Most preschool-aged children with ADHD are not offered first-line, evidence-based behavioral treatment, according to a research letter published in JAMA Pediatrics. Researchers assessed the rates of pediatricians’ recommendations of parent training in behavior management (PTBM) for parents of children aged 4-5 who had an ADHD diagnosis, had ADHD symptoms or were prescribed ADHD medications. The most common treatment recommendation was not PTBM but rather routine/habit modifications (41%), including dietary modifications (reduced sugar intake) and supplements (eg, omega-3 fatty acids), sleep hygiene, and limited screen time. Only 11% of patients received referrals for PTBM in ADHD-related visits. Nearly three in 10 medical records had mention of primary care provider (PCP)-provided counseling on PTBM, including handouts. The PCP prescribed ADHD medications for 32 of 192 patients, only 28% of whom had PTBM recommendations documented, including four patients for whom the PCP recommended PTBM before prescribing the first medication. Patients with public insurance were less likely to receive a PTBM recommendation (adjusted relative risk, 0.87) versus those with private insurance.