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christian counseling today
Vol. 20 no. 2
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The sample in the follow-up group included a total of 207
children, ages three to five, who were tracked for six years and
assessed at ages three, four, and six. The majority of these chil-
dren received a controlled trial of methylphenidate, plus their
parents received training to manage symptoms. Nearly 90%
of the children with moderate to severe ADHD continued to
show evidence of the diagnosis at the six-year marker despite
the interventions. Researchers concluded that ADHD in
preschoolers appears to be a relatively stable diagnosis even
with medication intervention and parent training.
8
Since ADHD diagnosed in the preschool years tends to
persist throughout childhood, the challenge is to find early,
intensive interventions that are effective. More research is
needed on the effects of medications on preschoolers over
the long-term, as well as the effects of combining different
medications. We also need more information regarding which
children have individual characteristics that might increase
long-term risk of symptoms, and which children have indi-
vidual characteristics that may reduce symptoms with age. For
example, the PAT study found that those children diagnosed
with comorbid disorders of oppositional defiant disorder and/
or conduct disorders had a 30% higher risk of retaining the
ADHD diagnosis at age six. Results also indicated that despite
treatment with medication, those children with moderate
to severe ADHD did not noticeably improve. Again, effec-
tive interventions with this age group are needed, preferably
non-pharmocological.
Medication, Diet and Psychological Treatments
With the growing concern about overmedicating children on
the minds of so many, preschoolers who are correctly diag-
nosed do need intervention. So what is being done to provide
non-prescription alternatives? One area often mentioned
is controlling diet and providing psychological treatments.
However, a recent meta-analysis on the evaluation of diet
and psychological treatments concluded that medication
approaches were better than other treatments studied.
Specifically, the study assessed three dietary interventions:
1) restricted elimination diets, 2) artificial food color exclu-
sions, and 3) free fatty acid supplementation. Psychological
treatments included cognitive training, neurofeedback and
behavioral interventions. Changes in ADHD symptom
severity were measured pre and post treatments. Symptoms
were rated by someone close to the child, like a parent, as well
as a blinded rater.
Results were interesting because they were impacted by the
raters. When both a parent and blinded rater did the assess-
ments, the dietary and psychological interventions showed
significant effects. However, when the rater was solely the
blinded person, only the free fatty acid supplementation and
the artificial food color exclusion made a difference. Based
on these results, the researchers wanted to know what would
happen if parents added fatty acid supplements to stimulant
treatment? A double-blind, placebo-controlled study found
no significant differences in the main symptoms of inatten-
tion, hyperactivity or impulsive behaviors with this addition.
9
The standardized mean differences for medication treatments
in children and adolescents is reported as 0.9; mean differ-
ences for the free fatty acid supplementation was 0.16; and
for the artificial food color exclusion, 0.42. Thus, medication
approaches still produced better mean scores regarding the
reduction of ADHD symptoms.
10
Solar Intensity and ADHD
Perhaps a promising area to explore is solar intensity. Sleep
specialists tell us that children with ADHD often have sleep-
onset insomnia and a delayed circadian phase. So another
group of researchers looked at the relationship between envi-
ronmental light exposure and ADHD prevalence. What they
found was that higher solar intensity was positively correlated
with lower ADHD prevalence. Exposing children to intense
sunlight during the day and reduced light exposure at night
may reduce some ADHD symptoms and act as a protective
factor.
11
Behavior Therapy for Preschoolers
Behavior therapy that includes parent management training
is also recommended. The Agency for Healthcare Research
and Quality (AHRQ) looked at all the studies on treatment
options for preschoolers and recommends parent behavioral
interventions.
12
Components from these programs proved
to be helpful, including: 1) Triple P (Positive Parenting of
Preschoolers)—an evidenced-based program with a multidis-
ciplinary focus, 2) Incredible Years of Parenting Program—a
model program recommended by the American Psychological
Association for children with conduct problems, 3) Parent-
Child Interaction Therapy—an empirically-supported
treatment for young children with emotional and behavioral
disorders, and 4) New Forest Parenting Program—a program
developed specifically for parents of children with ADHD.
In sum, behavior therapy along with medication
approaches remain the treatments of choice when it comes
to helping preschoolers with moderate to severe ADHD.
However, medications appear to be less effective with
preschoolers, and methylphenidate hydrochloride (the
most commonly prescribed medication) has not been
approved for children under the age of six by the FDA.
Furthermore, long-term effects of medication use have
yet to be determined, thus, supporting the idea that more
non-pharmacological interventions are needed with this
population. Finally, concerns over misdiagnosis point to the
need for extra vigilance regarding the differences between
recognizing normative development in childhood from signs
of a disorder.
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