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Approval of new medications for treatment of attention-deficit/hyperactivity disorder (ADHD), regulatory changes, and increased public awareness influence national trends in the diagnosis and treatment of this highly prevalent condition. Researchers used the IMS Health National Disease and Therapeutic Index, a national database of physician office visits, to determine patterns of change in ambulatory diagnosis and treatment of ADHD.
From 2000 to 2010, the number of physician outpatient visits coded for ADHD increased 66% (from 6.2 million to 10.4 million). During this time, rates of psychostimulant prescriptions decreased modestly from 96% to 87% of these visits. Prescriptions for atomoxetine decreased from 15% of treatment visits in 2003, when it was approved for treating ADHD, to 6% of visits in 2010. Prescriptions for other ADHD medications (clonidine, guanfacine, and bupropion) remained relatively constant (5%–9% of treatment visits). From 2000 to 2010, the proportion of office visits coded for ADHD decreased from 54% to 47% for pediatricians and increased from 24% to 36% for psychiatrists; no notable change in illness severity was noted during this period.
Garfield CF et al. Trends in attention deficit hyperactivity disorder ambulatory diagnosis and medical treatment in the United States, 2000–2010. Acad Pediatr 2012 Mar/Apr; 12:110.
Comment
The 66% increase in physician visits for children and adolescents with attention-deficit/hyperactivity disorder is consistent with other recent reports. Whether the trend reflects increased parent and provider awareness or a true increase in prevalence of ADHD is uncertain. In my opinion, the shift away from pediatricians and toward psychiatrists as treating clinicians is concerning, given the paucity of child psychiatrists in outpatient clinical practice and the high prevalence of ADHD. Limited participation by pediatricians in the care of these children might result from controversy about adverse cardiac events with some ADHD medications (JW Pediatr Adolesc Med Nov 16 2011). Further, some pediatricians might feel challenged by coexisting conditions (e.g., oppositional behavior, aggression, and anxiety). In addition to the growing number of CME programs for pediatricians focused on ADHD, the American Academy of Pediatrics recently expanded and updated its evidence-based guideline for diagnosis and treatment of ADHD (JW Pediatr Adolesc Med Nov 16 2011), providing an evidence-based foundation for primary care practice.