OBJECTIVES

: The American Academy of Pediatrics (AAP) guidelines (2011) recommend the use of evidence-based psychotherapy as a first-line ADHD treatment, particularly in preschoolers. This study assessed (1) the extent of stimulant prescribing in preschoolers and its association with health care utilization with respect to office-visits, hospital outpatient and ER visits compared to older children and adolescents. (2) association between children’s age and utilization parameters, and measured trends in stimulant use post release of the AAP guidelines.

METHODS

: Retrospective, cross-sectional data, obtained from the Medical Expenditure Panel Survey (MEPS, 2011-2015), were utilized to obtain ADHD sample. The sample was divided into three age groups: preschoolers (0 to 5 years), elementary schoolers (6 to 11 years), and adolescents (12 to 18 years). A one-way ANOVA was used to assess differences in office-based visits, outpatient care visits and ER visits among the three age groups. Chi-square analysis for different age groups assessed association between treatment type and key sociodemographic variables. Trends in stimulant and psychotherapy use in the three age groups were assessed.

RESULTS

: Compared to the other two age groups, 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), respectively. ANOVA and post-hoc analyses for group differences revealed significant differences among the three age groups for two of the three utilization variables (p<0.0001). A Pearson’s correlation analysis revealed younger age to be associated with an increase in number of ER visits.

CONCLUSIONS

Adherence to AAP treatment guidelines in preschoolers is less than optimal with respect to both stimulant drug use and psychotherapy. Overprescribing of stimulant drugs in preschoolers is associated with increased medical care utilization.