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TOPLINE:

Among 712,478 children seen in primary care, 68.2% of those aged 4-5 years who were diagnosed with attention-deficit/hyperactivity disorder (ADHD) received medication before age 7 years, with 42.2% receiving prescriptions within 30 days of diagnosis. Asian, Hispanic, and Black children were less likely to receive early prescriptions compared with White children.

METHODOLOGY:

• Researchers conducted a retrospective cohort study using electronic health records from primary care clinics affiliated with eight academic institutions participating in the PEDSnet Clinical Research Network between 2016 and 2023.
• The analysis included 712,478 children aged 3-5 years who had at least two visits 180 days apart, of whom 9708 (1.4%) received an ADHD diagnosis at age 4-5 years.
• Primary outcomes measured rates of ADHD diagnosis, stimulant and nonstimulant prescription before age 7 years, and time from first ADHD-related diagnosis to medication prescription.
• Multivariable Cox proportional hazards models evaluated associations between clinical and demographic variables and time from diagnosis to prescription, adjusting for institution, year, and primary care utilization.

TAKEAWAY:

• Among 9708 preschoolers with ADHD, Asian children (adjusted hazard ratio [aHR], 0.51; 95% CI, 0.38-0.68), Hispanic children (aHR, 0.75; 95% CI, 0.70-0.81), and Black children (aHR, 0.88; 95% CI, 0.83-0.94) were less likely to receive early prescriptions compared with White children.
• Older vs younger patients (aHR, 1.62; 95% CI, 1.55-1.69), male vs female patients (aHR, 1.17; 95% CI, 1.11-1.25), and publicly insured vs privately insured patients (aHR, 1.09; 95% CI, 1.03-1.15) were more likely to receive an early prescription.
• Of those prescribed medications, 77.5% received stimulants, 16.7% received nonstimulants, and 5.8% received both, with prescription rates varying across institutions from 44.1% to 74.1%.
• Follow-up care within 60 days of prescription occurred in 40.5% of cases, with rates ranging from 25.9% to 56.0% across institutions.

IN PRACTICE:

“The high rate of medication prescriptions among preschool-age children with ADHD and the lack of delay between initial diagnosis and prescription require further investigation to assess the appropriateness of early medication treatment. The variation in care among minoritized racial and ethnic groups uncovers disparities in care that require further exploration,” wrote the authors of the study.

SOURCE:

The study was led by Yair Bannett, MD, MS, Division of Developmental-Behavioral Pediatrics, Stanford University School of Medicine in Palo Alto, California. It was published online on August 29 in JAMA Network Open.

LIMITATIONS:

According to the authors, study cohort identification based on diagnostic codes carries potential for misclassification error. Information about primary care physician recommendations for first-line behavioral treatment was not available as it is typically documented in free text. Additionally, researchers noted that nonstimulant medications may have been prescribed to address sleep problems rather than ADHD symptoms in some cases.

DISCLOSURES:

The study received support from the Stanford Maternal and Child Health Research Institute and the National Institute of Mental Health grant K23MH128455. Farah W. Brink reported receiving grants from Nationwide Children’s Hospital during the conduct of the study. Holly K. Harris disclosed receiving research support from Ionis Pharmaceuticals, Grace Science Foundation, and Lou Foundation, as well as consulting fees from Shionogi, Inc., and Key Quest Health. Additional disclosures are noted in the original article.

This article was created using several editorial tools, including AI, as part of the process. Human editors reviewed this content before publication.