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PEDIATRICS Vol. 109 No. 5 May 2002, pp. 733-739

Psychotropic Medication Use in a Population of Children Who Have Attention-Deficit/Hyperactivity Disorder

James Guevara, MD, MPH^*, Paula Lozano, MD, MPH^,, Thomas Wickizer, PhD, MPH^||, Loren Mell, BS and Harlan Gephart, MD^¶

^* Division of General Pediatrics, Children’s Hospital of Philadelphia, Philadelphia, Pennsylvania
Division of General Pediatrics, University of Washington School of Medicine, Seattle, Washington
Center for Health Studies, Group Health Cooperative of Puget Sound, Seattle, Washington
^|| Department of Health Services, University of Washington School of Public Health and Community Medicine, Seattle, Washington
^¶ Center for Attention Deficit Disorders, Group Health Cooperative of Puget Sound, Redmond, Washington

--> Objective. Recent reports suggest a trend of increasing prevalence of psychotropic drug prescriptions among children with attention-deficit/hyperactivity disorder (ADHD); however, reasons for the increased use of such medications is unclear. The objectives of this study were to examine differences in nonstimulant psychotropic medication fills between children with and without identified ADHD and to assess associations with non-ADHD neurobehavioral disorders.

Methods. A population-based retrospective matched cohort study was conducted of a large group model health maintenance organization located in western Washington State. Eligible patients were children who were ages 3 to 17 years and were continuously enrolled and used services from January 1 to December 31, 1997 (N = 57 216). Children with ADHD were identified by a diagnosis of ADHD or a pharmacy fill for a stimulant medication using automated patient files. Children without ADHD were randomly selected and matched 4:1 to children with ADHD on age and gender. Neurobehavioral disorders and pharmacy fills for psychotropic medications were measured.

Results. During 1997, 2992 children were identified as having ADHD (5.2%). These children were more likely to have a diagnosis of a non-ADHD neurobehavioral disorders (adjusted odds ratio: 6.3; 95% confidence interval: 5.4–7.3) than children without ADHD. Although most (78%) were treated with stimulant medications, children who were identified as having ADHD were also more likely to receive pharmacy fills for nonstimulant medications than were children without ADHD. Nonstimulant medications were more often used along with stimulant medications and were frequently prescribed in association with ADHD after controlling for other disorders.

Conclusions. Children who were identified as having ADHD were more likely to have a diagnosis of other neurobehavioral disorders and to receive nonstimulant psychotropic medications than were children without ADHD. Because many of these drugs have little or no empirical basis in the treatment of ADHD, the rationale for their use is less clear. Future research to examine the use, effectiveness, and safety of these medications alone and in combination in children with ADHD is urgently needed.

Key Words: attention deficit disorder with hyperactivity • child • stimulant medications • psychotropic medications

Abbreviations: ADHD, attention-deficit/hyperactivity disorder • TCA, tricyclic antidepressant • GHC, Group Health Cooperative of Puget Sound • HMO, health maintenance organization • ICD-9, International Classification of Diseases, Ninth Revision • ODD, oppositional-defiant disorder • SADD, substance abuse/dependence disorders • SSRI, selective serotonin reuptake inhibitor • OR, odds ratio • CI, confidence interval

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Received for publication Jul 12, 2001; Accepted Dec 13, 2001.

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