Philadelphia—How did release of the 2011 American Academy of Pediatrics guideline change the rate of diagnosis of attention-deficit/hyperactivity disorder (ADHD) and prescribing of stimulants to children 4 to 5 years old?
That is the question answered by a new study published recently in the journal Pediatrics. Children’s Hospital of Philadelphia–led researchers extracted electronic health record data from 63 primary-care practices. Included in the information were preventive visits for children 48 to 72 months old receiving care from January 2008 to July 2014.
The study team compared rates of ADHD diagnosis and stimulant prescribing before and after release of the guideline, which suggests that, in preschool children ages 4 and 5 with ADHD, physicians should first try behavioral interventions, such as group or individual parent training in behavior management techniques.
The recommendations suggest that methylphenidate might be considered for preschool children with moderate-to-severe symptoms who do not see significant improvement after behavior therapy, starting with a lower dose. For elementary school children and adolescents, meanwhile, the AAP recommends both FDA-approved medications and behavior therapy.
Results indicate that, of 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% of visits before and 0.9% after guideline release. Stimulants were prescribed at 0.4% of visits in both time periods.
“A significantly increasing pre-guideline trend in ADHD diagnosis ended after guideline release,” study authors point out. “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.”
The research concludes that release of the 2011 guideline that addressed ADHD in preschoolers was associated with the end of an increasing rate of diagnosis, although 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,” the authors emphasize.
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