DOCTOR VISITS BY YOUNGSTERS WITH ADHD UP 90%

NEW YORK, Dec 14 (Reuters Health) -- The number of doctor visits made
by youngsters diagnosed with attention-deficit/hyperactivity disorder
(ADHD) increased by 90% between 1989 and 1996, and three-quarters of
those visits involved drug treatment, according to a report published
in the December issue of the Archives of Pediatrics and Adolescent
Medicine.

Dr. Julie Magno Zito of the University of Maryland in Baltimore led a
team of researchers in analyzing data from the National Ambulatory
Medical Care Survey, looking at visits for ADHD made by children aged
5 to 14, and at prescription patterns for these visits.

The proportion of youth visits to physicians that were for ADHD
increased steadily from 1989 to 1996, and so did the number of visits
that involved drug treatments. For example, the proportion of ADHD
youth visits that involved prescription for stimulants increased from
62% to 77%.

About 61% of ADHD visits were made to primary care providers, about
25% to psychiatrists, and about 8% to neurologists. The investigators
found significant differences in prescribing patterns according to
specialty: primary care doctors were more likely to prescribe
stimulants alone, while psychiatrists were more likely to prescribe
other psychotherapeutic drugs either alone or in combination with stimulants.

Zito and colleagues note that the standard therapy for ADHD is
stimulants, and over 80% of ADHD visits that involved medications
involved just those. But about 8% of medication-related visits
involved other drugs instead of stimulants, and about 10% involved
both. Youngsters receiving ''more complex'' drug therapy were more
likely to have depression or behavior disorders than those children
given only stimulants. The nonstandard drugs most often given to
children with ADHD were antidepressants, clonidine, and
antipsychotics.

The authors suggest that their findings should be used to guide
systematic research evaluating different therapies for different
groups of ADHD patients. Writing in an editorial in the same issue,
Dr. Mark L. Wolraich of Vanderbilt University in Nashville, Tennessee,
agrees.

``In the future, we will need to demonstrate that the treatments make
a difference in how the children behave,'' Wolraich states.

``As Zito and her colleagues point out, until we are better able to
address practice questions, it will be difficult for us to provide
realistic and effective practice guidelines and we will not be able to
answer the continuing public concern about to what extent is current
stimulant medication use appropriate,'' Wolraich concludes.

SOURCE: Archives of Pediatrics and Adolescent Medicine
1999;153:1257-1263, 1220-1221.

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