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Alsayouf HA. Growing evidence of pharmacotherapy effectiveness in managing attention-deficit/hyperactivity disorder in young children with or without autism spectrum disorder: a minireview. Front Psychiatry 2024; 15:1408876. [PMID: 38979493 PMCID: PMC11228304 DOI: 10.3389/fpsyt.2024.1408876] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/02/2024] [Accepted: 06/12/2024] [Indexed: 07/10/2024] Open
Abstract
Many children with autism spectrum disorder (ASD) also have attention-deficit/hyperactivity disorder (ADHD). ADHD in children is associated with increased risk of negative outcomes, and early intervention is critical. Current guidelines recommend psychosocial interventions such as behavioral training as the first line of therapy in managing ADHD symptoms in children with or without ASD. Where symptoms are refractory to these interventions, medications such as stimulants, α2-adrenergic agonist inhibitors, selective norepinephrine reuptake inhibitors, and second-generation antipsychotics are recommended. However, these pharmacotherapies do not have regulatory approval for use in children of preschool age, and evidence on their safety and efficacy in this population has historically been very limited. Since publication of the current guidelines in 2020, several new randomized controlled trials and real-world studies have been published that have investigated the efficacy and tolerability of these medications in preschool children with ADHD, with or without comorbid ASD. Here, we provide a review of the key findings of these studies, which suggest that there is growing evidence to support the use of pharmacological interventions in the management of ADHD in preschool children with comorbid ASD.
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Baweja R, Baweja R, Weidlich H, Nyland JE, Waschbusch DA, Waxmonsky JG. Treatment Utilization Pattern of Preschool Children With Attention-Deficit/Hyperactivity Disorder. J Atten Disord 2024; 28:708-721. [PMID: 38084067 DOI: 10.1177/10870547231215287] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 03/08/2024]
Abstract
OBJECTIVE The aim of this study was to identify patterns of ADHD care, including factors that guide selection and sequencing of treatments in a large nationwide sample of preschool-aged youth over the past 6 years. METHOD A retrospective cohort study utilizing a large electronic health record (TriNetX) of nearly 24,000 children ages 3 to 6 diagnosed with ADHD. RESULTS One in three preschoolers with ADHD were prescribed psychotropic medication, most commonly methylphenidate and guanfacine. One in 10 had at least one psychotherapy billing code during the entire assessment with most youth starting medication before psychotherapy. Rates of most treatments, including polypharmacy, increased with comorbid psychiatric disorders or sleep problems and over the course of the coronavirus pandemic. CONCLUSION Rates of treatment have increased over time but are still largely inconsistent with published care guidelines that advise therapy before medication. Clinicians appear to prioritize psychiatric comorbidity and sleep problems when selecting treatments.
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Affiliation(s)
- Raman Baweja
- Pennsylvania State College of Medicine, Hershey, PA, USA
| | - Ritika Baweja
- Pennsylvania State College of Medicine, Hershey, PA, USA
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Gleason MM. Editorial: It's Not Just a Phase, and We Know What to Do: Children With Early-Onset Mental Health Concerns Deserve Care Now. J Am Acad Child Adolesc Psychiatry 2023:S0890-8567(23)02237-2. [PMID: 38070866 DOI: 10.1016/j.jaac.2023.11.009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/06/2023] [Accepted: 11/30/2023] [Indexed: 12/26/2023]
Abstract
Suicide is the 2nd leading cause of death in 10-14 year old and the prevalence of suicidal thoughts and behaviors young children is as high as 7.5%.1 Importantly, children 5 to 11 years old account for 43% of STB-focused emergency department visits in the United States.2 Despite the public health implications of STBs, limited research has focused on the longitudinal development of STBs. In this issue of the Journal, Hennefield et al.3 provide valuable insight into the persistence of preschool-onset major depressive disorder (PO-MDD) and STBs in preadolescents, highlighting opportunities for clinical systems of care.
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Affiliation(s)
- Mary Margaret Gleason
- Children's Hospital of The King's Daughters, Eastern Virginia Medical School, Virginia.
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Sugaya LS, Farhat LC, Califano P, Polanczyk GV. Efficacy of stimulants for preschool attention-deficit/hyperactivity disorder: A systematic review and meta-analysis. JCPP ADVANCES 2023; 3:e12146. [PMID: 37720577 PMCID: PMC10501696 DOI: 10.1002/jcv2.12146] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/06/2022] [Accepted: 01/10/2023] [Indexed: 02/27/2023] Open
Abstract
Background Robust synthesis of evidence to support treatment recommendations for preschoolers with attention-deficit/hyperactivity disorder (ADHD) is lacking. The aim of this systematic review and meta-analysis was to review currently available evidence to evaluate the efficacy and acceptability of stimulants for preschool children with ADHD. Methods We searched electronic databases (CENTRAL, Embase, PubMed) from the database inception to March, 2022; and clinical trial registries through WHO ICTRP from the database inception to July, 2022, and selected double-blinded randomized controlled trials (RCTs) that compared stimulants against placebo for the treatment of preschoolers (age ≤ 7 years) with ADHD. Change in ADHD symptom severity was the primary outcome (efficacy) and all-cause dropout rates (acceptability) was the secondary outcome. Data were pooled with random-effects models weighted by the inverse of the variance. Risk of bias of individual studies were assessed with the Cochrane Risk of Bias tool version 2. The Grading of Recommendations Assessment, Development, and Evaluation approach was used to assess the quality of evidence. This study is registered with PROSPERO (CRD42022348597). Results Five RCTs (three methylphenidate immediate-release, one methylphenidate extended-release, and one lisdexamfetamine) were included. The analysis of efficacy was based on 489 participants. Meta-analysis of change in ADHD symptom severity demonstrated a significant effect in favor of stimulants over placebo (standardized mean difference = -0.59; 95% CI -0.77, -0.41; p < 0.0001). There was no evidence of heterogeneity but some concerns about publication bias. Regardless, the confidence of evidence was considered moderate. For acceptability, stimulants did not lead to an increased rate of all-cause discontinuation rates in comparison to placebo (OR = 0.59; 95% CI 0.15, 2.37; p = 0.45) but the confidence of estimate was very low. Conclusions Our findings demonstrated that stimulants are efficacious in reducing ADHD symptoms among preschool children. Clinicians should consider the use of stimulants when making treatment recommendations for preschoolers with ADHD.
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Affiliation(s)
- Luisa S. Sugaya
- Department of PsychiatryFaculdade de Medicina FMUSPUniversidade de São PauloSão PauloBrazil
- National Institute of Developmental Psychiatry (INPD)CNPqSão PauloBrazil
| | - Luis C. Farhat
- Department of PsychiatryFaculdade de Medicina FMUSPUniversidade de São PauloSão PauloBrazil
- National Institute of Developmental Psychiatry (INPD)CNPqSão PauloBrazil
| | - Pietro Califano
- Department of PsychiatryFaculdade de Medicina FMUSPUniversidade de São PauloSão PauloBrazil
| | - Guilherme V. Polanczyk
- Department of PsychiatryFaculdade de Medicina FMUSPUniversidade de São PauloSão PauloBrazil
- National Institute of Developmental Psychiatry (INPD)CNPqSão PauloBrazil
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Sugaya LS, Salum GA, de Sousa Gurgel W, de Morais EM, Del Prette G, Pilatti CD, Dalmaso BB, Leibenluft E, Rohde LA, Polanczyk GV. Efficacy and safety of methylphenidate and behavioural parent training for children aged 3-5 years with attention-deficit hyperactivity disorder: a randomised, double-blind, placebo-controlled, and sham behavioural parent training-controlled trial. THE LANCET. CHILD & ADOLESCENT HEALTH 2022; 6:845-856. [PMID: 36306807 PMCID: PMC9731509 DOI: 10.1016/s2352-4642(22)00279-6] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/25/2022] [Revised: 09/10/2022] [Accepted: 09/13/2022] [Indexed: 11/06/2022]
Abstract
BACKGROUND There is insufficient evidence to support treatment recommendations for preschool children aged 3-5 years with attention-deficit hyperactivity disorder (ADHD). We aimed to investigate the efficacy and safety of methylphenidate and behavioural parent training in reducing the frequency and severity of symptoms and improving global functioning in preschool children with ADHD. METHODS We did an 8-week, randomised, double-blind, placebo-controlled and sham behavioural parent training-controlled clinical trial (the MAPPA Study) in children aged 3-5 years with moderate-to-severe ADHD. The trial was conducted at the Institute of Psychiatry, Hospital das Clinicas, University of São Paulo Medical School, São Paulo, Brazil. Participants were randomly assigned (1:1:1) to receive immediate-release methylphenidate plus educational intervention (sham behavioural parent training), placebo medication plus behavioural parent training, or placebo medication plus educational intervention. Randomisation was done by an independent research manager by use of a permuted block randomisation procedure. Parents, teachers, study staff, and evaluators remained masked to group allocation. Methylphenidate and placebo were titrated to a maximum dose of 1·25 mg/kg per day administered orally twice daily, and behavioural parent training and the educational intervention were delivered weekly through 90 min sessions with both the child and parent, conducted by two psychologists or learning therapists. The primary outcomes were parents' and teachers' composite scores of the Swanson, Nolan, and Pelham-IV scale (SNAP-IV-P/T), the Clinical Global Impressions Severity (CGI-S) scale, and the Children's Global Assessment Scale (CGAS). This trial is registered with ClinicalTrials.gov, NCT02807870, and is now complete. All participants were invited to participate in an open observational follow-up, which is ongoing. FINDINGS Between Aug 21, 2016, and Oct 21, 2019, 153 children were randomly assigned to receive methylphenidate plus the educational intervention (n=51), placebo plus behavioural parent training (n=51), or placebo plus the educational intervention (n=51). Nine (6%) children discontinued treatment. All participants were included in the intention-to-treat analysis. Children in the methylphenidate plus educational intervention group showed greater reductions in the SNAP-IV-P/T (endpoint mean difference -3·93 [95% CI -7·14 to -0·73], p=0·049; effect size -0·55 [95% CI -0·99 to -0·10]) and CGI-S scores (endpoint mean difference -0·49 [-0·82 to -0·17], p=0·0088; effect size -0·70 [-1·16 to -0·24]) and a greater increase in CGAS scores (endpoint mean difference 5·25 [95% CI 2·09 to 8·40], p=0·0036; effect size 0·80 [95% CI 0·32 to 1·28]) than children in the placebo plus educational intervention group. Children in the placebo plus behavioural parent training group did not have significantly different SNAP-IV-P/T scores (endpoint mean difference -3·18 [95% CI -6·38 to 0·02], p=0·077; effect size -0·44 [95% CI -0·89 to 0·003]) or CGI-S scores (endpoint mean difference -0·35 [-0·68 to -0·03], p=0·052; effect size -0·50 [-0·96 to -0·04]) compared to children in the placebo plus educational intervention group, but they had a greater increase in CGAS scores compared to the placebo plus educational intervention group (endpoint mean difference 3·69 [0·53 to 6·85], p=0·033; effect size 0·56 [0·08 to 1·04]). Children in the methylphenidate plus educational intervention versus placebo plus behavioural parent training group did not have statistically or clinically significant differences in primary outcomes. Children in the methylphenidate plus educational intervention group had more mild adverse events than the other two groups, and there were no between-group differences for moderate or severe adverse events. INTERPRETATION Methylphenidate was effective in reducing ADHD symptoms and improving functionality, and behavioural parent training was effective in improving functionality for preschool children with ADHD after 8 weeks of treatment. FUNDING São Paulo Research Foundation and Brazilian National Council for Scientific and Technological Development.
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Affiliation(s)
- Luisa Shiguemi Sugaya
- Department of Psychiatry, Faculdade de Medicina, Universidade de São Paulo, São Paulo, Brazil; National Institute of Developmental Psychiatry, CNPq, São Paulo, Brazil
| | - Giovanni Abrahão Salum
- Department of Psychiatry, Universidade Federal do Rio Grande do Sul, Porto Alegre, Brazil; Section on Negative Affect and Social Processes, Hospital de Clínicas de Porto Alegre, Universidade Federal do Rio Grande do Sul, Porto Alegre, Brazil; National Institute of Developmental Psychiatry, CNPq, São Paulo, Brazil; Child Mind Institute, New York, NY, USA
| | - Wagner de Sousa Gurgel
- Department of Psychiatry, Faculdade de Medicina, Universidade de São Paulo, São Paulo, Brazil
| | | | - Giovana Del Prette
- Department of Psychiatry, Faculdade de Medicina, Universidade de São Paulo, São Paulo, Brazil
| | | | - Bianca Batista Dalmaso
- Department of Psychiatry, Faculdade de Medicina, Universidade de São Paulo, São Paulo, Brazil
| | - Ellen Leibenluft
- Emotion & Development Branch, National Institute of Mental Health, National Institutes of Health, Bethesda, MD, USA
| | - Luis Augusto Rohde
- Department of Psychiatry, Universidade Federal do Rio Grande do Sul, Porto Alegre, Brazil; National Institute of Developmental Psychiatry, CNPq, São Paulo, Brazil; ADHD Outpatient Program & Developmental Psychiatry Program, Hospital de Clínicas de Porto Alegre, Universidade Federal do Rio Grande do Sul, Porto Alegre, Brazil
| | - Guilherme Vanoni Polanczyk
- Department of Psychiatry, Faculdade de Medicina, Universidade de São Paulo, São Paulo, Brazil; National Institute of Developmental Psychiatry, CNPq, São Paulo, Brazil.
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A Review of Clinical Practice Guidelines in the Diagnosis and Treatment of Attention-Deficit/Hyperactivity Disorder. Child Adolesc Psychiatr Clin N Am 2022; 31:569-581. [PMID: 35697402 DOI: 10.1016/j.chc.2022.03.009] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
Clinical practice guidelines (CPGs) are systematically developed statements to assist practitioner and patient decisions about appropriate health care for specific clinical circumstances. CPGs have evolved during the last 2 decades from general consensus statements by prominent practitioners in the field to highly structured instruments. The Institute of Medicine has laid out specific standards for selecting the experts who develop a CPG and the process by which CPGs are developed. Attention-deficit/hyperactivity disorder (ADHD) has been the focus of more than 20 CPGs created by governments and professional societies, both in the United States and internationally. There is a good deal of consensus across these CPGs regarding the principles of the diagnosis and treatment of ADHD. Drawing on the rich research base in ADHD, all CPGs emphasize the need for screening, a diagnosis based on history and standardized rating scales, as well as the use of evidence-based psychosocial and pharmacologic treatments. They vary in terms of their emphasis on the role of psychosocial treatment and the degree to which they address comorbid disorders in ADHD. Although limited research has shown ADHG CPGs do change provider practice, there is no research examining if the changes in practice brought about by CPGs impact patient outcomes.
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Crouch E, Radcliff E, Bennett KJ, Brown MJ, Hung P. Examining the Relationship Between Adverse Childhood Experiences and ADHD Diagnosis and Severity. Acad Pediatr 2021; 21:1388-1394. [PMID: 33746042 DOI: 10.1016/j.acap.2021.03.009] [Citation(s) in RCA: 18] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/28/2020] [Revised: 02/21/2021] [Accepted: 03/05/2021] [Indexed: 11/19/2022]
Abstract
OBJECTIVE Although prior research has examined the prevalence of ACEs among children with attention deficit-hyperactivity disorder (ADHD), little is known about the household and family settings of children with ADHD. Our study utilizes a recent nationally representative dataset to examine the association between adverse childhood experiences (ACEs), child and household characteristics, and ADHD diagnosis and severity. METHODS Using the 2017-2018 National Survey of Children's Health (NSCH), our sample consisted of children three years of age or older, as this is the youngest age at which the NSCH begins to ask caregivers if a child has been diagnosed with ADHD (n = 42,068). Multivariable logistic regression was used to examine the association between ACE type, score, and ADHD and ADHD severity, controlling for child and household characteristics. RESULTS Children exposed to four or more ACEs had higher odds of ADHD (aOR 2.16; 95% CI 1.72-2.71) and moderate to severe ADHD (aOR 1.89; 95% CI 1.31-2.72) than children exposed to fewer than four ACEs. Other child characteristics positively associated with ADHD included age and public insurance; other Non-Hispanic races compared to Non-Hispanic White had lower odds of ADHD. Of children reported with ADHD, public insurance was also associated with caregiver-reported moderate to severe ADHD. CONCLUSIONS Children with ADHD have a higher prevalence of ACEs, making this study important for understanding the relationship between ACEs and ADHD at the population level.
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Affiliation(s)
- Elizabeth Crouch
- Rural and Minority Health Research Center, Arnold School of Public Health (E Crouch, E Radcliff, MJ Brown), University of South Carolina, Columbia, SC.
| | - Elizabeth Radcliff
- Rural and Minority Health Research Center, Arnold School of Public Health (E Crouch, E Radcliff, MJ Brown), University of South Carolina, Columbia, SC
| | - Kevin J Bennett
- Department of Family and Preventive Medicine (KJ Bennett), University of South Carolina School of Medicine, Columbia, SC
| | - Monique J Brown
- Rural and Minority Health Research Center, Arnold School of Public Health (E Crouch, E Radcliff, MJ Brown), University of South Carolina, Columbia, SC
| | - Peiyin Hung
- Rural and Minority Health Research Center, Arnold School of Public Health (E Crouch, E Radcliff, MJ Brown), University of South Carolina, Columbia, SC
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Green CD, Langberg JM. A Review of Predictors of Psychosocial Service Utilization in Youth with Attention-Deficit/Hyperactivity Disorder. Clin Child Fam Psychol Rev 2021; 25:356-375. [PMID: 34498154 DOI: 10.1007/s10567-021-00368-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/24/2021] [Indexed: 11/29/2022]
Abstract
Attention-deficit/hyperactivity disorder (ADHD) is one of the most common childhood disorders. Professional practice guidelines recommend combined treatment, psychopharmacological and psychosocial, for youth with ADHD. There have been multiple reviews of pharmacological prescription practices and utilization, however, less is known about predictors of ADHD psychosocial service utilization. Given the importance of accessing psychosocial treatment in relation to improving functional impairment, this review synthesizes evidence on predictors of ADHD psychosocial intervention utilization in clinic, community, and school settings. Eighteen studies were identified and included in the review. Findings are summarized across informant profile factors, predisposing characteristics, and barriers and facilitators. The most robust findings were for the impact of symptom severity/impairment, the presence of comorbidities, and age on ADHD psychosocial service utilization. Race/ethnicity, sex, parental knowledge of the disorder and insurance coverage were also identified as key factors. Future avenues of research are provided, and clinical and policy implications targeted at reducing psychosocial treatment disparities in youth with ADHD are discussed.
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Affiliation(s)
- Cathrin D Green
- Virginia Commonwealth University, 806 W. Franklin St, Box 842018, Richmond, VA, 23284, USA
| | - Joshua M Langberg
- Virginia Commonwealth University, 806 W. Franklin St, Box 842018, Richmond, VA, 23284, USA.
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9
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Ellis LA, Blakely B, Hazell P, Woolfenden S, Hiscock H, Sarkozy V, Gould B, Hibbert PD, Arnolda G, Ting HP, Wiles LK, Molloy CJ, Churruca K, Warwick M, Braithwaite J. Guideline adherence in the management of attention deficit hyperactivity disorder in children: An audit of selected medical records in three Australian states. PLoS One 2021; 16:e0245916. [PMID: 33556083 PMCID: PMC7869992 DOI: 10.1371/journal.pone.0245916] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/27/2020] [Accepted: 01/08/2021] [Indexed: 11/19/2022] Open
Abstract
OBJECTIVE To assess General Practitioner (GP) and pediatrician adherence to clinical practice guidelines (CPGs) for diagnosis, treatment and management of attention deficit hyperactivity disorder (ADHD). METHOD Medical records for 306 children aged ≤15 years from 46 GP clinics and 20 pediatric practices in Australia were reviewed against 34 indicators derived from CPG recommendations. At indicator level, adherence was estimated as the percentage of indicators with 'Yes' or 'No' responses for adherence, which were scored 'Yes'. This was done separately for GPs, pediatricians and overall; and weighted to adjust for sampling processes. RESULTS Adherence with guidelines was high at 83.6% (95% CI: 77.7-88.5) with pediatricians (90.1%; 95% CI: 73.0-98.1) higher than GPs (68.3%; 95% CI: 46.0-85.8; p = 0.02). Appropriate assessment for children presenting with signs or symptoms of ADHD was undertaken with 95.2% adherence (95% CI: 76.6-99.9), however ongoing reviews for children with ADHD prescribed stimulant medication was markedly lower for both pediatricians (51.1%; 95% CI: 9.6-91.4) and GPs (18.7%; 95% CI: 4.1-45.5). CONCLUSION Adherence to CPGs for ADHD by pediatricians was generally high. Adherence by GPs was lower across most domains; timely recognition of medication side effects is a particular area for improvement.
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Affiliation(s)
- Louise A. Ellis
- Centre for Healthcare Resilience and Implementation Science, Australian Institute of Health Innovation, Macquarie University, Sydney, New South Wales, Australia
| | - Brette Blakely
- Centre for Healthcare Resilience and Implementation Science, Australian Institute of Health Innovation, Macquarie University, Sydney, New South Wales, Australia
| | - Philip Hazell
- Discipline of Psychiatry, School of Medicine, University of Sydney, Camperdown, New South Wales, Australia
| | - Sue Woolfenden
- School of Women and Children’s Health, University of New South Wales, Randwick, New South Wales, Australia
| | - Harriet Hiscock
- Murdoch Children’s Research Institute, Royal Children’s Hospital, Department of Paediatrics, University of Melbourne, Parkville, Victoria, Australia
| | - Vanessa Sarkozy
- Tumbatin Developmental Clinic, Sydney Children’s Hospital Network, School of Women and Children’s Health, University of New South Wales, Randwick, New South Wales, Australia
| | - Bronwyn Gould
- General Practitioner, Paddington, New South Wales, Australia
| | - Peter D. Hibbert
- Centre for Healthcare Resilience and Implementation Science, Australian Institute of Health Innovation, Macquarie University, Sydney, New South Wales, Australia
- Australian Centre for Precision Health, Allied Health and Human Performance, University of South Australia, Adelaide, South Australia, Australia
- South Australian Health and Medical Research Institute (SAHMRI), Adelaide, South Australia, Australia
| | - Gaston Arnolda
- Centre for Healthcare Resilience and Implementation Science, Australian Institute of Health Innovation, Macquarie University, Sydney, New South Wales, Australia
| | - Hsuen P. Ting
- Centre for Healthcare Resilience and Implementation Science, Australian Institute of Health Innovation, Macquarie University, Sydney, New South Wales, Australia
| | - Louise K. Wiles
- Centre for Healthcare Resilience and Implementation Science, Australian Institute of Health Innovation, Macquarie University, Sydney, New South Wales, Australia
- Australian Centre for Precision Health, Allied Health and Human Performance, University of South Australia, Adelaide, South Australia, Australia
- South Australian Health and Medical Research Institute (SAHMRI), Adelaide, South Australia, Australia
| | - Charlotte J. Molloy
- Centre for Healthcare Resilience and Implementation Science, Australian Institute of Health Innovation, Macquarie University, Sydney, New South Wales, Australia
- Australian Centre for Precision Health, Allied Health and Human Performance, University of South Australia, Adelaide, South Australia, Australia
- South Australian Health and Medical Research Institute (SAHMRI), Adelaide, South Australia, Australia
| | - Kate Churruca
- Centre for Healthcare Resilience and Implementation Science, Australian Institute of Health Innovation, Macquarie University, Sydney, New South Wales, Australia
| | - Meagan Warwick
- Centre for Healthcare Resilience and Implementation Science, Australian Institute of Health Innovation, Macquarie University, Sydney, New South Wales, Australia
| | - Jeffrey Braithwaite
- Centre for Healthcare Resilience and Implementation Science, Australian Institute of Health Innovation, Macquarie University, Sydney, New South Wales, Australia
- * E-mail:
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Davis DW, Feygin Y, Creel L, Kong M, Jawad K, Sun J, Blum NJ, Lohr WD, Williams PG, Le J, Jones VF, Pasquenza N. Epidemiology of Treatment for Preschoolers on Kentucky Medicaid Diagnosed with Attention-Deficit/Hyperactivity Disorder. J Child Adolesc Psychopharmacol 2020; 30:448-455. [PMID: 32614247 DOI: 10.1089/cap.2020.0015] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/19/2023]
Abstract
Objectives: The National Survey of Children's Health reported a concerning increase in children 2-5 years being diagnosed with attention-deficit/hyperactivity disorder (ADHD) in 2016. Concerns include both the increase in diagnosing and potential deviations from published guidelines for the treatment of ADHD in preschoolers. The present study aims to describe the epidemiology and factors associated with receiving the diagnosis and treatment types for low-income preschoolers. Methods: Using Kentucky Medicaid claims from 2012 to 2017, a retrospective cohort study of children 2-5 years of age (n = 337,631) with a diagnosis of ADHD (n = 11,712) was completed. Trends in demographics, comorbidities, and treatment and provider types are presented. Multinomial logistic regression was used to determine predictors of receipt of the diagnosis and treatment type (a stimulant only, an alpha-2 agonist [A2A] only, both, or neither) based on nonmissing 2017 data (n = 2394). Results: The number of children in the cohort diagnosed with ADHD and receiving a stimulant decreased from 2012 to 2017, but the use of A2As increased. Primary care physicians were the most frequent prescribers of both medications. The adjusted odds ratios (AORs) of receipt of an A2A alone, stimulant alone, or both medications over receiving no ADHD medication were associated with specific demographics and comorbid conditions for each medication regimen. Race/ethnicity is associated with receiving the diagnosis of ADHD and treatment with A2A. Comorbid mental health conditions and provider type are associated with treatment type. Conclusion: Use of stimulants for preschoolers in Kentucky has decreased and A2A use has increased since 2012. Continued vigilance and long-term follow-up of preschoolers with ADHD are warranted. The appropriateness of the diagnosis and treatment type could not be determined.
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Affiliation(s)
- Deborah Winders Davis
- Department of Pediatrics, University of Louisville School of Medicine, Louisville, Kentucky, USA
| | - Yana Feygin
- Department of Pediatrics, University of Louisville School of Medicine, Louisville, Kentucky, USA
| | - Liza Creel
- Department of Health Management and System Sciences and University of Louisville School of Public Health and Information Science, Louisville, Kentucky, USA
| | - Maiying Kong
- Department of Bioinformatics and Biostatistics, University of Louisville School of Public Health and Information Science, Louisville, Kentucky, USA
| | - Kahir Jawad
- Department of Pediatrics, University of Louisville School of Medicine, Louisville, Kentucky, USA
| | - JingChao Sun
- Department of Bioinformatics and Biostatistics, University of Louisville School of Public Health and Information Science, Louisville, Kentucky, USA
| | - Nathan J Blum
- Department of Pediatrics, The Children's Hospital of Philadelphia, Philadelphia, Pennsylvania, USA
| | - W David Lohr
- Department of Pediatrics, University of Louisville School of Medicine, Louisville, Kentucky, USA
| | - P Gail Williams
- Department of Pediatrics, University of Louisville School of Medicine, Louisville, Kentucky, USA
| | - Jennifer Le
- Department of Pediatrics, University of Louisville School of Medicine, Louisville, Kentucky, USA
| | - V Faye Jones
- Department of Pediatrics, University of Louisville School of Medicine, Louisville, Kentucky, USA
| | - Natalie Pasquenza
- Department of Pediatrics, University of Louisville School of Medicine, Louisville, Kentucky, USA
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Waxmonsky JG, Baweja R, Liu G, Waschbusch DA, Fogel B, Leslie D, Pelham WE. A Commercial Insurance Claims Analysis of Correlates of Behavioral Therapy Use Among Children With ADHD. Psychiatr Serv 2019; 70:1116-1122. [PMID: 31451066 DOI: 10.1176/appi.ps.201800473] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/27/2023]
Abstract
OBJECTIVE The study examined factors associated with uptake of behavioral therapy among children with attention-deficit hyperactivity disorder (ADHD). METHODS Insurance claims data from 2008-2014 (MarketScan) were reviewed to examine associations between behavioral therapy use and demographic, patient, family, and provider factors. The association between ADHD medication use and future uptake of behavioral therapy was examined with logistic regression adjusted for covariates found to affect behavioral therapy use. RESULTS Among 827,396 youths with ADHD, under 50% received any billable behavioral therapy services over the 7 years. ADHD severity, gender, region of residence, assessment year, comorbid behavioral disorders, and behavioral therapy use by siblings were significantly associated with behavioral therapy use (p<0.001). Parent psychopathology and sibling medication use was not. Children prescribed ADHD medication were 2.5 times less likely than those not prescribed medication to use behavioral therapy, even after adjustment for severity of behavioral health symptoms and other covariates (odds ratio [OR]= 0.41, 95% confidence interval [CI]=.40-.41, p<0.001). Effects of medication use were stronger for future uptake of behavioral therapy (OR=0.25, 95% CI =0.24-0.25, p<.001). The impact of medication use on behavioral therapy use was equally strong for children under age 6 and for older children and did not weaken after release of 2011 guidelines recommending behavioral therapy as the initial ADHD treatment for young children. CONCLUSIONS Multiple systems, family, patient and provider factors affected behavioral therapy uptake. ADHD medication was a robust and potentially modifiable factor. It may be advisable to engage families in behavioral therapy prior to initiation of ADHD medication.
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Affiliation(s)
- James G Waxmonsky
- Department of Psychiatry (Waxmonsky, Baweja, Waschbusch), Department of Public Health Sciences (Liu, Leslie), and Department of Pediatrics (Fogel), Penn State College of Medicine, Hershey, Pennsylvania; Center for Children and Families, Department of Psychology, Florida International University, Miami (Pelham)
| | - Raman Baweja
- Department of Psychiatry (Waxmonsky, Baweja, Waschbusch), Department of Public Health Sciences (Liu, Leslie), and Department of Pediatrics (Fogel), Penn State College of Medicine, Hershey, Pennsylvania; Center for Children and Families, Department of Psychology, Florida International University, Miami (Pelham)
| | - Guodong Liu
- Department of Psychiatry (Waxmonsky, Baweja, Waschbusch), Department of Public Health Sciences (Liu, Leslie), and Department of Pediatrics (Fogel), Penn State College of Medicine, Hershey, Pennsylvania; Center for Children and Families, Department of Psychology, Florida International University, Miami (Pelham)
| | - Daniel A Waschbusch
- Department of Psychiatry (Waxmonsky, Baweja, Waschbusch), Department of Public Health Sciences (Liu, Leslie), and Department of Pediatrics (Fogel), Penn State College of Medicine, Hershey, Pennsylvania; Center for Children and Families, Department of Psychology, Florida International University, Miami (Pelham)
| | - Benjamin Fogel
- Department of Psychiatry (Waxmonsky, Baweja, Waschbusch), Department of Public Health Sciences (Liu, Leslie), and Department of Pediatrics (Fogel), Penn State College of Medicine, Hershey, Pennsylvania; Center for Children and Families, Department of Psychology, Florida International University, Miami (Pelham)
| | - Doug Leslie
- Department of Psychiatry (Waxmonsky, Baweja, Waschbusch), Department of Public Health Sciences (Liu, Leslie), and Department of Pediatrics (Fogel), Penn State College of Medicine, Hershey, Pennsylvania; Center for Children and Families, Department of Psychology, Florida International University, Miami (Pelham)
| | - William E Pelham
- Department of Psychiatry (Waxmonsky, Baweja, Waschbusch), Department of Public Health Sciences (Liu, Leslie), and Department of Pediatrics (Fogel), Penn State College of Medicine, Hershey, Pennsylvania; Center for Children and Families, Department of Psychology, Florida International University, Miami (Pelham)
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Biederman J, Fried R, DiSalvo M, Storch B, Pulli A, Woodworth KY, Biederman I, Faraone SV, Perlis RH. Evidence of Low Adherence to Stimulant Medication Among Children and Youths With ADHD: An Electronic Health Records Study. Psychiatr Serv 2019; 70:874-880. [PMID: 31242830 DOI: 10.1176/appi.ps.201800515] [Citation(s) in RCA: 30] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
OBJECTIVE The objective of this study was to evaluate rates and correlates of stimulant medication adherence in a sample of pediatric patients using data derived from electronic medical records (EMRs) from a large health care organization in a large metropolitan area. The study relied on a novel definition of medication adherence as a timely renewal of an index prescription determined using the electronically recorded issuance of a stimulant prescription in the EMR ("refill"). METHODS Prescription and sociodemographic data were extracted from the Partners HealthCare Research Patient Data Registry to calculate adherence to stimulant medication treatment. RESULTS In the EMR, 2,206 patients with prescriptions for central nervous system stimulant medication were identified. Results showed that 46% of the index prescriptions were refilled within the timeframe necessary for the patient to be considered consistently medicated. A multivariable logistic regression model predicting medication adherence from patient demographic and treatment characteristics yielded an area-under-the-curve statistic of 0.57, indicating that these characteristics predicted adherence only modestly better than chance. CONCLUSIONS EMR data from a large health care organization showed that 46% of pediatric patients were adherent to treatment with stimulants. Rates of medication adherence were worse among patients receiving care from a primary care provider than among those receiving care from a psychiatrist, in older patients, and in female patients and did not appear to be influenced by racial-ethnic group, economic class, stimulant type, or medication formulation (short or long acting). These findings, which show low rates of medication adherence among children and adolescents with ADHD, suggest the need for efforts to improve these rates.
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Affiliation(s)
- Joseph Biederman
- Clinical and Research Programs in Pediatric Psychopharmacology and Adult ADHD, Massachusetts General Hospital, Boston (J. Biederman, Fried, DiSalvo, Storch, Pulli, Woodworth, I. Biederman); Department of Psychiatry, Harvard Medical School, Boston (J. Biederman, Fried, Perlis); Department of Neuroscience and Physiology, State University of New York Upstate Medical University, Syracuse, New York, and K.G. Jebsen Centre for Psychiatric Disorders, Department of Biomedicine, University of Bergen, Bergen, Norway (Faraone); Center for Quantitative Health, Massachusetts General Hospital, Boston (Perlis)
| | - Ronna Fried
- Clinical and Research Programs in Pediatric Psychopharmacology and Adult ADHD, Massachusetts General Hospital, Boston (J. Biederman, Fried, DiSalvo, Storch, Pulli, Woodworth, I. Biederman); Department of Psychiatry, Harvard Medical School, Boston (J. Biederman, Fried, Perlis); Department of Neuroscience and Physiology, State University of New York Upstate Medical University, Syracuse, New York, and K.G. Jebsen Centre for Psychiatric Disorders, Department of Biomedicine, University of Bergen, Bergen, Norway (Faraone); Center for Quantitative Health, Massachusetts General Hospital, Boston (Perlis)
| | - Maura DiSalvo
- Clinical and Research Programs in Pediatric Psychopharmacology and Adult ADHD, Massachusetts General Hospital, Boston (J. Biederman, Fried, DiSalvo, Storch, Pulli, Woodworth, I. Biederman); Department of Psychiatry, Harvard Medical School, Boston (J. Biederman, Fried, Perlis); Department of Neuroscience and Physiology, State University of New York Upstate Medical University, Syracuse, New York, and K.G. Jebsen Centre for Psychiatric Disorders, Department of Biomedicine, University of Bergen, Bergen, Norway (Faraone); Center for Quantitative Health, Massachusetts General Hospital, Boston (Perlis)
| | - Barbara Storch
- Clinical and Research Programs in Pediatric Psychopharmacology and Adult ADHD, Massachusetts General Hospital, Boston (J. Biederman, Fried, DiSalvo, Storch, Pulli, Woodworth, I. Biederman); Department of Psychiatry, Harvard Medical School, Boston (J. Biederman, Fried, Perlis); Department of Neuroscience and Physiology, State University of New York Upstate Medical University, Syracuse, New York, and K.G. Jebsen Centre for Psychiatric Disorders, Department of Biomedicine, University of Bergen, Bergen, Norway (Faraone); Center for Quantitative Health, Massachusetts General Hospital, Boston (Perlis)
| | - Alexa Pulli
- Clinical and Research Programs in Pediatric Psychopharmacology and Adult ADHD, Massachusetts General Hospital, Boston (J. Biederman, Fried, DiSalvo, Storch, Pulli, Woodworth, I. Biederman); Department of Psychiatry, Harvard Medical School, Boston (J. Biederman, Fried, Perlis); Department of Neuroscience and Physiology, State University of New York Upstate Medical University, Syracuse, New York, and K.G. Jebsen Centre for Psychiatric Disorders, Department of Biomedicine, University of Bergen, Bergen, Norway (Faraone); Center for Quantitative Health, Massachusetts General Hospital, Boston (Perlis)
| | - K Yvonne Woodworth
- Clinical and Research Programs in Pediatric Psychopharmacology and Adult ADHD, Massachusetts General Hospital, Boston (J. Biederman, Fried, DiSalvo, Storch, Pulli, Woodworth, I. Biederman); Department of Psychiatry, Harvard Medical School, Boston (J. Biederman, Fried, Perlis); Department of Neuroscience and Physiology, State University of New York Upstate Medical University, Syracuse, New York, and K.G. Jebsen Centre for Psychiatric Disorders, Department of Biomedicine, University of Bergen, Bergen, Norway (Faraone); Center for Quantitative Health, Massachusetts General Hospital, Boston (Perlis)
| | - Itai Biederman
- Clinical and Research Programs in Pediatric Psychopharmacology and Adult ADHD, Massachusetts General Hospital, Boston (J. Biederman, Fried, DiSalvo, Storch, Pulli, Woodworth, I. Biederman); Department of Psychiatry, Harvard Medical School, Boston (J. Biederman, Fried, Perlis); Department of Neuroscience and Physiology, State University of New York Upstate Medical University, Syracuse, New York, and K.G. Jebsen Centre for Psychiatric Disorders, Department of Biomedicine, University of Bergen, Bergen, Norway (Faraone); Center for Quantitative Health, Massachusetts General Hospital, Boston (Perlis)
| | - Stephen V Faraone
- Clinical and Research Programs in Pediatric Psychopharmacology and Adult ADHD, Massachusetts General Hospital, Boston (J. Biederman, Fried, DiSalvo, Storch, Pulli, Woodworth, I. Biederman); Department of Psychiatry, Harvard Medical School, Boston (J. Biederman, Fried, Perlis); Department of Neuroscience and Physiology, State University of New York Upstate Medical University, Syracuse, New York, and K.G. Jebsen Centre for Psychiatric Disorders, Department of Biomedicine, University of Bergen, Bergen, Norway (Faraone); Center for Quantitative Health, Massachusetts General Hospital, Boston (Perlis)
| | - Roy H Perlis
- Clinical and Research Programs in Pediatric Psychopharmacology and Adult ADHD, Massachusetts General Hospital, Boston (J. Biederman, Fried, DiSalvo, Storch, Pulli, Woodworth, I. Biederman); Department of Psychiatry, Harvard Medical School, Boston (J. Biederman, Fried, Perlis); Department of Neuroscience and Physiology, State University of New York Upstate Medical University, Syracuse, New York, and K.G. Jebsen Centre for Psychiatric Disorders, Department of Biomedicine, University of Bergen, Bergen, Norway (Faraone); Center for Quantitative Health, Massachusetts General Hospital, Boston (Perlis)
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