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Common Use of Stimulants and Alpha-2 Agonists to Treat Preschool Attention-Deficit Hyperactivity Disorder: A DBPNet
Nathan J Blum1, Justine Shults2, Elizabeth Harstad3
1Department of Pediatrics, The Children's Hospital of Philadelphia, Philadelphia, PA.
Insights
Stimulants and alpha-2 agonists (A2As) are frequently prescribed for preschool ADHD, with varying usage patterns observed. Further research is needed to clarify optimal A2A and stimulant use in young children.
Area of Science:
- Pediatric Medicine
- Neurodevelopmental Disorders
- Pharmacology
Background:
- Attention-deficit hyperactivity disorder (ADHD) affects preschool-aged children.
- Treatment options for pediatric ADHD include stimulants and alpha-2 agonists (A2As).
- Developmental-Behavioral Pediatrics Research Networks facilitate multi-site studies on child development and behavior.
Purpose of the Study:
- To describe the prescribing patterns of stimulants and A2As for preschool children diagnosed with ADHD.
- To identify factors associated with the prescription of these medications across two research sites.
Main Methods:
- Retrospective analysis of electronic health records from January 2010 to December 2011.
- Inclusion criteria: children aged 2-5 years with an ADHD diagnosis.
- Multivariable models used to analyze prescribing trends for stimulants and A2As.
Main Results:
- Over 984 children with ADHD, 34.8% received stimulants and 24.7% received A2As.
- A2As were more frequently prescribed at one site compared to the other.
- Older preschoolers were more likely to receive stimulants, while younger ones received A2As; both were prescribed for comorbid conditions.
Conclusions:
- Alpha-2 agonists are utilized by some developmental-behavioral pediatricians for preschool ADHD.
- Variations in A2A use suggest a potential lack of consensus.
- Comparative effectiveness research is recommended to define optimal use of A2As versus stimulants for preschool ADHD.
Objective:
To describe the use of stimulants and alpha-2 agonists (A2As) for the treatment of preschool-aged children with attention-deficit hyperactivity disorder (ADHD) at 2 Developmental-Behavioral Pediatrics Research Network sites.
Methods:
Demographic information, diagnoses, and medications prescribed by developmental-behavioral pediatricians (DBPs) were extracted from the electronic health record for all outpatient visits from January 1, 2010, to December 31, 2011. The subset of visits for children aged 2 to 5 years who had a diagnosis of ADHD was included in this analysis. Multivariable models were constructed to identify factors associated with prescribing stimulants and A2As.
Results:
Over the 2-year period, 984 children with a diagnosis of ADHD were seen at 1779 visits. Of the 984 children, 342 (34.8%) were prescribed a stimulant, and 243 (24.7%) were prescribed an A2A. Both medications were prescribed at the same visit at least once during the 2-year period for 97 children (9.9%). Alpha-2 agonists were prescribed more often at site 2 than site 1 (OR [odds ratio] = 1.62, p = 0.015). Stimulants were more likely to be prescribed for older preschool-aged children (OR = 1.66, p < 0.001), and A2As were more likely to be prescribed for younger children (OR = 0.82, p = 0.02). Both stimulants and A2As were more likely to be prescribed to children with ADHD and comorbid conditions.
Conclusion:
Alpha-2 agonists are commonly used by some DBPs for preschool ADHD. Variation in the use of A2As across sites may indicate a lack of consensus on when to use these medications and suggests a need for comparative effectiveness research to better define the relative benefits and side effects of A2As and stimulants for the treatment of preschool ADHD.
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