A triangular model for diagnosis and management of preschool ADHD: Symptom or syndrome?

Attention deficit/hyperactivity disorder (ADHD) is a common, well-defined, developmental disorder with a recognized genetic-neurologic basis. Studies report pathogenic involvement of the dopaminergic and serotonergic pathways. Its presentation in the preschool years is variable and can be mistaken for other common behavioral and developmental problems. The aim of this work is to propose an interactive "triangular model" based on the temperamental-genetic, emotional-behavioral, and developmental-genetic pathways of ADHD to explain the evolution of the clinical picture and serve as a guide to appropriate management, particularly in the preschool years. The model can also be used in parental counseling. This article describes 3 illustrative cases of preschool children with hyperactive and inattentive behaviors who were diagnosed with ADHD by standardized developmental and psychological batteries and followed at 2 child developmental centers. By applying the model, treatment could be targeted at the predominant area of difficulty for each child.