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Stimulant medication in pre-school children in New South Wales
Yalcke Eysbouts1, Alison Poulton, Pia Salmelainen
1Department of Pediatrics, Radboud University Nijmegen Medical Centre, Australia.
Insights
Treatment rates for children under 4 with ADHD declined, but those treated showed similar attrition to older children. While stimulant medication improved behavior in most young children, concerns remain about co-prescribed drugs.
Area of Science:
- Pediatric Psychiatry
- Neurodevelopmental Disorders
- Pharmacotherapy
Background:
- Attention-deficit hyperactivity disorder (ADHD) diagnosis and treatment in very young children remain areas of clinical and research interest.
- Understanding treatment patterns and outcomes for children under 4 years with ADHD is crucial for evidence-based practice.
Purpose of the Study:
- To analyze the trends in annual treatment rates for children under 4 years with ADHD from 1997 to 2006.
- To compare the treatment rate and attrition of this young group with children initiating treatment at the modal age (7 years).
- To describe the clinical profiles and treatment responses of children under 4 years receiving stimulant medication for ADHD.
Main Methods:
- A retrospective analysis of electronic prescription and authority records from the New South Wales Department of Health.
- Review of clinical reports for children under 4 years diagnosed with ADHD.
Main Results:
- The annual rate of initiating ADHD treatment for children under 4 years progressively declined between 1997 and 2006.
- In 2001, children under 4 represented only 1.1% of new ADHD treatment initiations, compared to 13.6% at the modal age of 7 years.
- No significant difference in attrition rates was observed between children under 4 and those at the modal age.
- Among children under 4 with available clinical reports (n=235), oppositional behavior (78%) and developmental problems (43%) were common comorbidities.
- Non-pharmacological interventions were used in 77% of cases, and non-stimulant medications in 50%.
- Stimulant therapy resulted in reported behavioral improvement in 76% of children under 4.
Conclusions:
- Children under 4 treated with stimulant medication for ADHD constitute a small subgroup often presenting with high comorbidity.
- The majority of these young children demonstrated a favorable response to stimulant medication.
- A significant concern is the high rate of co-prescription of other psychotropic medications with known toxicity and unproven efficacy in this age group.
Aims:
The aims of this study were: (i) to examine the annual treatment rate of children under 4 years from 1997 to 2006; (ii) to compare their treatment rate and attrition with that of children starting treatment at the modal age; (iii) to describe the clinical characteristics of children aged less than 4 years and their response to stimulant medication for the treatment of attention-deficit hyperactivity disorder.
Methods:
Retrospective study of electronic prescription and authority records of the New South Wales Department of Health and a review of clinical reports.
Results:
The annual treatment initiation rate for children under 4 years showed a progressive decline over the decade. In 2001, 13.6% of the children starting treatment were aged 7 years (modal age); those aged <4 years represented 1.1% of the total. There was no significant difference in attrition rate between these two groups. For those aged <4 years with clinical reports available (n= 235), oppositional behaviour and developmental problems were reported frequently (78 and 43%, respectively). Non-pharmacological interventions were implemented in 77% and non-stimulant medications were prescribed in 50%. For 76% of children, an improvement in behaviour was reported after stimulant therapy.
Conclusions:
Children treated with stimulant medication aged <4 years were a small subgroup with a high rate of co-morbidity. The majority were perceived to have a favourable response to stimulant medication. However, there was a disturbingly high rate of prescribing of other psychotropic medications of known toxicity and unproven efficacy.
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