Many children with ADHD have difficulty with transitions, especially very young children. A five year long study out of Lehigh University reviews the benefits of counting down the time before switching activities and found that at least in children, youngsters are better able to control outbursts spurred by ADHD. The five-year study, paid for by the National Institutes of Health, provided a range of behavioral-only therapies to 135 preschoolers with severe ADHD. Families were given either parent-education classes only, or parenting classes plus home and preschool visits by researchers who customized techniques for each child. After a year, aggression and other problem behaviors had dropped, and learning improved, by about 30 percent, the researchers report this month in a journal of the National Association of School Psychologists.

What helped? Stressing consistent rules and routines, and more praise for good behavior than punishment for bad. Surprisingly, both groups fared equally well, raising questions about how to tell which children need more intense aid. Preschoolers with ADHD learn best through repeated practice so the study stressed role-playing things like how to ask to share a toy. Parents were taught to reserve stronger punishments for worst cases, and to try reward systems where children gain or lose “points” for behavior instead. Even the time-out standby was to be used sparingly.