Attention-deficit/hyperactivity disorder (ADHD) is commonly diagnosed, but we know little about the comparative effectiveness of the various behavioral and pharmacologic treatment options, especially in preschoolers at risk for ADHD because of clinically significant disruptive behavior. The US Agency for Healthcare Research and Quality has sponsored a comparative effectiveness review  of interventions for this group of children.
This comprehensive review examined 55 studies between 1980 and 2011. The interventions that were evaluated in these studies were parent behavior training, combined home and school/day care interventions, and methylphenidate use. Data were extracted using customized software.
The investigators found that more studies of all of these interventions are consistently documenting effectiveness, but parent behavior training interventions had greater evidence of effectiveness than methylphenidate for treatment of preschoolers at risk for ADHD.
As clinicians, we must be careful in our prescribing of stimulants for young children, and we should consider behavioral approaches first. I'm Dr. Peter Yellowlees.