Determinants of initial pharmacological treatment for youths with attention-deficit/hyperactivity disorder.
OBJECTIVE
The aim of this study was to investigate determinants of initial psychotropic treatment for attention-deficit/hyperactivity disorder (ADHD).


METHODS
The retrospective cohort design included 28,763 newly diagnosed youths <21 years, with 18 months of continuous Medicaid eligibility between 1994 and 2003. Multivariate logistic regression was used to evaluate associations between clinical, sociodemographic, and provider characteristics and ADHD drug (stimulants/atomoxetine) use and six other psychotropic drug classes within 6 months after the ADHD diagnosis claim.


RESULTS
The categories male, school-aged, white, rural dwelling, and foster care were positively associated with ADHD treatment. Youths diagnosed by psychiatrists were 42% less likely to receive ADHD drugs than those diagnosed by primary care physicians. Of the 26% youths with mental co-morbidities, 31.3% concomitantly used non-ADHD psychotropic medications. The presence of other mental disorders decreased the probability of ADHD drug use by 14-54%. Antipsychotics (55.1%) or antidepressants (56.4%) were used by more than half of patients with concomitant bipolar disorder. A total of 26.4% of patients without mental co-morbidities received non-ADHD drugs, either with or without concomitant stimulant use (18.8% and 7.6%, respectively).


CONCLUSIONS
Sociodemographic, clinical, and provider characteristics are associated with initial treatment for youths with ADHD. More evidence on psychotropic safety and efficacy is needed considering the high prevalence of concomitant mental disorders, multidrug regimens, and off-label use.
Chen
Chih-Ying
CY
Department of Pharmaceutical Outcomes and Policy, College of Pharmacy, University of Florida, Gainesville, Florida 32610-0496, USA. cychen@ufl.edu
Gerhard
Tobias
T
Winterstein
Almut G
AG
D000293:Adolescent; D018759:Adrenergic Uptake Inhibitors / Q000627:therapeutic use*; D000367:Age Factors; D000069445:Atomoxetine Hydrochloride; D001289:Attention Deficit Disorder with Hyperactivity / Q000188:drug therapy* / Q000453:epidemiology*; D002648:Child; D002675:Child, Preschool; D015331:Cohort Studies; D015897:Comorbidity; D003710:Demography; D005194:Family Practice; D005260:Female; D005581:Foster Home Care; D006801:Humans; D008297:Male; D001523:Mental Disorders / Q000188:drug therapy / Q000453:epidemiology*; D010818:Practice Patterns, Physicians'; D011437:Propylamines / Q000627:therapeutic use*; D011619:Psychotropic Drugs / Q000627:therapeutic use*; D012189:Retrospective Studies; D012737:Sex Factors
D018759:Adrenergic Uptake Inhibitors; D011437:Propylamines; D011619:Psychotropic Drugs; D000069445:Atomoxetine Hydrochloride