This study will evaluate if Ritalin LA™ is safe and effective for ADHD treatment in 4-to-5-year olds.

This is a single site, open-label, four-week feasibility study of long-duration beaded methylphenidate (B-MPH), also known as Ritalin LA™. B-MPH is a FDA-approved medication for children 6 years and older with attention-deficit/hyperactivity disorder (ADHD), but there are no studies of its use in preschoolers. This study will evaluate the safety and effectiveness of B-MPH for ADHD treatment in 4-to-5-year old children.

Total study duration is approximately 5 weeks. It includes a screening evaluation and 4 weeks of B-MPH treatment with doses ranging from 10 to 30 mg (based on the individual tolerability and efficacy). The study doctor will conduct parent-training sessions during the treatment visits.

Inclusion Criteria:

1. Parents/guardians and children must speak English and/or Spanish; parents/guardians must sign consent form; children must verbally assent.
2. Boys and girls from 4-5 years old (inclusive) at screening.
3. Children who meet the DSM-IV criteria for a primary diagnosis of ADHD (combined or hyperactive subtype), with symptoms present for at least 9 months.
4. Children who demonstrate adequate need for treatment due to ADHD symptom-severity and clinical impairment.
5. Children with IQ of at least 70 confirmed by valid IQ test.
6. Children who are in educational settings (pre-school, kindergarten, or elementary school program) with at least 8 same-age peers for at least two half days weekly.
7. Parents and children who can attend weekly study visits.
8. Children who are naïve to ADHD medications; received ADHD medications in the past but are not currently treated; or on ADHD medications but finding them inconvenient (due to short duration of action) or not very helpful

Exclusion Criteria:

1. Children and parents/guardians who do not understand or cannot follow necessary instructions; children and parents who are unwilling to comply with study procedures or cooperate with child psychiatrist.
2. Children taking excluded medications.
3. Children with history of intolerance to MPH/stimulant medications or no response to adequate stimulant trials.
4. Children with current adjustment disorder, autism, psychosis, bipolar disorder, significant suicidality, or other psychiatric disorders.
5. Children with history of physical, sexual, or emotional abuse, which lead to a significant impact on the clinical presentation and potentially some ADHD symptoms.
6. Children with screening abnormalities deemed clinically significant by child psychiatrist.

5 weeks (Baseline and 4 treatment visits)

Using open-ended questions, the child psychiatrist elicited information about adverse events at baseline and at each subsequent visit. Information was obtained by observation and direct questioning such as, "Have you had any (other) medical problems since your last visit?" or "Have you felt different in any way since your last visit?"

The conclusions of this study are limited by its small size, the open-label design, and the possible confound of the parent training intervention.