Pharmacotherapy of the Preschool ADHD Treatment Study (PATS) Children Growing Up
Benedetto Vitiello1, Deborah Lazzaretto2, Kseniya Yershova3
1National Institute of Mental Health (NIMH), Bethesda, MD.
Insights
Long-term ADHD treatment in preschoolers showed varied medication use. While stimulants remained common, many children were off medication, and some used antipsychotics, often linked to comorbidities.
Area of Science:
- Child and Adolescent Psychiatry
- Neurodevelopmental Disorders
- Pharmacotherapy Research
Background:
- Attention-deficit/hyperactivity disorder (ADHD) is a common neurodevelopmental disorder.
- Early diagnosis in preschoolers necessitates understanding long-term treatment trajectories.
- Preschool ADHD Treatment Study (PATS) provided a cohort for longitudinal follow-up.
Purpose of the Study:
- To investigate the long-term psychopharmacological treatment patterns.
- To describe medication use in children diagnosed with ADHD as preschoolers.
- To assess treatment outcomes up to 6 years post-initial study.
Main Methods:
- Systematic, prospective, naturalistic follow-up of 303 preschoolers diagnosed with ADHD.
- Reassessment of participants at 3 and 6 years after the controlled study.
- Pharmacotherapy data collected from parents, defining use as medication for ≥50% of days in the prior 6 months.
Main Results:
- At 3 years, 65.0% used indicated ADHD medication; at 6 years, 70.9% used indicated ADHD medication.
- Stimulant monotherapy was the most common treatment (41.3% at year 3, 40.2% at year 6).
- Antipsychotic use increased from 8.3% at year 3 to 13.4% at year 6, associated with comorbidities and lower functioning.
Conclusions:
- Long-term pharmacotherapy for preschoolers with ADHD is heterogeneous.
- Stimulant medications remain a primary treatment, but a significant proportion of children discontinue medication.
- Antipsychotic use, though less common, is associated with greater comorbidity and functional impairment.
Objective:
To describe the long-term psychopharmacological treatment of children first diagnosed with attention-deficit/hyperactivity disorder (ADHD) as preschoolers.
Method:
In a systematic, prospective, naturalistic follow-up, 206 (68.0%) of the 303 children who participated in the Preschool ADHD Treatment Study (PATS) were reassessed 3 years (mean age 7.4 years) and 179 (59.1%) were reassessed 6 years (mean age 10.4 years) after completion of the controlled study. Pharmacotherapy and clinical data were obtained from the parents. Pharmacotherapy was defined as use of a specific class of medication for at least 50% of the days in the previous 6 months.
Results:
At year 3, a total of 34.0% of the participants were on no pharmacotherapy, 41.3% were on stimulant monotherapy, 9.2% were on atomoxetine alone or with a stimulant, 8.3% were on an antipsychotic usually together with a stimulant, and the remaining 7.2% were on other pharmacotherapy; overall, 65.0% were on an indicated ADHD medication. At year 6, a total of 26.8% of the participants were on no pharmacotherapy, 40.2% were on stimulant monotherapy, 4.5% were on atomoxetine alone or with a stimulant, 13.4% were on an antipsychotic, and 15.1% were on other pharmacotherapy; overall, 70.9% were on an indicated ADHD medication. Antipsychotic treatment was associated with more comorbidity, in particular disruptive behavior disorders and pervasive development disorders, and a lower level of functioning.
Conclusion:
In this study, the long-term pharmacotherapy of preschoolers with ADHD was heterogeneous. Although stimulant medication continued to be used by most children, about 1 child in 4 was off medication, and about 1 in 10 was on an antipsychotic.
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