OBJECTIVES: The 2011 American Academy of Pediatrics (AAP) guidelines recommend the use of evidence-based psychotherapy as a first-line of treatment in ADHD and as a preferred alternative to stimulant medications, particularly in preschool children. This study assesses compliance with ADHD treatment guidelines and the extent of psychotherapy use and stimulant medication prescribing in preschoolers vs. older children (elementary school & adolescents).

METHODS: Retrospective data, obtained from the Medical Expenditure Panel Survey (MEPS, 2011-2015), was utilized to obtain ADHD sample which was divided into three age groups: preschoolers, elementary schoolers, and adolescents. A chi-square analysis was performed to compare the use of ADHD stimulants and psychotherapy in the three age groups. Differences in the utilization of office-based visits, outpatient visits and ER visits among the three age groups were analyzed using a one-way ANOVA to assess the impact of chosen therapy.

RESULTS: Out of 135,487 preschool children with ADHD, 78.3% used stimulant medications only, whereas only 13.4% used psychotherapy alone, and 8.4% used a combination therapy. Compared to children in elementary school and adolescents, preschoolers had higher number of office-based visits (10.41 vs 9.90 & 7.68; p<0.0001), outpatient visits (3.41 vs 0.27 & 0.28; p<0.0001) and ER visits (0.43 vs 0.19 & 0.19; p<0.0001). ANOVA revealed significant group differences overall; preschoolers had more ER visits and the mean difference (MD) was statistically significant in comparison to elementary schoolers (MD=0.238, p<0.0001), and to adolescents (MD=0.239, p<0.0001).

CONCLUSIONS: Adherence to AAP treatment guidelines for stimulant prescribing and behavioral therapy in preschoolers is less than optimal. Overprescribing of stimulant drugs is associated with increased medical care utilization, particularly in preschoolers and younger children. Routine prescribing of ADHD stimulants in preschoolers must be done in accordance with the treatment guidelines to avoid risky consequences and to decrease cost of care.