title: ADHD Treatment in Primary Care: Demographic Factors, Medication Trends, and Treatment Predictors.
abstract: The aim of this study is to determine the prevalence and characteristics of youth with attention-deficit hyperactivity disorder (ADHD) in Ontario, Canada, and to determine the predictors of psychotropic medication prescriptions in youth with ADHD.
  
  
  
  This is a cross-sectional retrospective chart abstraction of more than 250 000 medical records from youth aged 1 to 24 years in a large geographical region in Ontario, Canada, linked to population-based health administrative data. A total of 10 000 charts were randomly selected and manually reviewed using predetermined criteria for ADHD and comorbidities. Prevalence, comorbidities, demographic indicators, and health service utilization characteristics were calculated. Predictors of treatment characteristics were determined using logistic regression modelling.
  
  
  
  The prevalence of ADHD was 5.4% (7.9% males, 2.7% females). Youth with ADHD had significant psychiatric comorbidities. The majority (70.0%) of ADHD patients received prescriptions for stimulant or nonstimulant ADHD medication. Antipsychotic prescriptions were provided to 11.9% of ADHD patients versus 0.9% of patients without ADHD. Antidepressant prescriptions were provided to 19.8% versus 5.4% of patients with and without ADHD, respectively. Predictors of antidepressant prescriptions were increasing age (odds ratio [OR], 1.14; 95% confidence interval [CI], 1.07 to 1.21), psychiatric consultation (OR, 2.04; 95% CI, 1.16 to 3.58), and diagnoses of both anxiety and depression (OR, 18.4; 95% CI, 8.03 to 42.1), whereas the only predictor of antipsychotic prescriptions was psychiatric consultation (OR, 3.85; 95% CI, 2.11 to 7.02).
  
  
  
  Youth with ADHD have more psychiatric comorbidities than youth without ADHD. The majority of youth with ADHD received stimulant medications, and a significant number received additional psychotropic medications, with psychiatric consultation predicting medication use.
authors.affiliation: 1 Department of Psychiatry, University of Toronto, Toronto, Ontario, Canada.
authors.forename: Tanya S
authors.initials: TS
authors.lastname: Hauck
authors.affiliation: 2 Institute for Clinical Evaluative Sciences, Toronto, Ontario, Canada.
authors.forename: Cindy
authors.initials: C
authors.lastname: Lau
authors.affiliation: 2 Institute for Clinical Evaluative Sciences, Toronto, Ontario, Canada.
authors.forename: Laura Li Foa
authors.initials: LLF
authors.lastname: Wing
authors.affiliation: 1 Department of Psychiatry, University of Toronto, Toronto, Ontario, Canada.|2 Institute for Clinical Evaluative Sciences, Toronto, Ontario, Canada.|3 Centre for Addiction and Mental Health, Toronto, Ontario, Canada.|4 Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, Ontario, Canada.
authors.forename: Paul
authors.initials: P
authors.lastname: Kurdyak
authors.affiliation: 2 Institute for Clinical Evaluative Sciences, Toronto, Ontario, Canada.|4 Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, Ontario, Canada.|5 Department of Family and Community Medicine, University of Toronto, Toronto, Ontario, Canada.|6 University Health Network, Toronto Western Hospital Family Health Team, Toronto, Ontario, Canada.
authors.forename: Karen
authors.initials: K
authors.lastname: Tu
mesh_terms: D000293:Adolescent; D000328:Adult; D001007:Anxiety / Q000188:drug therapy / Q000453:epidemiology; D001289:Attention Deficit Disorder with Hyperactivity / Q000188:drug therapy* / Q000453:epidemiology*; D000697:Central Nervous System Stimulants / Q000627:therapeutic use*; D002648:Child; D002675:Child, Preschool; D015897:Comorbidity; D003430:Cross-Sectional Studies; D003863:Depression / Q000188:drug therapy / Q000453:epidemiology; D005260:Female; D006801:Humans; D007223:Infant; D008297:Male; D009864:Ontario / Q000453:epidemiology; D011320:Primary Health Care / Q000706:statistics & numerical data*; D011619:Psychotropic Drugs / Q000627:therapeutic use*; D012189:Retrospective Studies; D055815:Young Adult
chemical_list: D000697:Central Nervous System Stimulants; D011619:Psychotropic Drugs
keywords: ADHD; antipsychotics; child and adolescent psychiatry; epidemiology; pharmacoepidemiology