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In Dr Stephen Pittelli's letter to the editor, "Methylphenidate to Treat Preschoolers: Have We Gone Too Far?" (Psychiatric Times, September 2007, page 18) referring to an article by Dr Karen Wagner, he expressed concern about the use of powerful drugs to treat so-called attention-deficit/hyperactivity disorder (ADHD) in preschoolers while ignoring family and psychosocial issues. In response, Dr Wagner replied that the drugs in a particular study were used only in patients who continued to fulfill ADHD severity criteria after 10 weeks of parent training. She seems to imply that inconsistent and/or abusive parenting-an obvious and welldocumented cause of acting out and unruliness in children-is cured after 10 weeks of parental psychoeducation and therefore, the continuing behavior of the child must be evidence of an underlying neurobehavioral disorder.