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Julie Magno Zito, PhD; Daniel J. Safer, MD; Susan dosReis, PhD; Laurence S. Magder, PhD; James F. Gardner, ScM; Deborah A. Zarin, MD

Arch Pediatr Adolesc Med. 1999;153:1257-1263.

Objectives  (1) To describe temporal patterns of office visits for attention-deficit/hyperactivity disorder (ADHD) and stimulant treatment for 5- to 14-year-old US youths; (2) to compare youth visits for ADHD with and without medication according to patient demographics, physician specialty, reimbursement source, and comorbid diagnoses; and (3) to compare office visits for youths with ADHD in relation to common medication patterns (stimulants alone, stimulants with other psychotherapeutic medication, and nonstimulant psychotherapeutic medications alone).

Design  Survey based on a national probability sample of office-based physicians in the United States.

Setting  Physician offices.

Participants  A systematically sampled group of office-based physicians.

Main Outcome Measures  National estimates of office visits for ADHD and psychotherapeutic drug visits for ADHD for each year and for a combined 8-year period.

Results  Youth visits for ADHD as a percentage of total physician visits had a 90% increase, from 1.9% in 1989 to 3.6% in 1996. Stimulant therapy within ADHD youth visits rose from 62.6% in 1989 to 76.6% in 1996. While the majority of non-ADHD youth visits were conducted by primary care physicians, one third of ADHD youth visits were managed by psychiatry and neurology specialists. Health maintenance organization insurance was the reimbursement source for 17.9% of non-ADHD youth visits but only 11.7% of ADHD youth visits. Complex medication therapy was more likely to be prescribed by psychiatrists and less likely to be related to visits with health maintenance organization reimbursement.

Conclusions  National survey estimates in the 1990s confirm the substantial increase in visits for youths diagnosed as having ADHD, with more than three quarters of these visits associated with psychotherapeutic medication treatment. Physician specialty and reimbursement source variables identify distinct patient populations with a gradient in psychotherapeutic medication patterns from single-drug standard (stimulant) therapy to complex multidrug treatment regimens for which evidence-based scientific information is lacking.

From the Department of Pharmacy Practice and Science, School of Pharmacy (Drs Zito and dosReis and Mr Gardner), Department of Psychiatry, School of Medicine (Dr Zito), and Department of Epidemiology School of Medicine (Dr Magder), University of Maryland, Baltimore; Departments of Pediatrics and Psychiatry, Johns Hopkins Medical Institutions, Baltimore (Dr Safer); and American Psychiatric Association, Washington, DC (Dr Zarin).

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