Association of Coexisting Conditions, Attention-Deficit/Hyperactivity Disorder Medication Choice, and Likelihood of Improvement in Preschool-Age Children: A Developmental Behavioral Pediatrics Research Network Study

Alexis Deavenport-Saman; Douglas L Vanderbilt; Elizabeth Harstad; Justine Shults; William Barbaresi; Ami Bax; Jaclyn Cacia; Sandra Friedman; Angela LaRosa; Irene Loe; Shruti Mittal; Nathan Blum

doi:10.1089/cap.2022.0009

Association of Coexisting Conditions, Attention-Deficit/Hyperactivity Disorder Medication Choice, and Likelihood of Improvement in Preschool-Age Children: A Developmental Behavioral Pediatrics Research Network Study

J Child Adolesc Psychopharmacol. 2022 Aug;32(6):328-336. doi: 10.1089/cap.2022.0009. Epub 2022 Jul 5.

Authors

Alexis Deavenport-Saman^{1

2}, Douglas L Vanderbilt^{1

2}, Elizabeth Harstad³, Justine Shults^{4

5}, William Barbaresi³, Ami Bax⁶, Jaclyn Cacia⁴, Sandra Friedman^{7

8}, Angela LaRosa⁹, Irene Loe¹⁰, Shruti Mittal¹¹, Nathan Blum^{4

5}

Affiliations

¹ Department of Pediatrics, Children's Hospital Los Angeles, Los Angeles, California, USA.
² Department of Pediatrics, Keck School of Medicine, University of Southern California, Los Angeles, California, USA.
³ Boston Children's Hospital, Boston, Massachusetts, USA.
⁴ Children's Hospital of Philadelphia, Philadelphia, Pennsylvania, USA.
⁵ Department of Pediatrics, Perelman School of Medicine at University of Pennsylvania, Philadelphia, Pennsylvania, USA.
⁶ University of Oklahoma Health Sciences Center, Oklahoma City, Oklahoma, USA.
⁷ Children's Hospital Colorado, Aurora, Colorado, USA.
⁸ Department of Pediatrics, School of Medicine, University of Colorado Anschutz Medical Campus, Aurora, Colorado, USA.
⁹ Department of Pediatrics, Medical University of South Carolina, Charleston, South Carolina, USA.
¹⁰ Department of Pediatrics, Stanford University School of Medicine, Stanford, California, USA.
¹¹ Atrium Health, Concord, North Carolina, USA.

PMID: 35787014
DOI: 10.1089/cap.2022.0009

Abstract

Objectives: 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. Methods: 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. Results: 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%; p < 0.001). Coexisting ASD and sleep disorder were associated with increased likelihood of starting A2As versus stimulants (p < 0.0005; p = 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%; p = 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%; p = 0.037). Conclusions: 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.

Keywords: alpha-2 adrenergic agonists; attention-deficit/hyperactivity disorder; coexisting conditions; improvement; preschool age; stimulants.

MeSH terms

Attention Deficit Disorder with Hyperactivity* / complications
Attention Deficit Disorder with Hyperactivity* / diagnosis
Attention Deficit Disorder with Hyperactivity* / drug therapy
Autism Spectrum Disorder* / complications
Autism Spectrum Disorder* / drug therapy
Central Nervous System Stimulants* / therapeutic use
Child
Child, Preschool
Humans
Retrospective Studies
Sleep Wake Disorders* / drug therapy

Substances

Central Nervous System Stimulants