Prescribing of psychostimulant medications for attention deficit hyperactivity disorder in children: Differences between clinical specialties
Preen, D. B., Calver, J., Sanfilippo, F. M., Bulsara, M., & Holman, C. D. (2008). Prescribing of psychostimulant medications for attention deficit hyperactivity disorder in children: differences between clinical specialties. Medical Journal of Australia, 188(6), 337-339.
Objective: To examine differences in psychostimulant prescribing between paediatricians and child/adolescent psychiatrists for treating children with attention deficit hyperactivity disorder (ADHD) in Western Australia.
Design: Using whole-population prescribing data, logistic and linear regressions were used to model the number of children (aged 2–17 years) treated with psychostimulants between August 2003 and December 2004 for ADHD and medication dose prescribed by clinical specialty, controlling for age, sex, body weight, and other medication use.
Main outcome measures: Mean number of patients treated by specialty; associations between prescriber specialty and patient characteristics; associations between stimulant dose and patient characteristics and prescriber specialty.
Results: 54 paediatricians and 23 child/adolescent psychiatrists prescribed stimulant medications for children with ADHD. The mean number of patients treated (per prescriber) was 159.8 (range, 1–1977) for paediatricians and 34.3 (range, 1–166) for psychiatrists. Boys were 32% more likely to be treated with stimulants by paediatricians (P = 0.002). Psychiatrists were 2.9 times (95% CI, 2.4–3.3; P < 0.001) more likely than paediatricians to treat patients with multiple psychotropic medications. When controlled for all other factors, psychiatrists prescribed higher stimulant doses (4.5 mg/day greater; 95% CI, 2.0–7.0 mg/day; P < 0.001) than paediatricians.
Conclusion: Treatment of children with stimulant medicines for ADHD differed between clinical specialties. Paediatricians treated more patients per prescriber, a greater proportion of boys, and a younger age demographic, but relied less on combined psychotropic pharmacotherapy and prescribed lower stimulant doses than psychiatrists.