Department of Pediatrics, Children's Hospital Los Angeles, Los Angeles, California, USA.
Department of Pediatrics, Keck School of Medicine, University of Southern California, Los Angeles, California, USA.
J Child Adolesc Psychopharmacol. 2022 Aug;32(6):328-336. doi: 10.1089/cap.2022.0009. Epub 2022 Jul 5.
To determine whether conditions coexisting with attention-deficit/hyperactivity disorder (ADHD) in preschool-age children are associated with choice of stimulants or alpha-2 adrenergic agonists (A2As) and/or likelihood of improvement in ADHD symptoms. A retrospective electronic health record review of 497 children from 7 Developmental Behavioral Pediatrics Research Network (DBPNet) sites. Children were <72 months when treated with medication for ADHD from January 1, 2013 to July 1, 2017. We abstracted coexisting conditions, initial medication prescribed, and whether the medication was associated with improvement in symptoms. Analysis of improvement was adjusted for clustering by clinician and site. The median (interquartile range) child age at the time of initiation of ADHD medication was 62 (54-67) months. The most common coexisting conditions included language disorders (40%), sleep disorders (28%), disruptive behavior disorders (22.7%), autism spectrum disorder (ASD; 21.8%), and motor disorders (19.9%). No coexisting conditions were present in 17.1%; 1 in 36.8%, 2 in 26.8%, and ≥3 in 19.3%. Stimulants were initially prescribed for 322 (64.8%) and A2A for 175 (35.2%) children. Children prescribed stimulants were more likely to have no coexisting conditions than those prescribed A2A (22.3% vs. 7.4%; < 0.001). Coexisting ASD and sleep disorder were associated with increased likelihood of starting A2As versus stimulants ( < 0.0005; = 0.002). The association between medication treatment and improvement varied by number of coexisting conditions for 0, 1, 2, or ≥3, respectively (84.7%, 73.8%, 72.9%, 64.6%; = 0.031). Children with ≥3 coexisting conditions were less likely to respond to stimulants than children with no coexisting conditions (67.4% vs. 79.9%; = 0.037). Among preschool-age children with ADHD, those with ≥3 coexisting conditions were less likely to respond to stimulants than those with no coexisting conditions. This was not found for A2A, but further research is needed as very few children with no coexisting conditions were treated with A2A.
为了确定学龄前儿童共患的注意缺陷多动障碍（ADHD）是否与选择兴奋剂或α-2 肾上腺素能激动剂（A2A）以及/或 ADHD 症状改善的可能性相关。这是对来自 7 个发育行为儿科学研究网络（DBPNet）的 497 名儿童进行的回顾性电子健康记录审查。这些儿童在 2013 年 1 月 1 日至 2017 年 7 月 1 日期间，因 ADHD 接受药物治疗时的年龄均<72 个月。我们提取了共患疾病、初始处方药物以及药物是否与症状改善相关的信息。通过医生和地点聚类调整了改善分析。开始 ADHD 药物治疗时儿童的中位数（四分位距）年龄为 62（54-67）个月。最常见的共患疾病包括语言障碍（40%）、睡眠障碍（28%）、破坏性行为障碍（22.7%）、自闭症谱系障碍（ASD；21.8%）和运动障碍（19.9%）。无共患疾病的占 17.1%；1 种共患疾病占 36.8%，2 种共患疾病占 26.8%，≥3 种共患疾病占 19.3%。322 名儿童最初开了兴奋剂处方（64.8%），175 名儿童开了 A2A 处方（35.2%）。与 A2A 相比，开兴奋剂的儿童更有可能没有共患疾病（22.3% vs. 7.4%；<0.001）。ASD 和睡眠障碍共患与更有可能开始使用 A2A 而不是兴奋剂有关（<0.0005；=0.002）。对于共患疾病为 0、1、2 或≥3 种的儿童，药物治疗与改善之间的关联分别为 84.7%、73.8%、72.9%和 64.6%（=0.031）。与无共患疾病的儿童相比，≥3 种共患疾病的儿童对兴奋剂的反应较差（67.4% vs. 79.9%；=0.037）。在患有 ADHD 的学龄前儿童中，与无共患疾病的儿童相比，≥3 种共患疾病的儿童对兴奋剂的反应较差。对于 A2A，并未发现这种情况，但需要进一步研究，因为几乎没有无共患疾病的儿童接受 A2A 治疗。
