Determinants of Initial Pharmacological Treatment for Youths with Attention-Deficit/Hyperactivity Disorder

Objectives: The aim of this study was to investigate determinants of initial psychotropic treatment for attention-deficit/hyperactivity disorder (ADHD). Methods: The retrospective cohort design included 28,763 newly diagnosed youths <21 years, with 18 months of continuous Medicaid eligibility between 1994 and 2003. Multivariate logistic regression was used to evaluate associations between clinical, sociodemographic, and provider characteristics and ADHD drug (stimulants/atomoxetine) use and six other psychotropic drug classes within 6 months after the ADHD diagnosis claim. Results: The categories male, school-aged, white, rural dwelling, and foster care were positively associated with ADHD treatment. Youths diagnosed by psychiatrists were 42% less likely to receive ADHD drugs than those diagnosed by primary care physicians. Of the 26% youths with mental co-morbidities, 31.3% concomitantly used non-ADHD psychotropic medications. The presence of other mental disorders decreased the probability of ADHD drug use by 14-54%. Antipsychotics (55.1%) or antidepressants (56.4%) were used by more than half of patients with concomitant bipolar disorder. A total of 26.4% of patients without mental co-morbidities received non-ADHD drugs, either with or without concomitant stimulant use (18.8% and 7.6%, respectively). Conclusion: Sociodemographic, clinical, and provider characteristics are associated with initial treatment for youths with ADHD. More evidence on psychotropic safety and efficacy is needed considering the high prevalence of concomitant mental disorders, multidrug regimens, and off-label use.