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Pediatrics. 2016 Dec;138(6). pii: e20162025. Epub 2016 Nov 15.

Preschool ADHD Diagnosis and Stimulant Use Before and After the 2011 AAP Practice Guideline.

Author information

1
Center for Pediatric Clinical Effectiveness fiks@email.chop.edu.
2
PolicyLab.
3
Pediatric Research Consortium, and.
4
Department of Biomedical and Health Informatics, Children's Hospital of Philadelphia, Philadelphia, Pennsylvania.
5
Pediatric Research in Office Settings, American Academy of Pediatrics, Elk Grove Village, Illinois.
6
Departments of Pediatrics, and.
7
Biostatistics and Epidemiology, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania; and.
8
Center for Pediatric Clinical Effectiveness.
9
University of Vermont College of Medicine, Burlington, Vermont.

Abstract

OBJECTIVE:

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.

METHODS:

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.

RESULTS:

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.

CONCLUSIONS:

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.

PMID:
27940706
PMCID:
PMC5127073
[Available on 2017-12-01]
DOI:
10.1542/peds.2016-2025
[Indexed for MEDLINE]
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