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Arch Pediatr Adolesc Med. 2000;154:636.

	Since this article does not have an abstract, we have provided the first 150 words of the full text and any section headings.

I do not doubt that an observant, thorough, and experienced physician may correctly diagnose attention-deficit/hyperactivity disorder in a very young child. It takes, I suspect, some additional courage to prescribe psychotropic medication for that child. Can Rapley et al¹ provide any information on what types of physicians (eg, pediatricians, family practitioners, general psychiatrists, or child psychiatrists) made that diagnosis and started pharmacotherapy?

Howard Fischer, MD
Division of Ambulatory Pediatrics
Children's Hospital of Michigan
3901 Beaubien Blvd
Detroit, MI 48201

1. Rapley MD, Mullan PB, Alvarez FJ, Eneli IU, Wang J, Gardiner JC. Diagnosis of attention-deficit/hyperactivity disorder and use of psychotropic medication in very young children. Arch Pediatr Adolesc Med. 1999;153:1039-1045. FREE FULL TEXT

In reply

I thank Dr Fischer for raising the issue about who provides service for very young children with attention-deficit/hyperactivity disorder. The following information about provider specialty was presented as a poster at the Pediatric Academic Societies Annual Meeting.¹

In the first report, 223 children aged 3 years or younger were identified as having a diagnosis of attention-deficit/hyperactivity disorder within the Michigan Medicaid fee-for-service plan from October 1, 1995, to December . . . [Full Text of this Article]