Nonpharmacological interventions for preschool ADHD: State of the evidence and implications for practice

What exactly is the psychologist to do to increase the probability that intervention can alter the multiple impairments and often poor long-term outcomes associated with preschool-onset attention-deficit/hyperactivity disorder (ADHD)? Intervening to support a preschool child with ADHD is complex given the child's developmental stage and the need to coordinate services across multiple people and settings. Identifying what interventions have been empirically evaluated and the extent to which these interventions affect ADHD-related behaviors and impairments is a critical first-step to providing quality care for these children. Recent guidelines set forth by the American Academy of Pediatrics (2011, ADHD: Clinical practice guidelines for the diagnosis, evaluation and treatment of attention/deficit-hyperactivity disorder in children and adolescents. Pediatrics, 128, 1007-1022. doi:10.1542/peds.2011-2654) recommend that medication only be used when behavioral interventions are not available or when significant room for improvement exists following effective implementation of behavioral interventions. As such, we review herein nonpharmacological interventions for preschool ADHD, identifying approaches in the published literature focused on training parents, teachers, and children, as well as dietary restrictions, nutritional supplements, and acupuncture interventions. This review suggests that behaviorally based approaches focused on parent and teacher training are the most well-studied and effective interventions. Child-training approaches, dietary interventions, nutritional supplements, and acupuncture require substantially more evaluation before clinical implications can be fully appreciated. We conclude by discussing key principles gleaned from this literature for psychological practice for the treatment of preschool children with ADHD.