Table AKQ1: Effectiveness of interventions for ADHD and DBD in children younger than 6 years of age

InterventionLevel of EvidenceConclusion
Parent Behavior TrainingSOE: High

SMD: −0.68 (95% CI, −0.88 to −0.47)
Parent behavioral interventions are an efficacious treatment option for preschoolers with DBD and show benefit for ADHD symptoms.

These studies support the long-term effectiveness of parent interventions for preschoolers with DBD, including ADHD symptoms, with evidence that benefits are maintained for up to 2 years. There also appears to be a dose-response effect.
Multicomponent Home and School or Daycare-Based InterventionsSOE: InsufficientEvidence is drawn from few reports.

Where there is no socioeconomic burden, multicomponent interventions work as well as a structured parent education program in several domains.

Where there is socioeconomic burden, the treatment classroom appears to be the primary beneficial intervention, and this appears to be related to lack of parent engagement and attendance at PBT sessions. Relative benefits of the school-based intervention diminished over 2 years.
Medication (MPH Only)SOE: Low

SMD: −0.83 (95% CI, −1.21 to −0.44)
With evidence drawn primarily from the PATS study, MPH (e.g., short-acting, immediate-release MPH) is both efficacious and generally safe for treatment of ADHD symptoms, but there has been no long-term followup in preschoolers.

Note: ADHD = attention deficit hyperactivity disorder; CI = confidence interval; DBD = disruptive behavior disorder; KQ = Key Question; MPH = methylphenidate; PATS = Preschool ADHD Treatment Study; PBT = parent behavior training; SMD = standardized mean difference; SOE = strength of evidence.

From: Executive Summary

Cover of Attention Deficit Hyperactivity Disorder
Attention Deficit Hyperactivity Disorder: Effectiveness of Treatment in At-Risk Preschoolers; Long-Term Effectiveness in All Ages; and Variability in Prevalence, Diagnosis, and Treatment [Internet].
Comparative Effectiveness Reviews, No. 44.
Charach A, Dashti B, Carson P, et al.

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