Related Experiment Videos
Preschool ADHD Diagnosis and Stimulant Use Before and After the 2011 AAP Practice Guideline
Alexander G Fiks1,2,3,4,5,6, Michelle E Ross7, Stephanie L Mayne8,2
1Center for Pediatric Clinical Effectiveness fiks@email.chop.edu.
Insights
The 2011 American Academy of Pediatrics guideline for attention-deficit/hyperactivity disorder (ADHD) in preschoolers ended an increasing diagnosis trend. Stimulant prescribing rates for children remained constant, offering reassurance for standardized care.
Area of Science:
- Pediatric Health
- Neurodevelopmental Disorders
- Clinical Guidelines
Background:
- The 2011 American Academy of Pediatrics guideline aimed to standardize attention-deficit/hyperactivity disorder (ADHD) diagnosis and management in young children.
- Prescribing stimulants for ADHD in preschoolers is a sensitive issue due to developmental considerations.
Purpose of the Study:
- To assess the impact of the 2011 American Academy of Pediatrics guideline on ADHD diagnosis and stimulant prescribing in 4- to 5-year-old children.
- To analyze trends in ADHD diagnosis and stimulant use before and after the guideline's release.
Main Methods:
- Utilized electronic health record data from 63 primary care practices.
- Included preventive visits for children aged 48-72 months between January 2008 and July 2014.
- Employed logistic regression with splines and practice-level clustering to compare pre- and post-guideline rates.
Main Results:
- ADHD diagnoses increased from 0.7% to 0.9% of visits post-guideline, but a significant increasing pre-guideline trend ceased.
- Stimulant prescription rates remained constant at 0.4% of visits in both periods.
- Observed significant practice-level variations in diagnostic and prescribing patterns.
Conclusions:
- The 2011 guideline coincided with the cessation of increasing ADHD diagnosis rates in preschoolers.
- Stimulant prescribing rates remained stable, which is reassuring given the guideline's recommendations.
- The findings support the guideline's role in promoting a standardized diagnostic approach and appropriate stimulant use.
Objective:
To evaluate the change in the diagnosis of attention-deficit/hyperactivity disorder (ADHD) and prescribing of stimulants to children 4 to 5 years old after release of the 2011 American Academy of Pediatrics guideline.
Methods:
Electronic health record data were extracted from 63 primary care practices. We included preventive visits from children 48 to 72 months old receiving care from January 2008 to July 2014. We compared rates of ADHD diagnosis and stimulant prescribing before and after guideline release using logistic regression with a spline and clustering by practice. Patterns of change (increase, decrease, no change) were described for each practice.
Results:
Among 87 067 children with 118 957 visits before the guideline and 56 814 with 92 601 visits after the guideline, children had an ADHD diagnosis at 0.7% (95% confidence interval [CI], 0.7% to 0.8%) of visits before and 0.9% (95% CI, 0.8% to 0.9%) after guideline release and had stimulant prescriptions at 0.4% (95% CI, 0.4% to 0.4%) of visits in both periods. A significantly increasing preguideline trend in ADHD diagnosis ended after guideline release. The rate of stimulant medication use remained constant before and after guideline release. Patterns of change from before to after the guideline varied significantly across practices.
Conclusions:
Release of the 2011 guideline that addressed ADHD in preschoolers was associated with the end of an increasing rate of diagnosis, and the rate of prescribing stimulants remained constant. These are reassuring results given that a standardized approach to diagnosis was recommended and stimulant treatment is not first-line therapy for this age group.