (2021). https://doi.org/10.1007/s40263-021-00806-z

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