This Article  • Full text  • Full text PDF  • Send to a friend  • Save in My Folder  • Save to citation manager  • Permissions  Citing Articles  • Citation map  • Citing articles on HighWire  • Citing articles on ISI (49)  • Contact me when this article is cited  Related Content  • Similar articles in this journal  Topic Collections  • Diagnosis  • Psychiatry  • Attention Deficit Hyperactivity Disorder  • Alert me on articles by topic

Marsha D. Rappley, MD; Patricia B. Mullan, PhD; Francisco J. Alvarez; Ihouma U. Eneli, MD; Jenny Wang, PhD; Joseph C. Gardiner, PhD

Arch Pediatr Adolesc Med. 1999;153:1039-1045.

Context  Increases in diagnosis and treatment of attention-deficit/hyperactivity disorder (ADHD) have elicited public and professional concern. Research suggests that this trend warrants the inclusion of previously underdiagnosed children and adults. It is not clear whether this trend includes young children.

Objective  To identify patterns of diagnosis and treatment of ADHD in very young children over time.

Design  Descriptive study of Michigan Medicaid claims data.

Patients  Inclusion criteria included recorded ADHD diagnosis, continuous Medicaid eligibility during a 15-month period, and age 3 years or younger at the first date of service.

Main Outcome Measures  Diagnoses of ADHD, conditions commonly comorbid with ADHD, other chronic health conditions, and injuries; treatments such as psychological services and psychotropic medication; and the number of ambulatory visits.

Results  We identified 223 children aged 3 years or younger diagnosed with ADHD. Many had conditions commonly comorbid with ADHD (44%), other chronic health conditions (41%), and injuries (40%). More than half received psychotropic medication (57%); fewer received psychological services (27%). Twenty-two different psychotropic medications were used. Patterns included more than 1 psychotropic medication (46%) in 30 combinations of simultaneous use and 44 combinations of sequential use. The mean number of ambulatory visits was 18.

Conclusions  Children aged 3 years or younger had ADHD diagnosed and received markedly variable psychotropic medication regimens. Little information is available to guide these practices. The presence of comorbid conditions and injuries attests to these children's vulnerability. Resources must be identified that will enable physicians to better respond to the compelling needs of these children and their families.

From the Departments of Pediatrics and Human Development (Drs Rappley and Eneli) and Epidemiology (Drs Wang and Gardiner) and the Office of Medical Education Research and Development (Dr Mullan), College of Human Medicine, Michigan State University, East Lansing. Mr Alvarez is a third-year medical student, College of Human Medicine, and a graduate assistant, Department of Pediatrics and Human Development, Michigan State University.

THIS ARTICLE HAS BEEN CITED BY OTHER ARTICLES

Stigmatizing Attitudes and Beliefs About Treatment and Psychiatric Medications for Children With Mental Illness
Pescosolido et al.
Psychiatr. Serv. 2007;58:613-618.
ABSTRACT | FULL TEXT  

Attention Deficit-Hyperactivity Disorder
Rappley
NEJM 2005;352:165-173.
FULL TEXT  

Use of Practice Guidelines in the Primary Care of Children With Attention-Deficit/Hyperactivity Disorder
Rushton et al.
Pediatrics 2004;114:e23-e28.
ABSTRACT | FULL TEXT  

Concomitant Psychotropic Medication for Youths
Safer et al.
Am. J. Psychiatry 2003;160:438-449.
ABSTRACT | FULL TEXT  

Use of Psychotropic Medications in Young, Preschool Children: Primum Non Nocere
Barbaresi
Arch Pediatr Adolesc Med 2003;157:121-123.
FULL TEXT  

Use of Psychotropic Agents in Preschool Children: Associated Symptoms, Diagnoses, and Health Care Services in a Health Maintenance Organization
DeBar et al.
Arch Pediatr Adolesc Med 2003;157:150-157.
ABSTRACT | FULL TEXT  

Prescribing of Psychotropic Medications for Children by Australian Pediatricians and Child Psychiatrists
Efron et al.
Pediatrics 2003;111:372-375.
ABSTRACT | FULL TEXT  

How efficacious and safe is short-acting methylphenidate for the treatment of attention-deficit disorder in children and adolescents? A meta-analysis
Schachter et al.
CMAJ 2001;165:1475-1488.
ABSTRACT | FULL TEXT  

Psychopharmacology for Young Children: Clinical Needs and Research Opportunities
Vitiello
Pediatrics 2001;108:983-989.
ABSTRACT | FULL TEXT  

Pediatric Stimulant and Selective Serotonin Reuptake Inhibitor Prescription Trends: 1992 to 1998
Rushton and Whitmire
Arch Pediatr Adolesc Med 2001;155:560-565.
ABSTRACT | FULL TEXT  

Ritalin Poisoning
Accardo
AAP Grand Rounds 2001;5:11-12.
FULL TEXT  

What About Sleep?
Divgi and Rappley
Arch Pediatr Adolesc Med 2000;154:636-636.
FULL TEXT  

Who Is Medicating Very Young Children With Attention-Deficit/Hyperactivity Disorder?
Fischer and Rappley
Arch Pediatr Adolesc Med 2000;154:636-636.
FULL TEXT  

Psychotropic Drug Use in Very Young Children
Coyle
JAMA 2000;283:1059-1060.
FULL TEXT