Parental behavior training is an efficacious treatment option for preschoolers with disruptive behavior disorders or ADHD symptoms. Benefits for children with disruptive behavior disorders are maintained at least 6 months and up to 2 years in some studies. Parents who attend more parental behavior training sessions see more improvement in their child’s behavior.

MPH^* is efficacious and generally safe for treating ADHD symptoms, but there has been limited long-term followup in preschoolers beyond 12 months.

Evidence is insufficient to know if there is an additional benefit to combining different treatments.

It should be noted that where there is socioeconomic burden, a school-based intervention appears to be the primary beneficial intervention. Benefits, however, diminished over 2 years. This appears to be related to lack of parental engagement and attendance at sessions.

Psychostimulants provide control of ADHD symptoms and are generally well tolerated for months to years at a time. The best evidence for benefits is for MPH^* in the setting of careful medication monitoring for up to 14 months.

Atomoxetine appears to be safe and effective for treating ADHD symptoms over a period of 12 months.

Extended-release guanfacine may reduce ADHD symptoms, but evidence is insufficient to permit an evidence-based conclusion about its long-term effectiveness.

Evidence is insufficient to know if behavioral or psychosocial treatment alone is an effective long-term treatment option for children ages 6 years or older with ADHD.

There are not enough studies to know if parental behavior training or school-based interventions are effective as long-term treatment options for children ages 6 years or older with ADHD. However, one good-quality study and its extension showed that school-based programs to enhance academic skills are effective in improving achievement scores in multiple domains.

Both psychostimulant medication alone and a combination of medication and behavioral treatment are effective in treating ADHD plus ODD symptoms in children. Results are most applicable to elementary school-age boys of normal intelligence with the combined subtype of ADHD.