Practitioner Review: Assessment and treatment of preschool children with attention‐deficit/hyperactivity disorder

Background Attention‐deficit/hyperactivity disorder ( ADHD ) often emerges during the preschool years and remains impairing throughout the life span. Early identification and intervention may yield lasting benefits that alter the often‐adverse trajectory of the disorder. Methods This Practitioner Review provides up‐to‐date information regarding the evaluation and treatment of ADHD in preschool children. The clinical presentation of ADHD in preschool children, its persistence into later childhood, the applicability of DSM ‐5 criteria for preschoolers with ADHD , and early predictors of long‐term trajectories are addressed, as well as current findings from randomized controlled trials of both nonpharmacological and pharmacological interventions. Results Symptoms of hyperactivity/impulsivity extend down to age 3, but several inattention symptoms, as defined by DSM ‐V, less accurately differentiate preschoolers with and without ADHD . Most preschool youth with ADHD symptoms continue to manifest symptoms and impairment into school‐age and adolescence. However, few predictors of persistence beyond early severity have been identified. Behavioral interventions constitute a first‐line treatment for preschool ADHD symptoms, with telepsychiatry increasing in prominence to help to mitigate financial, geographic, and/or logistical barriers to care. Pharmacological interventions, particularly psychostimulants, also confer demonstrable benefits, yet efficacy and safety profiles are less desirable relative to findings in school‐age youth. Conclusions Acute treatments have demonstrable efficacy, but do not appear to fundamentally alter underlying mechanisms or long‐term trajectories.