Although a common psychological disorder, pharmacologic treatment of attention-deficit hyperactivity disorder can be a costly endeavor. Among 4- to 5-year olds, methylphenidate is a safe, efficacious, and cost-effective option for short-, intermediate-, and long-acting medication options. Short-acting methylphenidate, intermediate-acting methylphenidate extended release and sustained release, and long-acting methylphenidate are the most efficacious and cost-effective medications. The selection of nonstimulant medications should be based on recommended guidelines rather than primarily on cost. For children incapable of swallowing pills, the most efficacious and cost-effective treatments are short-acting dextroamphetamine liquid and long-acting methylphenidate capsules that can be opened and sprinkled over food.