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ADHD Diagnoses in Preschool Children Have Stabilized

A rapid increase in ADHD diagnoses for children aged 4 to 6 has tapered off since the AAP released its updated guidelines in 2011, a new study says.

November 16, 2016

ADHD diagnoses in preschool children — which had been increasing at a rapid rate prior to 2011 — have stabilized, perhaps due to updated diagnosis and treatment guidelines released by the American Academy of Pediatrics (AAP) that year, according to a recent study. Medication use since 2011 has remained stable as well, the researchers say, assuaging another worry and suggesting an increase in more age-appropriate care.

The new research report, published in Pediatrics on November 15, looked at 143,881 children between the ages of 4 and 6 who were evaluated for ADHD between 2008 and 2014. Since the guidelines were released in 2011, the sample was divided into pre- and post-guideline groups. Pre-guideline children were diagnosed with ADHD at a rate of 0.7 percent, while post-guideline children were diagnosed at a rate of 0.9 percent. Stimulant use stayed the same pre- and post-guideline, at a rate of 0.4 percent.

Though diagnosis rates clearly increased, the researchers say the year-over-year uptick is much less drastic than it had been in years prior to 2011 — indicating that the AAP’s revised guidelines have successfully addressed the diagnosis boom that worried many ADHD experts. The unchanged rate of stimulant use is a positive sign as well, researchers say, since the AAP guidelines promote behavioral therapy as the best treatment for preschool-aged children.

“These are reassuring results given that a standardized approach to diagnosis was recommended and stimulant treatment is not recommended as first-line therapy for this age group,” said study author Alexander G. Fiks, MD, MSCE, associate director of the Center for Pediatric Clinical Effectiveness at Children’s Hospital of Philadelphia.

The change in diagnosis rates varied significantly between different practices, the study authors note, indicating that some doctors may not be following the guidelines as faithfully as others.

“Because guidelines standardize care, we expected to see decreased variation across sites after guideline release. However, we found varying responses of sites to the guideline, and the interquartile range across practices for both diagnosis and stimulant prescribing did not narrow,” the authors write. “These findings indicate that although the overall results of our study are reassuring, practices may be responding differently to the guideline both for diagnosis and prescribing, and standardization of ADHD practice may be difficult to achieve.”

To fix this problem, experts propose technological solutions to the question of ADHD diagnosis, including doctor-patient portals to enhance communication and electronic rating scales that “can be completed and reviewed by the providers and families on an ongoing basis,” said Mark L. Wolraich, MD, from the University of Oklahoma Health Sciences Center. Dr. Wolraich was not involved in the study, but wrote an analysis of it that also appeared in ~Pediatrics~.

“There needs to be greater standardization of assessment and treatment modalities so that we can better examine the outcomes of changes in treatment,” he added. “It truly will take a full-service integrated village to optimize ADHD care across the life span.”

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