1. 349 (36.1%) of 966 children were prescribed ADHD medications.
Pharmacotherapy in Preschoolers with Attention Deficit Hyperactivity Disorder
Mittal S., Lally M., Boan A., Larosa A., Kral M., Macias M.
Medical University of South Carolina, Charleston SC
Background
Results
Conclusions
Our results found that 36.1% of preschool aged-children seen at our institution were prescribed a medication for ADHD, which is lower than the ~44% found in a national parent reported sample.
At our institution, alpha agonists were the most common ADHD prescribed medication of choice for 3 and 4 year olds despite lack of evidence and/or expert opinion to support their use for ADHD prior to the age of 6.
Emerging research supports our findings; one recent study found 50% of young children were taking a non-stimulant, non-FDA approved medication to treat ADHD
The results of our study, as well as others, highlights a large disparity between current evidence-based guidelines and practitioners’ prescribing trends.
Although research has found that preschoolers experience more side effects on stimulants than in older children, we can only hypothesize why physicians are prescribing alpha agonists so commonly in very young children.
This study provides therapeutic information for a vulnerable population that is not well studied.
We hope the information here can serve as the basis of future research assessing the use of alpha agonists in the treatment of preschoolers with ADHD.
More research is needed in preschoolers to determine medication efficacy, rate of side effects, and long term outcomes and effects on the developing brain.
The American Academy of Pediatrics (AAP) 2011 clinical practice guidelines recommend behavioral therapy as first line treatment for preschool-aged children with ADHD.
For children exhibiting moderate-to-severe dysfunction or in areas where evidence-based behavioral treatment is not available, medications may be considered.
Based off the criteria used by the preschool ADHD treatment study (PATS), moderate-severe dysfunction is defined as symptoms persisting for at least 9 months, dysfunction in both home and other settings (preschool or child care), and inadequate response to behavioral therapy.
Methylphenidate immediate release (MPH IR) is the only medication with moderate evidence showing efficacy and safety in preschool-aged children.
Moreover, the only FDA approved medication for children ages 3 and older is dextroamphetamine (DEX), which is not recommended by the AAP and has no evidence to support its use in preschoolers.
Non-stimulants, such as alpha agonists (AA) are not yet recommended as monotherapy.
To determine ADHD medication prescribing trends for preschool aged children seen at the Medical University of South Carolina with a diagnosis of ADHD and/or disruptive behavior disorder.
Secondary objectives of this study included: 1) if to determine if comorbid diagnosis of autism affects prescribing patterns; 2)to determine prescribing patterns by gender and insurance status.
Data were gathered via retrospective review of the electronic medical record (EMR) at MUSC.
966 children met inclusion criteria and comprised the sample.
Inclusion criteria: children aged 2-5 seen over a 3-year period between the date range of July, to July 1, 2016 with a diagnosis of ADHD, disruptive behavior, hyperkinesis NOS, or oppositional defiant disorder.
Data were analyzed by Fischer exact test and Chi square.
Medication trends by age
Children on medications – age distribution
349 (36.1%) of 966 children were prescribed ADHD medications.
Objectives
KEY FINDINGS:
The most commonly prescribed medication for 2, 3, and 4 year-olds was an alpha agonist.
The most commonly prescribed medication for 5 year-olds was methylphenidate (MPH).
Males were more likely to be on a long acting stimulant. (P=.0186)
Children with a comorbid diagnosis of autism were not more likely to be prescribed a medication when compared to children without a diagnosis of autism.
There was no difference in prescribing patterns for Medicaid patients when compared to private insurance.
DESIGN/METHODS
REFERENCES
Hoogman, M. (2017). "Subcortical brain volume differences in participants with attention deficit hyperactivity disorder in children and adults: a cross-sectional mega-analysis." Lancet Psychiatry, The 4(4):
Sharma, A. and J. Couture (2014). "A review of the pathophysiology, etiology, and treatment of attention-deficit hyperactivity disorder (ADHD)." Ann Pharmacotherapy 48(2): ADHD: Clinical Practice Guideline for the Diagnosis, Evaluation, and Treatment of Attention-Deficit/Hyperactivity Disorder in Children and Adolescents
Subcommittee on Attention-Deficit/Hyperactivity Disorder, Steering Committee on Quality Improvement and Management. Pediatrics Nov 2011, 128 (5)  ; DOI:  /peds