Department of Pediatrics, The Children's Hospital of Philadelphia, Philadelphia, PA.
Department of Biostatistics and Epidemiology, Perelman School of Medicine, Philadelphia, PA.
J Dev Behav Pediatr. 2018 Sep;39(7):531-537. doi: 10.1097/DBP.0000000000000585.
To describe the use of stimulants and alpha-2 agonists (A2As) for the treatment of preschool-aged children with attention-deficit hyperactivity disorder (ADHD) at 2 Developmental-Behavioral Pediatrics Research Network sites.
Demographic information, diagnoses, and medications prescribed by developmental-behavioral pediatricians (DBPs) were extracted from the electronic health record for all outpatient visits from January 1, 2010, to December 31, 2011. The subset of visits for children aged 2 to 5 years who had a diagnosis of ADHD was included in this analysis. Multivariable models were constructed to identify factors associated with prescribing stimulants and A2As.
Over the 2-year period, 984 children with a diagnosis of ADHD were seen at 1779 visits. Of the 984 children, 342 (34.8%) were prescribed a stimulant, and 243 (24.7%) were prescribed an A2A. Both medications were prescribed at the same visit at least once during the 2-year period for 97 children (9.9%). Alpha-2 agonists were prescribed more often at site 2 than site 1 (OR [odds ratio] = 1.62, p = 0.015). Stimulants were more likely to be prescribed for older preschool-aged children (OR = 1.66, p < 0.001), and A2As were more likely to be prescribed for younger children (OR = 0.82, p = 0.02). Both stimulants and A2As were more likely to be prescribed to children with ADHD and comorbid conditions.
Alpha-2 agonists are commonly used by some DBPs for preschool ADHD. Variation in the use of A2As across sites may indicate a lack of consensus on when to use these medications and suggests a need for comparative effectiveness research to better define the relative benefits and side effects of A2As and stimulants for the treatment of preschool ADHD.
描述在 2 个发育行为儿科学研究网络（Developmental-Behavioral Pediatrics Research Network）站点中，发育行为儿科学医生（developmental-behavioral pediatricians，DBPs）使用兴奋剂和 α-2 激动剂（alpha-2 agonists，A2As）治疗学龄前注意缺陷多动障碍（attention-deficit hyperactivity disorder，ADHD）儿童的情况。
从 2010 年 1 月 1 日至 2011 年 12 月 31 日的电子健康记录中提取了所有门诊就诊的人口统计学信息、诊断和 DBP 开具的药物信息。本分析纳入了年龄在 2 至 5 岁、诊断为 ADHD 的儿童就诊的亚组。构建多变量模型以确定与开具兴奋剂和 A2As 相关的因素。
在 2 年期间，1779 次就诊中有 984 名患有 ADHD 的儿童。在 984 名儿童中，342 名（34.8%）被开具了兴奋剂，243 名（24.7%）被开具了 A2A。在 2 年期间，至少有 97 名儿童（9.9%）在同一次就诊中同时开具了这两种药物。与站点 1 相比，站点 2 更常开具 A2A（比值比[odds ratio] = 1.62，p = 0.015）。年龄较大的学龄前儿童更有可能被开具兴奋剂（比值比=1.66，p < 0.001），而年龄较小的儿童更有可能被开具 A2A（比值比=0.82，p = 0.02）。兴奋剂和 A2A 更有可能被开具给患有 ADHD 和共病的儿童。
一些 DBP 经常为学龄前 ADHD 儿童开具 A2A。各站点之间 A2A 使用的差异可能表明在何时使用这些药物方面缺乏共识，并表明需要开展比较有效性研究，以更好地确定 A2A 和兴奋剂治疗学龄前 ADHD 的相对益处和副作用。
