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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.

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