Intervention for preschoolers at risk for Attention-Deficit/Hyperactivity Disorder (ADHD): Service before diagnosis

Cantwell [Cantwell DP. Empircism and child psychiatry. In: The 1990 C. Charles Burlingame, M.D., Award Lecture, Hartford, Connecticut: The institute of living; 1990 [1]] recognized age and ethnicity as important factors that should be considered in evaluating the clinical phenomenology of childhood disorders. Here we describe how these factors have been addressed in CHOC-UCI Initiative for the Development of Attention and Readiness (CUIDAR), an early intervention and prevention model for children at risk for diagnosis with Attention-Deficit/Hyperactivity Disorder (ADHD). CUIDAR was developed to address age by focusing on needs of families with young children and ethnicity by focusing on the needs of Hispanic families that speak Spanish. This program provides ‘service before diagnosis’ by removing barriers and offering psychosocial intervention (parent training) before the usual first-line treatment of ADHD (i.e. pharmacological intervention). We present data from the start-up phase of CUIDAR to evaluate differences in ethnic groups on the basis of important measures of effectiveness, such as parental satisfaction, gains in parenting skills, and reductions in child behavior problems. Cantwell [Cantwell DP. Empircism and child psychiatry. In: The 1990 C. Charles Burlingame, M.D., Award Lecture, Hartford, Connecticut: The institute of living; 1990 [1]] also recognized that clinicians often must provide treatment with a great deal of ‘therapeutic enthusiasm’ even though the intervention may be based on inadequate research data, and in this situation he recommended creating an atmosphere in which systematic observations could be made in the existing clinical context even when controlled research was not feasible. The data we report here were accumulated in this fashion during the development of CUIDAR, which was funded by the Children's and Families Commission of Orange County as a service delivery program.