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Cited by 162Attention Deficit Hyperactivity DisorderPharmaceutical studies and practicesNeuroethics, Human Enhancement, Biomedical Innovations

Psychotherapeutic medication patterns for youths with attention-deficit/hyperactivity disorder

Zito, Julie Magno, Safer, Daniel J., dosReis, Susan, Magder, Laurence S., Gardner, James F., Zarin, Deborah A.·1999·Archives of Pediatrics & Adolescent Medicine
DOI 10.1001/archpedi.153.12.1257
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Abstract

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 melication 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.

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  • Published studies disagree about ethnic disparities in adherence: some report that minority youths are more likely to stop treatment early and to use psychiatric services and medication less, while others find no ethnic differences in mental health prescribing, referrals, or counseling after diagnosis.

    “The current literature on ethnic disparities in adherence is somewhat inconsistent: some studies indicate that minority youths are at increased risk for premature treatment discontinuation and lower use of psychiatric services and medication, 23,31 but other studies suggest no ethnic disparities in mental health prescription rates, referrals, and counseling once a diagnosis is made.32,33”

    From Medication Adherence in the MTA: Saliva Methylphenidate Samples Versus Parent Report and Mediating Effect of Concomitant Behavioral Treatment (2009) · cites this paper as [32]

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Authors
Zito, J. M., Safer, D. J., dosReis, S., Magder, L. S., Gardner, J. F., & Zarin, D. A.
Affiliations
  • University of Maryland, Baltimore (US)
  • American Psychiatric Association (US)
Corresponding author
Zito, Julie Magno
ORCID
Venue
Archives of Pediatrics & Adolescent Medicine
Publisher
American Medical Association (AMA)
Published
1999-12-01
Volume
153
Issue
12
Pages
1257
ISSN
1072-4710 (ISSN-L)
DOI
10.1001/archpedi.153.12.1257
OpenAlex
W2118215319
Cited by
162
References
19
Citations by year
2023: 2 · 2021: 1 · 2020: 1 · 2018: 2 · 2017: 1 · 2016: 3 · 2015: 6 · 2014: 7 · 2013: 6 · 2012: 8
FWCI
7.37
Type
journal article
Language
en
Open access
closed
Locations
  • Archives of Pediatrics and Adolescent Medicine (publishedVersion)
  • PubMed (publishedVersion)
Funders
  • National Institutes of Health (5r01mh055259-03)
  • National Institute of Mental Health (R01 MH55259)
Topics
  • Health Sciences › Medicine › Psychiatry and Mental health › Attention Deficit Hyperactivity Disorder
  • Health Sciences › Medicine › Pediatrics, Perinatology and Child Health › Pharmaceutical studies and practices
  • Life Sciences › Neuroscience › Cognitive Neuroscience › Neuroethics, Human Enhancement, Biomedical Innovations
Keywords
attention deficit hyperactivity disorder, stimulant medication, medication use patterns, office visits, youth, temporal trends, physician specialty, health maintenance organizations, multidrug therapy, comorbidities, primary care
MeSH terms
Adolescent, Central Nervous System Stimulants, Attention Deficit Disorder with Hyperactivity, Child, Child, Preschool, Drug Therapy, Combination, Female, Humans, Insurance, Health, Reimbursement, Male, Medicine, Office Visits, Practice Patterns, Physicians', Psychotropic Drugs, Specialization, Time Factors, United States

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