[1365.5] Medication Management of Preschool ADHD by Pediatric Sub-Specialists: Non-Compliance with AAP Clinical Guidelines
Jaeah Chung, Suzanne Sunday, David Meryash, Alyson Gutman, Andrew Adesman. Developmental and Behavioral Pediatrics, Cohen Children's Medical Center of New York, New Hyde Park, NY; Biostatistics, Feinstein Institute for Medical Research, Manhasset, NY.
BACKGROUND: Current clinical guidelines for pediatricians (AAP) and child psychiatrists (AACAP) recommend that preschoolers with ADHD (P-ADHD) generally receive treatment with behavioral modification (BM) before pharmacotherapy, and that methylphenidate (MPH) be used as the first line medication.
OBJECTIVE: 1. To examine to what extent pediatric subspecialists (PSs) adhere to AAP guidelines regarding pharmacotherapy for P-ADHD 2. To identify differences in treatment approach among subspecialties.
DESIGN/METHODS: The Preschool ADHD Treatment Questionnaire (PATQ) was developed and mailed to a randomized sample of 3,000 PSs nationwide. The PATQ asked how often PSs recommend parent training in BM and how often they recommend medication as a first- or second-line treatment. PSs were also asked which type of medication they typically choose first.
RESULTS: 714 (23.8%) surveys were received, and analyses were limited to 560 board-certified pediatric subspecialists who diagnose P-ADHD: 322 developmental-behavioral pediatricians (DBP), 170 child psychiatrists (CP), and 68 child neurologists (CN). 21% of PSs reported using medication as a first-line treatment often or very often. 69.5% use medication as a second-line treatment often or very often. Availability of BM (or lack thereof) was not associated with decision to use medication as a first-line treatment. Among PSs who prescribe medication for P-ADHD (first- or second-line), more than one-third (38.3%) said they prescribe a medication other than MPH initially (19.4% amphetamines; 18.9% non-stimulants). 90.7% of PSs often or very often recommend BM – even in communities with limited availability. No differences were noted across subspecialties regarding medication initiation criteria or selection. Likewise, no differences were noted between PSs who primarily treat patients with Medicaid versus private insurance. When adherence to AAP guidelines was defined as initial treatment with BM (not medication) and pharmacotherapy specifically with MPH as second-line treatment, only 12% CP, 8% DBP, and 9% CN complied with clinical guidelines. 19% of PSs stated that they expected the number of children for whom they will prescribe medication in the future will increase (vs 78% no change and 3% decrease).
CONCLUSIONS: The overwhelming majority of pediatric subspecialists deviate from current AAP guidelines for treatment of preschool ADHD regarding medication initiation and selection.
First Author is a Fellow in Training
Session: Platform Session: Developmental / Behavioral Pediatrics: ADHD (10:30 AM - 12:30 PM)
Date/Time: Saturday, May 4, 2013 - 11:30 AM
Room: 102B - Walter E. Washington Convention Center
Course Code: 1365