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How Effective is Stimulant Medication with Preschoolers?
Although stimulant medication has been shown to reduce a child’s ADHD symptoms in numerous studies, virtually all of this work has been conducted using school age children. Considerably less is known, therefore, about effectiveness of stimulant medication treatment for preschoolers.
A study that appeared in the October 1997 issue of the Journal of the American Academy of Child and Adolescent Psychiatry takes a careful look at this important question. In this study, 31 children with ADHD between the ages of 4 and 6 participated in a double blind placebo controlled study in which they received either a placebo or methylphenidate (i.e. the generic form of Ritalin) twice a day. In this double blind study, neither the child nor parents knew whether placebo or medication had been taken. Any improvements that were observed in children’s functioning could thus be attributed to a real effect of the medication, and not to a placebo effect.
In both the placebo and medication conditions, children were given tests of attention and impulsivity, and parents were asked to completed standardized ratings of their child’s behavior. As has been repeatedly demonstrated in studies with older children, medication produced improvements on cognitive tests of attention and impulsivity, as well as on certain behaviors assessed by the parent rating scales. An important exception to these generally positive findings, however, was that no improvements were observed in children’s tendency to comply with parental requests. In other words, children’s tendency to be defiant did not show substantial improvement.
The results of this study highlight both the benefits and limitations of stimulant medication treatment for ADHD. In regards to the former, the study provides good initial documentation that methylphenidate can play an important role in the management of primary ADHD symptoms (i.e. attention problems and impulsivity) for younger children.
These results also highlight the fact that for many children with ADHD, medication is only part of an overall treatment plan. Recall that children’s tendency to comply with parental requests did not improve with medication. This difficulty would need to be targeted by other means, and specialized behavior management programs for children with ADHD have been developed and shown to be effective in increasing children’s compliance.
If you are having difficulty managing your child’s behavior it is VERY important to consult with a knowledgeable mental health professional to learn about the strategies that can make this easier. In addition to helping things go more smoothly in the present, this can be extremely important for preventing the development of more serious behavior problems down the road.
Note: This article originally appeared in Attention Research Update, an online newsletter written by Dr. David Rabiner, a Duke University psychologist and former member of CHADD's Professional Advisory Board. You can learn more about Attention Research Update and sign up for a free subscription at www.helpforadd.com.