The diagnosis and management of attention-deficit/hyperactivity disorder in preschool children: the state of our knowledge and practice

Design of a Collaborative Knowledge Framework for Personalised Attention Deficit Hyperactivity Disorder (ADHD) Treatments

Attention deficit hyperactivity disorder (ADHD) is a neurodevelopmental disorder. From the data collected by the Ministry of Public Health, Thailand, it has been reported that more than one million Thai youths (6-12 years) have been diagnosed with ADHD (2012-2018) This disorder is more likely to occur in males (12%) than females (4.2%). If ADHD goes untreated, there might be problems for individuals in the long run. This research aims to design a collaborative knowledge framework for personalised ADHD treatment recommendations. The first objective is to design a framework and develop a screening tool for doctors, parents, and teachers for observing and recording behavioural symptoms in ADHD children. This screening tool is a combination of doctor-verified criteria and the ADHD standardised screening tool (Vanderbilt). The second objective is to introduce practical algorithms for classifying ADHD types and recommending appropriate individual behavioural therapies and activities. We applied and compared four well-known machine-learning methods for classifying ADHD types. The four algorithms include Decision Tree, Naïve Bayes, neural network, and k-nearest neighbour. Based on this experiment, the Decision Tree algorithm yielded the highest average accuracy, which was 99.60%, with F1 scores equal to or greater than 97% for classifying each type of ADHD.

Increased risk of developing psychiatric disorders in children with attention deficit and hyperactivity disorder (ADHD) receiving sensory integration therapy: a population-based cohort study

Parents of children with attention deficit hyperactivity disorder (ADHD) have been found to prefer sensory integration (SI) training rather than guideline-recommended ADHD treatment. This study investigated whether SI intervention for children with ADHD was associated with a reduced risk of subsequent mental disorders. From children < 8-years-old newly diagnosed with ADHD in a nationwide population-based dataset, we established a SI cohort and a non-SI cohort (N =  1945) matched by propensity score. Incidence and hazard ratios of subsequent psychiatric disorders were compared after a maximum follow-up of 9 years. The incidence of psychiatric disorders was 1.4-fold greater in the SI cohort, with an adjusted hazard ratio of 1.41 (95% confidence interval 1.20-1.67), comparing to the non-SI cohort. Risks were elevated for emotional disturbances, conduct disorders, and adjustment disorders independent of age, gender, or comorbidity. Among children with only psychosocial intervention, the incidence of psychiatric disorders was 3.5-fold greater in the SI cohort than in the non-SI cohort. To our knowledge, this is the first study to report an increased risk of developing psychiatric disorders for children with ADHD who received SI compared to those who did not. Potential adverse effects of SI for ADHD children should be carefully examined and discussed before practice.

Treatment of Attention-Deficit/Hyperactivity Disorder in Preschool-Age Children: Child and Adolescent Psychiatrists' Adherence to Clinical Practice Guidelines

OBJECTIVES

To compare child and adolescent psychiatrists' (CAPs) practices in the treatment of preschool children with attention-deficit/hyperactivity disorder (P-ADHD) with published guidelines, and to determine which clinical factors most influence physicians' decisions to initiate pharmacotherapy for P-ADHD.

METHODS

We developed and mailed the Preschool ADHD Treatment Questionnaire (PATQ) to a randomly selected national sample of ∼2200 CAPs trained in the management of ADHD. The PATQ asked CAPs about their approach to clinical management of children ages 4-5 years with ADHD-specifically, how often they recommend parent training in behavior management, medication as a first- or second-line treatment, and which medication they typically choose first. CAPs also rated the perceived importance of 19 different clinical factors in their decision to initiate pharmacotherapy. These 19 factors reflected five child-centered areas of concern: ADHD risk factors, education concerns, social issues (SI), emotional stress, and physical safety (PS). The physicians were asked to rate each factor on a 4-point Likert scale from "not important" to "very important."

RESULTS

The final sample consisted of 339 board-certified CAPs. When adherence to the Academy of Child and Adolescent Psychiatry (AACAP) guidelines was defined as initial treatment with behavior management (not medication) and pharmacotherapy specifically with methylphenidate as second-line treatment, only 7.4% of CAPs followed clinical guidelines. Most physicians identified PS as an important or very important factor when initiating pharmacotherapy for P-ADHD (93.4%), followed by educational concerns (EC) (79.9%), emotional stress (69.6%), SI (52.8%), and the presence of risk factors for ADHD (32.7%).

CONCLUSIONS

The overwhelming majority of CAPs do not follow current AACAP guidelines for treatment of P-ADHD, especially regarding medication initiation and selection. When deciding whether to prescribe medication for P-ADHD, safety and EC were the most important and historical risk factors for ADHD were the least important clinical factors.

Factors Influencing Time Lag Between Initial Parental Concern and First Visit to Child Psychiatric Services Among ADHD Children in Japan

The aim of this study was to examine the factors associated with a time lag between initial parental concern about ADHD symptoms and the first visit to a hospital in Japan that offers child psychiatric services. We investigated the demographic characteristic, symptoms, diagnosis, and healthcare system factors including duration between initial parental concern about symptoms and the first visit to a hospital (N = 387). The mean time lag between initial parental concern and the first visit to a hospital was 2.6 years. Risk factors for a longer time lag include the young age of a child, behavioral problems of the child, lower maternal education, difficulty in determining appropriate medical institution, referral route, and the distance from home to the hospital. A more established connection between a hospital with child psychiatric services and other health institutions is recommended for earlier referral to an appropriate hospital.

Clinical diagnosis and management of attention deficit hyperactivity disorder in preschool children

PURPOSE OF REVIEW

To provide an overview of clinical advances and research findings related to attention deficit hyperactivity disorder (ADHD) in preschool children, with an emphasis on assessment and management.

RECENT FINDINGS

The American Academy of Pediatrics has just released new clinical practice guidelines for the diagnosis and management of ADHD. These guidelines are broader in scope, now extending down to preschool children (ages 4 and 5 years). With respect to diagnosis, the American Psychiatric Association has recently proposed modifications to the Diagnostic and Statistical Manual of Mental Disorders (DSM-IV); the current draft version of DSM-V includes changes to the diagnosis criteria for ADHD. With respect to treatment of preschool children with ADHD, studies continue to support the efficacy of behavioral interventions. Regarding pharmacotherapy, a large, recently completed, placebo-controlled study of methylphenidate for preschool ADHD identified some age-related medication differences.

SUMMARY

ADHD can be reliably diagnosed in preschool children. Behavior therapy remains the recommended first-line treatment approach; pharmacotherapy is sometimes indicated as a treatment adjunct, or, less commonly, a treatment alternative.

Attention problems and parent-rated behavior and stress in young children at risk for developmental delay

The aim of this article is to characterize the neurobehavior of young children at risk for developmental delay and attention problems. Two hundred and eighty-one children, ages 18 to 70 months, were evaluated. All parents/guardians completed the Child Development Inventory, Child Behavior Checklist for Ages 1&frac12; to 5, Inventory for Client and Agency Planning, and Parenting Stress Index-Short Form. All children had significant delays (developmental ratios <.70). A Mann-Whitney U test compared those with and without attention problems (T score >70). A 2-tailed P value of <.05 indicated statistical significance. Children with attention problems were more likely to have withdrawn behavior, sleep problems, and aggressive behavior. All had severe problem behaviors, and their families experienced significant stress. Attention problems and other serious problem behaviors occur frequently in young children at risk for developmental delay. Parental stress warrants prompt intervention for their children and positive supports for them.

The development of hyperactive-impulsive behaviors during the preschool years: the predictive validity of parental assessments

The objectives of this study were to establish the different developmental trajectories of hyperactive-impulsive behaviors on the basis of both mother and father ratings at 19, 32, 50, and 63 months, and to examine the predictive validity of these trajectories with respect to later hyperactive-impulsive behaviors, as rated by teachers in the first 2 years of school. Hyperactive-impulsive behaviors were assessed in a population-based sample of 1,112 twins (565 boys and 547 girls) at 19, 32, 50, and 63 months of age. The results revealed a differentiated and consistent view of developmental trajectories of hyperactive-impulsive behaviors derived from these repeated assessments, with 7.1% of children seen by mothers (7% for fathers) as displaying high and stable hyperactive-impulsive behaviors. According to mother ratings, children on a high-chronic trajectory were more likely than other children to display hyperactive-impulsive behaviors at 72 and 84 months according to their teachers. Repeated measures over time and father-based trajectories significantly added to the prediction teacher later ratings of hyperactive-impulsive behaviors. These results support the predictive validity of parental assessment of hyperactive-impulsive behaviors during the preschool years and their use to identify children at risk for further evaluation and possible intervention.

[Attention deficit hyperactivity disorder (ADHD) in preschoolers: nature, assessment and treatment]

Attention deficit hyperactivity disorder (ADHD) is the most frequently diagnosed behaviour problem in school-age children. Although more and more preschool-age children are referred in clinical settings for typical ADHD symptoms, few studies have examined the nature, the assessment as well as the treatment of ADHD in this age group. This literature review addresses the nature, the assessment, and the treatment of ADHD during the preschool period. The main themes reviewed are: prevalence, symptomatology, etiology, comorbidity, consequences on normal development and adaptation of the child, evolution of symptoms from preschool to school period, difficulties related to diagnosis, assessment modalities, psychosocial treatment, and pharmacological treatment.

Attention-deficit/hyperactivity disorder or hyperactivity in preschool children

This article describes the evidence for the presentation of attention-deficit/hyperactivity disorder in young children and discusses the literature describing the manifestations of the condition, and assessment and treatment techniques.

Attention Deficit Hyperactivity Disorder Across the Lifespan: The Child, Adolescent, and Adult

Management of a child, adolescent, college student, or adult with ADD/ADHD (ADHD) is reviewed with emphasis on pharmacologic approaches in the adult. Psychological treatment includes psychotherapy, cognitive-behavior therapy, support groups, parent training, biofeedback, meditation, and social skills training. Medications are reviewed that research has revealed can improve the core symptomatology of a child or adolescent with ADHD. These medications include stimulants (psychostimulants), antidepressants, alpha-2 agonists, and a norepinephrine reuptake inhibitor. Psychopharmacology approved and/or used in pediatric patients are also used in adults with ADHD, though most are not officially FDA-approved. It is emphasized that ADHD management should include a multi-modal approach, involving appropriate educational interventions, appropriate psychological management of the patient of any age, and judicious use of medications. Such an approach is recommended to benefit those with ADHD achieve their maximum potential across the human life span.