Youths initially diagnosed with ADHD receive an array of medications
Among children and adolescents newly diagnosed with attention-deficit/hyperactivity disorder (ADHD), youths who were male, school-aged, white, living in rural areas, or under foster care were more likely to be treated with ADHD drugs (stimulants). In addition to these sociodemographic factors, provider specialty (primary care, psychiatry, neurology, other specialty) also influenced treatment, according to a team of researchers from the University of Florida and Rutgers University. Children diagnosed by psychiatrists were 42 percent less likely to receive ADHD drugs. However, they were more likely to receive other psychotropics than children diagnosed by primary care physicians, even after adjusting for other coexisting mental disorders.
Of the 26 percent of youths with both ADHD and other mental disorders, such as depression or bipolar disorder, close to a third used non-ADHD psychotropic medications. These patients were between 14 and 56 percent less likely to receive ADHD medications. The researchers also discovered that more than 25 percent of patients without other mental disorders received off-label psychotropic medications in their initial ADHD drug regimen. Antidepressants were the most common nonstimulant off-label drug class prescribed, along with atypical antipsychotics and anticonvulsants.
The study included 28,763 youths between the ages of 6 and 18 who were enrolled for at least 18 months in the Florida Medicaid fee-for-service program between 1994 and 2004. Because of the large size of the study sample, the researchers were able to examine psychotropic drug treatment in some less common coexisting mental disorders and also patterns of use among minority youth. For example, the researchers found that, contrary to previous research, Hispanics, not blacks, were the minority group least likely to receive drug treatment. The researchers call for more studies on psychotropic safety and efficacy, given the high prevalence of coexisting mental disorders, multidrug regimens, and off-label drug use among youth with ADHD. This study was supported by the Agency for Healthcare Research and Quality (HS16097).
See "Determinants of initial pharmacological treatment for youths with attention-deficit/hyperactivity disorder," by Chih-Ying Chen, M.H.A., Tobias Gerhard, Ph.D., and Almut G. Winterstein, Ph.D., in the Journal of Child and Adolescent Psychopharmacology 2009, 19(2), pp. 187-195.
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