Psychotherapeutic medication patterns for youths with attention-deficit/hyperactivity disorder

Objectives: (1) To describe temporal patterns of office visits for attentio n-deficit/hyperactivity disorder (ADHD) and stimulant treatment for 5- to 1 4-year-old US youths; (2) to compare youth visits for ADHD with and without medication according to patient demographics, physician specialty, reimbur sement source, and comorbid diagnoses, and (3) to compare office visits for youths with ADHD in relation to common medication patterns (stimulants alo ne, stimulants with other psychotherapeutic medication, and nonstimulant ps ychotherapeutic medications alone). Design: Survey based on a national probability sample of office-based physi cians in the United States. Setting: Physician offices. Participants: A systematically sampled group of office-based physicians. Main Outcome Measures: National estimates of office visits for ADHD and psy chotherapeutic drug visits for ADHD for each year and for a combined 8-year period. Results:Youth visits for ADHD as a percentage of total physician visits had a 90% increase, from 1.9% in 1989 to 3.6% in 1996. Stimulant therapy withi n ADHD youth visits rose from 62.6% in 1989 to 76.6% in 1996. While the maj ority of non-ADHD youth visits were conducted by primary care physicians, o ne third of ADHD youth visits were managed by psychiatry and neurology spec ialists. Health maintenance organization insurance was the reimbursement so urce for 17.9% of non-ADHD youth visits but only 11.7% of ADHD youth visits . Complex medication therapy was more likely to be prescribed by psychiatri sts and less likely to be related to visits with health maintenance organiz ation reimbursement. Conclusions: National survey estimates in the 1990s confirm the substantial increase in visits for youths diagnosed as having ADHD, with more than thr ee quarters of these visits associated with psychotherapeutic medication tr eatment. Physician specialty and reimbursement source variables identify di stinct patient populations with a gradient in psychotherapeutic medication patterns from single-drug standard (stimulant) therapy to complex multidrug treatment regimens for which evidence-based scientific information is lack ing.