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.

Schizophrenia is a severe and persistent mental illness that affects upwards of two million Americans and its treatment is estimated to cost {dollar}32 billion annually. Although pharmacotherapy represents the mainstay of treatment for schizophrenia, recent pharmacoepidemiologic data on practice patterns in large U.S. populations are limited. To address this need, a study was conducted with the following aims: (1) to characterize the patterns of pharmacologic management of schizophrenia and its demographic and clinical correlates in typical clinical practice settings; (2) to develop analytic models to examine the associations between characteristics of drug therapy and outcomes; and (3) to look for evidence of behavioral toxicity of antipsychotic medications. The data from this study were derived from a patient survey supplemented with medical record information of 719 participants recruited from inpatient and outpatient psychiatric facilities in two states for the Schizophrenia Patient Outcomes Research Team (PORT) study. The final study samples consisted of 224 inpatients and 358 outpatients that met eligibility criteria and had valid medical record data. Ethnic disparities in prescribing were identified, such that non-white patients received fewer newer antipsychotic medications, more long-acting injectable (depot) antipsychotic medications, higher average daily antipsychotic doses, and fewer adjunctive medications than their white counterparts, regardless of treatment setting. Geographic variations in prescribing patterns, in which newer antipsychotics and adjunctive medications (inpatients only) were prescribed more frequently in rural areas of State A and in urban areas of State B, and depot antipsychotics were prescribed more often in urban areas of State A and rural areas of State B, were also noted. The hypothesized model of an indirect relationship among pharmacotherapy and outcomes variables (functioning and satisfaction) that is mediated by symptoms and medication side effects was not supported by the data in either treatment setting. Also, evidence of behavioral toxicity of antipsychotics was not identified. Pronounced variations in the pharmacologic management of schizophrenia were revealed. Investigations of the outcomes of pharmacotherapy and the behavioral toxicity of antipsychotic medications should be undertaken, utilizing different measurement scales and a prospective, longitudinal study design.