Commentary

This study by Sonuga-Barke et al is an important addition to the literature on the treatment of preschool age children with ADHD symptoms. Recent studies have emphasised the importance of medication in the treatment of ADHD,^1,2 but the first line medication, methylphenidate, is not licensed for preschool age children. As a result, most psychiatrists in the UK will not diagnose the condition in children <5 years of age. The Multimodal Treatment Study of Children with ADHD reported that medication management alone or in combination with behavioural therapy was the most effective treatment for school age children, with no difference between medication management and combination therapy in direct comparison.¹ In contrast, the study by Sonuga-Barke et al concentrated on children who were not medicated, and thus provides options for alternative treatment. Importantly, this study measured outcomes in both children and mothers, as parenting a child with these symptoms is an exhausting experience both physically and emotionally.

Strengths of the study include its randomised design and the masking to treatment allocation of the psychologist who assessed outcomes. The clinical importance of this research lies in the difference in effect between the PT programme approach, which is described in behavioural and educational terms, and a non-directive, supportive alternative. The results indicate a clear difference, favouring PT over PCS, and suggest that such methods of early intervention can be effective. It is not yet known whether these effects continue over the long term. The authors note that the effects of PT were maintained at 15 weeks follow up and it would be interesting to know if these effects endure beyond that point. Furthermore, this study did not seek to answer the question of whether PT reduces the need for long term medication. More research is needed to explore this exciting possibility.