Psychostimulants in preschool children with attention-deficit/hyperactivity disorder: clinical evidence from a
J K Ghuman1, G S Ginsburg, G Subramaniam
1Division of Child and Adolescent Psychiatry, John Hopkins University School of Medicine, Baltimore, MD, USA. ghuman@kennedykrieger.org
Insights
Preschool children with attention-deficit/hyperactivity disorder (ADHD) show a positive response to psychostimulant treatment over 24 months, though side effects necessitate careful monitoring. Long-term ADHD management in this age group requires ongoing clinical evaluation.
Area of Science:
- Child and Adolescent Psychiatry
- Developmental Psychology
- Pharmacology
Background:
- Attention-deficit/hyperactivity disorder (ADHD) is a common neurodevelopmental disorder in preschool children.
- Psychostimulant medications are frequently used to manage ADHD symptoms.
- Limited data exists on the long-term efficacy and safety of psychostimulants in very young children.
Purpose of the Study:
- To evaluate the response to psychostimulant treatment in preschool children diagnosed with ADHD.
- To assess treatment outcomes over 3, 12, and 24 months.
- To monitor the occurrence and severity of side effects associated with psychostimulant use.
Main Methods:
- A retrospective chart review of 27 preschool children (ages 3-5) with ADHD treated with psychostimulants.
- Independent chart review by two child and adolescent psychiatrists.
- Utilized Clinical Global Impressions (CGI) scale for illness severity and improvement, and Side Effects Rating Form for adverse events.
Main Results:
- Psychostimulant response rates were high: 74% at 3 months, 70% at 12 and 24 months.
- Significant improvement in CGI severity-of-illness ratings over 24 months (p < .0001).
- Side effects decreased over time (63% at 3 months to 29% at 24 months) and were mostly mild; 11% discontinued medication due to side effects.
Conclusions:
- Preschool children with ADHD, particularly those with co-occurring developmental disorders, respond well to psychostimulants.
- Close monitoring is essential due to the frequency of side effects.
- Findings may not generalize to all preschool children with ADHD due to the study population's specific characteristics.
Objective:
To examine psychostimulant response in preschool children with attention-deficit/hyperactivity disorder (ADHD) in an outpatient child psychiatry clinic (housed within a developmental disorders institution) over 3, 12, and 24 months of treatment.
Method:
A systematic retrospective chart review was conducted for 27 preschool children with ADHD who were started on psychostimulants between the ages of 3 and 5 years, inclusive. Two child and adolescent psychiatrists reviewed each chart independently, using the Clinical Global Impressions (CGI) scale to rate the severity of illness and global improvement and the Side Effects Rating Form to rate side effects.
Results:
Over 24 months, psychostimulants were stopped in three children (11%) because of side effects and concomitant psychotropic medications were added in seven children (26%). The CGI severity-of-illness ratings showed a significant effect of time over 3, 12, and 24 months of psychostimulant treatment (all p values < .0001). Rate of response was 74% at 3 months and 70% at 12 and 24 months. Side effects were mostly mild and occurred in 63% of the children at 3 months, 41% at 12 months, and 29% at 24 months.
Conclusions:
The findings suggest that preschool children with developmental disorders respond to psychostimulants but need close monitoring because of frequent side effects. Inasmuch as the study participants were recruited from a child psychiatry clinic housed within a developmental disorders institution and had a high rate of developmental disorders, the findings may not generalize to other preschool children with ADHD.
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