For preschool children at risk for ADHD parent behavioral training beats medications

It might seem counter-intuitive to medicate preschool children at risk for ADHD with drugs like Ritalin®, but a team of investigators tested the assumption and found that parent behavioral training (PBT) yields better outcomes than methylphenidate without risk of side effects by examining the evidence for a variety of treatments in a study just published in the journal Pediatrics. To shed light on how best to treat children younger than 6 years who exhibit disruptive behavior or ADHD...

"The US Agency for Healthcare Research and Quality sponsored a comparative effectiveness review of interventions for preschoolers at risk for attention-deficit/hyperactivity disorder (ADHD)."

The authors searched studies from 1980 to 2011that examined children less than 6 years with clinically significant disruptive behavior, including ADHD. The examined the effect of parent behavior training (PBT), combined home and school/day care interventions, and methylphenidate (Ritalin, Concerta) use. Out of fifty-five studies were examined there were only eight “good” studies that examined PBT. Interestingly, they found only one good study that evaluated methylphenidate use. When they churned the data the results showed that for PBT...

"...SOE [strength of evidence for parent behavioral training] was high for improved child behavior, with minimal heterogeneity among studies. SOE for methylphenidate was low. Combined home and school/day care interventions showed inconsistent results. The literature reported adverse effects for methylphenidate but not for PBT.

There are a range of evidence-based biological assessments and interventions to support the brain health of preschool children (see the Parents' Guide To Brain Health). The authors conclude:

"With more studies consistently documenting effectiveness, PBT interventions have greater evidence of effectiveness than methylphenidate for treatment of preschoolers at risk for ADHD."