Patterns of psychopharmacologic treatment for attention deficit hyperactivity disorder

Abstract

Outpatient office visits and stimulant medication treatments for attention deficit hyperactivity disorder (ADHD), the most common childhood psychiatric disorder, show sizeable increases in the US from 1990-1995. Current research findings do not fully explain the increases in diagnostic and treatment prevalence. Descriptive information of ADHD treatments across different youth populations would inform how clinical, demographic, and cultural factors influence treatment practices. This study examines child characteristics, parental perceptions, and health care system factors associated with ADHD medication treatment to understand their role in clinical decision-making. The specific aims of the study are to: compare ADHD treatment patterns for health maintenance organization (HMO) child members with Medicaid child members in the same geographic region; describe ADHD treatment referral patterns among a sample of school-aged children in an HMO; and survey parents' knowledge, attitude, and satisfaction with their child's ADHD treatment. Data were obtained from HMO and Medicaid computerized medical and prescription databases and a self-administered Attitude, Satisfaction, Knowledge and Medication Experiences (ASK-ME) survey for parents of children with ADHD. Findings from the computerized data show that HMO youths receiving care from a non-mental health provider were 4 times more likely to be diagnosed with ADHD than Medicaid youths. The survey study findings revealed that Caucasian parents had significantly greater knowledge of and more positive attitudes towards ADHD medication treatment. A larger proportion of non-Caucasian than Caucasian parents preferred counseling over medication and believed that stimulant medication led to substance abuse. Parents in both groups had false expectations about the medication's ability to improve the child's academic performance and behavior later in life. Parents were less satisfied with the medication's ability to enhance their child's self-esteem and social relations at home and at school. This study identified health care system, clinical, economic, and racial differences in perceptions of and treatments for ADHD among HMO and Medicaid youths. Additional research that includes a broader range of racial, cultural, and economic characteristics is needed to corroborate these findings. This work is important for the advancement of scientific knowledge of pediatric psychopharmacologic practices and for improvement in the clinical management of children with ADHD.