Do Externalizing and Internalizing Symptoms Moderate Medication Response in Preschool Attention-Deficit/Hyperactivity...

Area of Science:

• Pediatric Neurology
• Child Psychiatry
• Pharmacology

Background:

• Attention-deficit/hyperactivity disorder (ADHD) is common in preschoolers.
• Stimulant (STIM) medications and alpha-2 adrenergic agonists (A2As) are frequently used to treat ADHD in young children.
• Predicting medication response in preschool ADHD is crucial for effective treatment.

Purpose of the Study:

• To investigate if parent-reported ADHD symptom severity, externalizing symptoms (EXT), or internalizing symptoms (INT) moderate treatment response to STIM and A2As in preschoolers with ADHD.
• To identify specific symptom profiles that predict differential medication response.

Main Methods:

• Retrospective chart review of 309 children under 72 months with ADHD treated with medication.
• Analysis of parent rating scale data for ADHD symptom severity, EXT, and INT.
• Ordinal logistic regression models used to predict medication response based on symptom severity and medication class.

Main Results:

• ADHD symptom severity did not predict medication response.
• Both EXT and INT symptoms moderated response, with significant interactions by medication class.
• Children with higher EXT or INT symptoms were less likely to respond to STIM compared to A2As.
• Response rates to STIM and A2As became more similar as EXT and INT symptom levels increased.

Conclusions:

• In preschool ADHD, low EXT or INT symptom ratings are associated with a higher likelihood of response to STIM medications.
• Treatment response to STIM and A2As shows similar patterns for children with high levels of EXT or INT symptoms.
• These findings can help guide personalized medication selection for preschoolers with ADHD based on their symptom profiles.