Treatment of Preschoolers with Attention-Deficit/ Hyperactivity Disorder Desiree W. Murray Published online: 30 July 2010 # Springer Science+Business Media, LLC 2010 Abstract This article reviews the current treatment litera- ture for attention-deficit/hyperactivity disorder (ADHD) in preschoolers. Parent training studies show consistent behavioral improvements reported by teachers and observ- ers as well as parents, with evidence of clinically significant improvement in ADHD symptoms for up to 2 years. Few other behavioral interventions have been evaluated, al- though data from a large psychosocial, multimodal inter- vention are forthcoming. There is evidence to support the benefit of immediate-release stimulant medication for up to 1 year; however, effects do not seem to be as large, and some of the side effects may be greater than for school-age children. With regard to nonstimulants such as atomoxetine, there are literally no controlled outcome data for children with ADHD who are younger than 5 years of age. Overall, a great deal remains to be learned about the safety and efficacy of pharmacotherapy in this age group. Fortunately, results of several large intervention studies will be available soon to better inform clinical practice. Keywords ADHD . Preschool . Psychosocial . Parenting Introduction Attention-deficit/hyperactivity disorder (ADHD) in pre- schoolers has become established as a valid psychiatric disorder, with prevalence estimates ranging from 2% to 6% in community samples [1, 2]. Despite some differences in symptom presentation in younger children, similar patterns of comorbidity and impairment have been identified [3]. In the largest clinical sample available, oppositional and aggressive behaviors co-occurred with ADHD at rates as high as 70%, communication disorders at rates greater than 20%, and anxiety disorders at rates of 14.5% [4]. Many areas of impairment have been identified among pre- schoolers with ADHD, including relationships with parents, siblings, peers, and teachers, as well as their ability to cooperate with family activities and behave appropriately in public, which requires limitations of activities outside the home [5]. Academically, preschoolers with ADHD perform more poorly on tests of pre-academic skills [6] and have identified deficits in working memory, planning, and delay of gratification [7]. A large community survey indicated that more than 40% had been suspended from a preschool or day care setting at least once, and 16% had been expelled (Egger, personal communication). Evidence indicates that ADHD may be more severe and complicated in younger children and those with earlier- onset ADHD. Within a sample of clinically diagnosed children 3 to 5.5 years of age with ADHD, symptoms were rated by parents and teachers as more severe in younger children [4]. Earlier age at onset of ADHD (recalled by parents in annual increments from birth to 6 years of age) within a clinical sample of elementary school-age children was also associated with higher rates of parent-reported aggressive symptoms [8]. Diagnosis during the preschool years also predicts the development of other psychiatric disorders and creates significant risk for the development of secondary impairments such as school failure and peer difficulties during adolescence [9, 10]. Unfortunately, ADHD in preschoolers seems quite stable over time, with symptoms remaining to age 6 years in 50% of children identified at age 3, and in 48% at age 9 [11]. D. W. Murray (*) Department of Psychiatry, Duke University Medical Center, 718 Rutherford Street, Durham, NC 27705, USA e-mail: dwmurray@duke.edu Curr Psychiatry Rep (2010) 12:374–381 DOI 10.1007/s11920-010-0142-6