A retrospective chart review of 27 preschool children with ADHD who were treated with psychostimulants between 3 and 5 years of age, inclusive, was conducted at the Kennedy Krieger Institute, Johns Hopkins University School of Medicine, and the University of Maryland School of Medicine, Baltimore, MD. Methylphenidate (MPH) was given in 22 (82%), dextroamphetamine in 4, and Adderal in 1. Eight were switched to an alternate stimulant during follow-up, because of inadequate response, side effects, or rebound. The mean mg/kg daily doses and mean total daily doses of MPH were 0.55-1.16 mg/kg and 12-26 mg. Amphetamine doses were 0.43-0.6 mg/kg daily and 7.5-15 mg/daily. A Clinical Global Impressions (CGI) scale to rate severity of ADHD showed significant improvements at 3, 12, and 24 months of treatment. Side effects were mostly mild, in 63% of children at 3 months, 41% at 12 months, and 29% at 24 months. Decreased appetite occurred in 52%, stomachache in 40%, depression in 30%, headache in 26%, insomnia 22%, tachycardia 7%, picking at skin 4%, rocking 4%, and nosebleeds 4%. Growth was not slowed. Treatment was discontinued in 11% because of side effects. Comorbid disruptive behavior, anxiety, or mood disorders occurred in 26% and required concomitant psychotropic medications. [1]

COMMENT. Preschool children with ADHD and developmental disorders respond to psychostimulant medication but require close monitoring because of a relatively high incidence of side effects. A high rate of comorbid ODD and mood disorders may require concomitant or alternative psychotropic medications. A previous study, reviewed in Ped Neur Briefs April 2001;15:28-29, has demonstrated that parent training in behavior management techniques may accomplish a similar response to psychostimulants without the risk of side effects.