title: Preschool ADHD Diagnosis and Stimulant Use Before and After the 2011 AAP Practice Guideline.
abstract: 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.
  
  
  
  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.
  
  
  
  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.
  
  
  
  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.
authors.affiliation: Center for Pediatric Clinical Effectiveness fiks@email.chop.edu.|PolicyLab.|Pediatric Research Consortium, and.|Department of Biomedical and Health Informatics, Children's Hospital of Philadelphia, Philadelphia, Pennsylvania.|Pediatric Research in Office Settings, American Academy of Pediatrics, Elk Grove Village, Illinois.|Departments of Pediatrics, and.
authors.forename: Alexander G
authors.initials: AG
authors.lastname: Fiks
authors.affiliation: Biostatistics and Epidemiology, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania; and.
authors.forename: Michelle E
authors.initials: ME
authors.lastname: Ross
authors.affiliation: Center for Pediatric Clinical Effectiveness.|PolicyLab.
authors.forename: Stephanie L
authors.initials: SL
authors.lastname: Mayne
authors.affiliation: Center for Pediatric Clinical Effectiveness.|PolicyLab.
authors.forename: Lihai
authors.initials: L
authors.lastname: Song
authors.affiliation: Pediatric Research in Office Settings, American Academy of Pediatrics, Elk Grove Village, Illinois.
authors.forename: Weiwei
authors.initials: W
authors.lastname: Liu
authors.affiliation: Pediatric Research in Office Settings, American Academy of Pediatrics, Elk Grove Village, Illinois.
authors.forename: Jennifer
authors.initials: J
authors.lastname: Steffes
authors.affiliation: Pediatric Research in Office Settings, American Academy of Pediatrics, Elk Grove Village, Illinois.
authors.forename: Banita
authors.initials: B
authors.lastname: McCarn
authors.affiliation: Center for Pediatric Clinical Effectiveness.|Department of Biomedical and Health Informatics, Children's Hospital of Philadelphia, Philadelphia, Pennsylvania.|Departments of Pediatrics, and.
authors.forename: Robert W
authors.initials: RW
authors.lastname: Grundmeier
authors.affiliation: Biostatistics and Epidemiology, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania; and.
authors.forename: A Russell
authors.initials: AR
authors.lastname: Localio
authors.affiliation: Pediatric Research in Office Settings, American Academy of Pediatrics, Elk Grove Village, Illinois.|University of Vermont College of Medicine, Burlington, Vermont.
authors.forename: Richard
authors.initials: R
authors.lastname: Wasserman
mesh_terms: D001289:Attention Deficit Disorder with Hyperactivity / Q000175:diagnosis* / Q000188:drug therapy*; D001291:Attitude of Health Personnel; D000697:Central Nervous System Stimulants / Q000008:administration & dosage*; D002675:Child, Preschool; D015331:Cohort Studies; D016001:Confidence Intervals; D004363:Drug Utilization / Q000592:standards*; D005260:Female; D005500:Follow-Up Studies; D019983:Guideline Adherence / Q000592:standards*; D006801:Humans; D016015:Logistic Models; D008297:Male; D058007:Physicians, Primary Care / Q000706:statistics & numerical data; D017410:Practice Guidelines as Topic / Q000592:standards; D010818:Practice Patterns, Physicians'; D011320:Primary Health Care / Q000592:standards; D012189:Retrospective Studies; D012720:Severity of Illness Index; D013997:Time Factors
chemical_list: D000697:Central Nervous System Stimulants