Department of Psychology, Queens College and the Graduate Center, City University of New York, New York, NY, USA.
Department of Child and Adolescent Psychiatry, NYU Child Study Center, New York, NY, USA.
J Child Psychol Psychiatry. 2019 Sep;60(9):930-943. doi: 10.1111/jcpp.13014. Epub 2019 Jan 28.
Attention-deficit/hyperactivity disorder (ADHD) often emerges during the preschool years and remains impairing throughout the life span. Early identification and intervention may yield lasting benefits that alter the often-adverse trajectory of the disorder.
This Practitioner Review provides up-to-date information regarding the evaluation and treatment of ADHD in preschool children. The clinical presentation of ADHD in preschool children, its persistence into later childhood, the applicability of DSM-5 criteria for preschoolers with ADHD, and early predictors of long-term trajectories are addressed, as well as current findings from randomized controlled trials of both nonpharmacological and pharmacological interventions.
Symptoms of hyperactivity/impulsivity extend down to age 3, but several inattention symptoms, as defined by DSM-V, less accurately differentiate preschoolers with and without ADHD. Most preschool youth with ADHD symptoms continue to manifest symptoms and impairment into school-age and adolescence. However, few predictors of persistence beyond early severity have been identified. Behavioral interventions constitute a first-line treatment for preschool ADHD symptoms, with telepsychiatry increasing in prominence to help to mitigate financial, geographic, and/or logistical barriers to care. Pharmacological interventions, particularly psychostimulants, also confer demonstrable benefits, yet efficacy and safety profiles are less desirable relative to findings in school-age youth.
Acute treatments have demonstrable efficacy, but do not appear to fundamentally alter underlying mechanisms or long-term trajectories.
注意缺陷多动障碍（ADHD）通常在学龄前出现，并在整个生命周期中持续存在。早期识别和干预可能会产生持久的益处，改变该障碍通常的不良轨迹。
本实践综述提供了关于学龄前儿童 ADHD 的评估和治疗的最新信息。本文讨论了学龄前儿童 ADHD 的临床表现、其延续至儿童后期、DSM-5 标准在学龄前 ADHD 儿童中的适用性以及长期轨迹的早期预测因素，以及非药物和药物干预的随机对照试验的当前发现。
多动/冲动症状可延续至 3 岁，但 DSM-V 定义的一些注意力不集中症状不太能准确区分有和无 ADHD 的学龄前儿童。大多数有 ADHD 症状的学龄前儿童会继续出现症状和损伤，进入学龄期和青春期。然而，除了早期严重程度之外，很少有预测因素可以确定持续存在的可能性。行为干预是治疗学龄前 ADHD 症状的一线治疗方法，远程精神病学的重要性日益增加，以帮助减轻经济、地理和/或后勤方面的护理障碍。药物干预，特别是精神兴奋剂，也有明显的益处，但相对于学龄期青少年的发现，其疗效和安全性特征不太理想。
急性治疗有明显的疗效，但似乎并没有从根本上改变潜在的机制或长期轨迹。
