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Common Use of Stimulants and Alpha-2 Agonists to Treat Preschool Attention-Deficit Hyperactivity Disorder

A DBPNet Study

Blum, Nathan J., MD*; Shults, Justine, PhD; Harstad, Elizabeth, MD; Wiley, Susan, MD§; Augustyn, Marilyn, MD; Meinzen-Derr, Jareen K., PhD; Wolraich, Mark L., MD**; Barbaresi, William J., MD

Journal of Developmental & Behavioral Pediatrics: September 2018 - Volume 39 - Issue 7 - p 531–537
doi: 10.1097/DBP.0000000000000585
Original Article

Objective: To describe the use of stimulants and alpha-2 agonists (A2As) for the treatment of preschool-aged children with attention-deficit hyperactivity disorder (ADHD) at 2 Developmental-Behavioral Pediatrics Research Network sites.

Methods: Demographic information, diagnoses, and medications prescribed by developmental-behavioral pediatricians (DBPs) were extracted from the electronic health record for all outpatient visits from January 1, 2010, to December 31, 2011. The subset of visits for children aged 2 to 5 years who had a diagnosis of ADHD was included in this analysis. Multivariable models were constructed to identify factors associated with prescribing stimulants and A2As.

Results: Over the 2-year period, 984 children with a diagnosis of ADHD were seen at 1779 visits. Of the 984 children, 342 (34.8%) were prescribed a stimulant, and 243 (24.7%) were prescribed an A2A. Both medications were prescribed at the same visit at least once during the 2-year period for 97 children (9.9%). Alpha-2 agonists were prescribed more often at site 2 than site 1 (OR [odds ratio] = 1.62, p = 0.015). Stimulants were more likely to be prescribed for older preschool-aged children (OR = 1.66, p < 0.001), and A2As were more likely to be prescribed for younger children (OR = 0.82, p = 0.02). Both stimulants and A2As were more likely to be prescribed to children with ADHD and comorbid conditions.

Conclusion: Alpha-2 agonists are commonly used by some DBPs for preschool ADHD. Variation in the use of A2As across sites may indicate a lack of consensus on when to use these medications and suggests a need for comparative effectiveness research to better define the relative benefits and side effects of A2As and stimulants for the treatment of preschool ADHD.

*Department of Pediatrics, The Children's Hospital of Philadelphia, Philadelphia, PA;

Department of Biostatistics and Epidemiology, Perelman School of Medicine, Philadelphia, PA;

Division of Developmental Medicine, Boston Children's Hospital, Boston, MA;

§Department of Pediatrics, Cincinnati Children's Hospital and Medical Center, Cincinnati, OH;

Department of Pediatrics, Boston Medical Center, Boston, MA;

Department of Biostatistics and Epidemiology, Cincinnati Children's Hospital Medical Center, Cincinnati, OH;

**Department of Pediatrics, University of Oklahoma Health Sciences Center, Oklahoma City, OK.

Address for reprints: Nathan J. Blum, MD, Department of Pediatrics, The Children's Hospital of Philadelphia, 3550 Market Street, Philadelphia, PA 19014; e-mail:

Supported by cooperative agreement UA3MC20218 and by projects T77MC00012 and T77MC00011 from the Maternal and Child Health Bureau, Health Resources and Services Administration and the U.S. Department of Health and Human Services. This information or content and conclusions are those of the authors and should not be construed as the official position or policy of, nor should any endorsements be inferred by HRSA, HHS or the US government.

Disclosure: The authors declare no conflict of interest.

Received September , 2017

Accepted April , 2018

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