attention deficit hyperactivity disorder (ADHD). Recent evidence supports initial
treatment with nonpharmacological interventions (behavior therapy) in preschool age children (3-
5). Parent-child behavioral therapy improves problem behaviors and parent-child relationships. It involves
teaching parents to consistently implement effective behavioral techniques (eg, rewards and non-punitive
consequences to shape behavior, calm limit setting, structured daily schedules, minimizing
distractions). Behavioral interventions can also be used in patients who do not meet full ADHD criteria or in
combination with medication for school-aged children and adolescents with ADHD.
Medication in preschool children should be considered when behavioral therapy fails or the child's function is
severely impaired (repeatedly expelled from day care or school, risks injuring others). The family's
preferences and values should always be considered in treatment decisions.