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Trends in Attention Deficit Hyperactivity Disorder Ambulatory Diagnosis and Medical Treatment in the United States, 2000–2010

  • Craig F. Garfield
    Affiliations
    Department of Pediatrics, Northwestern University, Chicago, Ill (Dr Garfield); Department of Medical Social Sciences, Northwestern University, Chicago, Ill (Dr Garfield); Department of Neurology, Johns Hopkins Medicine, Baltimore, Md (Dr Dorsey); Department of Medicine, University of Chicago Hospitals, Chicago, Ill (Ms Zhu, Dr Alexander, Ms Higashi and Ms Kornfield); Department of Health Care Policy, Harvard Medical School, Boston, Mass (Dr Dusetzina and Dr Huskamp); Center for Health and the Social Sciences, University of Chicago, Chicago, Ill (Dr Alexander and Dr Conti); Department of Pediatrics, University of Chicago Hospitals, Chicago, Ill (Dr Conti); Department of Pediatrics, Massachusetts General Hospital and Harvard Medical School, Boston, Mass (Dr Perrin); and Department of Pharmacy Practice, University of Illinois at Chicago School of Pharmacy, Chicago, Ill (Dr Alexander)
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  • E. Ray Dorsey
    Affiliations
    Department of Pediatrics, Northwestern University, Chicago, Ill (Dr Garfield); Department of Medical Social Sciences, Northwestern University, Chicago, Ill (Dr Garfield); Department of Neurology, Johns Hopkins Medicine, Baltimore, Md (Dr Dorsey); Department of Medicine, University of Chicago Hospitals, Chicago, Ill (Ms Zhu, Dr Alexander, Ms Higashi and Ms Kornfield); Department of Health Care Policy, Harvard Medical School, Boston, Mass (Dr Dusetzina and Dr Huskamp); Center for Health and the Social Sciences, University of Chicago, Chicago, Ill (Dr Alexander and Dr Conti); Department of Pediatrics, University of Chicago Hospitals, Chicago, Ill (Dr Conti); Department of Pediatrics, Massachusetts General Hospital and Harvard Medical School, Boston, Mass (Dr Perrin); and Department of Pharmacy Practice, University of Illinois at Chicago School of Pharmacy, Chicago, Ill (Dr Alexander)
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  • Shu Zhu
    Affiliations
    Department of Pediatrics, Northwestern University, Chicago, Ill (Dr Garfield); Department of Medical Social Sciences, Northwestern University, Chicago, Ill (Dr Garfield); Department of Neurology, Johns Hopkins Medicine, Baltimore, Md (Dr Dorsey); Department of Medicine, University of Chicago Hospitals, Chicago, Ill (Ms Zhu, Dr Alexander, Ms Higashi and Ms Kornfield); Department of Health Care Policy, Harvard Medical School, Boston, Mass (Dr Dusetzina and Dr Huskamp); Center for Health and the Social Sciences, University of Chicago, Chicago, Ill (Dr Alexander and Dr Conti); Department of Pediatrics, University of Chicago Hospitals, Chicago, Ill (Dr Conti); Department of Pediatrics, Massachusetts General Hospital and Harvard Medical School, Boston, Mass (Dr Perrin); and Department of Pharmacy Practice, University of Illinois at Chicago School of Pharmacy, Chicago, Ill (Dr Alexander)
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  • Haiden A. Huskamp
    Affiliations
    Department of Pediatrics, Northwestern University, Chicago, Ill (Dr Garfield); Department of Medical Social Sciences, Northwestern University, Chicago, Ill (Dr Garfield); Department of Neurology, Johns Hopkins Medicine, Baltimore, Md (Dr Dorsey); Department of Medicine, University of Chicago Hospitals, Chicago, Ill (Ms Zhu, Dr Alexander, Ms Higashi and Ms Kornfield); Department of Health Care Policy, Harvard Medical School, Boston, Mass (Dr Dusetzina and Dr Huskamp); Center for Health and the Social Sciences, University of Chicago, Chicago, Ill (Dr Alexander and Dr Conti); Department of Pediatrics, University of Chicago Hospitals, Chicago, Ill (Dr Conti); Department of Pediatrics, Massachusetts General Hospital and Harvard Medical School, Boston, Mass (Dr Perrin); and Department of Pharmacy Practice, University of Illinois at Chicago School of Pharmacy, Chicago, Ill (Dr Alexander)
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  • Rena Conti
    Affiliations
    Department of Pediatrics, Northwestern University, Chicago, Ill (Dr Garfield); Department of Medical Social Sciences, Northwestern University, Chicago, Ill (Dr Garfield); Department of Neurology, Johns Hopkins Medicine, Baltimore, Md (Dr Dorsey); Department of Medicine, University of Chicago Hospitals, Chicago, Ill (Ms Zhu, Dr Alexander, Ms Higashi and Ms Kornfield); Department of Health Care Policy, Harvard Medical School, Boston, Mass (Dr Dusetzina and Dr Huskamp); Center for Health and the Social Sciences, University of Chicago, Chicago, Ill (Dr Alexander and Dr Conti); Department of Pediatrics, University of Chicago Hospitals, Chicago, Ill (Dr Conti); Department of Pediatrics, Massachusetts General Hospital and Harvard Medical School, Boston, Mass (Dr Perrin); and Department of Pharmacy Practice, University of Illinois at Chicago School of Pharmacy, Chicago, Ill (Dr Alexander)
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  • Stacie B. Dusetzina
    Affiliations
    Department of Pediatrics, Northwestern University, Chicago, Ill (Dr Garfield); Department of Medical Social Sciences, Northwestern University, Chicago, Ill (Dr Garfield); Department of Neurology, Johns Hopkins Medicine, Baltimore, Md (Dr Dorsey); Department of Medicine, University of Chicago Hospitals, Chicago, Ill (Ms Zhu, Dr Alexander, Ms Higashi and Ms Kornfield); Department of Health Care Policy, Harvard Medical School, Boston, Mass (Dr Dusetzina and Dr Huskamp); Center for Health and the Social Sciences, University of Chicago, Chicago, Ill (Dr Alexander and Dr Conti); Department of Pediatrics, University of Chicago Hospitals, Chicago, Ill (Dr Conti); Department of Pediatrics, Massachusetts General Hospital and Harvard Medical School, Boston, Mass (Dr Perrin); and Department of Pharmacy Practice, University of Illinois at Chicago School of Pharmacy, Chicago, Ill (Dr Alexander)
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  • Ashley Higashi
    Affiliations
    Department of Pediatrics, Northwestern University, Chicago, Ill (Dr Garfield); Department of Medical Social Sciences, Northwestern University, Chicago, Ill (Dr Garfield); Department of Neurology, Johns Hopkins Medicine, Baltimore, Md (Dr Dorsey); Department of Medicine, University of Chicago Hospitals, Chicago, Ill (Ms Zhu, Dr Alexander, Ms Higashi and Ms Kornfield); Department of Health Care Policy, Harvard Medical School, Boston, Mass (Dr Dusetzina and Dr Huskamp); Center for Health and the Social Sciences, University of Chicago, Chicago, Ill (Dr Alexander and Dr Conti); Department of Pediatrics, University of Chicago Hospitals, Chicago, Ill (Dr Conti); Department of Pediatrics, Massachusetts General Hospital and Harvard Medical School, Boston, Mass (Dr Perrin); and Department of Pharmacy Practice, University of Illinois at Chicago School of Pharmacy, Chicago, Ill (Dr Alexander)
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  • James M. Perrin
    Affiliations
    Department of Pediatrics, Northwestern University, Chicago, Ill (Dr Garfield); Department of Medical Social Sciences, Northwestern University, Chicago, Ill (Dr Garfield); Department of Neurology, Johns Hopkins Medicine, Baltimore, Md (Dr Dorsey); Department of Medicine, University of Chicago Hospitals, Chicago, Ill (Ms Zhu, Dr Alexander, Ms Higashi and Ms Kornfield); Department of Health Care Policy, Harvard Medical School, Boston, Mass (Dr Dusetzina and Dr Huskamp); Center for Health and the Social Sciences, University of Chicago, Chicago, Ill (Dr Alexander and Dr Conti); Department of Pediatrics, University of Chicago Hospitals, Chicago, Ill (Dr Conti); Department of Pediatrics, Massachusetts General Hospital and Harvard Medical School, Boston, Mass (Dr Perrin); and Department of Pharmacy Practice, University of Illinois at Chicago School of Pharmacy, Chicago, Ill (Dr Alexander)
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  • Rachel Kornfield
    Affiliations
    Department of Pediatrics, Northwestern University, Chicago, Ill (Dr Garfield); Department of Medical Social Sciences, Northwestern University, Chicago, Ill (Dr Garfield); Department of Neurology, Johns Hopkins Medicine, Baltimore, Md (Dr Dorsey); Department of Medicine, University of Chicago Hospitals, Chicago, Ill (Ms Zhu, Dr Alexander, Ms Higashi and Ms Kornfield); Department of Health Care Policy, Harvard Medical School, Boston, Mass (Dr Dusetzina and Dr Huskamp); Center for Health and the Social Sciences, University of Chicago, Chicago, Ill (Dr Alexander and Dr Conti); Department of Pediatrics, University of Chicago Hospitals, Chicago, Ill (Dr Conti); Department of Pediatrics, Massachusetts General Hospital and Harvard Medical School, Boston, Mass (Dr Perrin); and Department of Pharmacy Practice, University of Illinois at Chicago School of Pharmacy, Chicago, Ill (Dr Alexander)
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  • G. Caleb Alexander
    Correspondence
    Address correspondence to G. Caleb Alexander, MD, MS, The University of Chicago, 5841 S. Maryland, MC 2007, Chicago, IL 60637.
    Affiliations
    Department of Pediatrics, Northwestern University, Chicago, Ill (Dr Garfield); Department of Medical Social Sciences, Northwestern University, Chicago, Ill (Dr Garfield); Department of Neurology, Johns Hopkins Medicine, Baltimore, Md (Dr Dorsey); Department of Medicine, University of Chicago Hospitals, Chicago, Ill (Ms Zhu, Dr Alexander, Ms Higashi and Ms Kornfield); Department of Health Care Policy, Harvard Medical School, Boston, Mass (Dr Dusetzina and Dr Huskamp); Center for Health and the Social Sciences, University of Chicago, Chicago, Ill (Dr Alexander and Dr Conti); Department of Pediatrics, University of Chicago Hospitals, Chicago, Ill (Dr Conti); Department of Pediatrics, Massachusetts General Hospital and Harvard Medical School, Boston, Mass (Dr Perrin); and Department of Pharmacy Practice, University of Illinois at Chicago School of Pharmacy, Chicago, Ill (Dr Alexander)
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Published:February 13, 2012DOI:https://doi.org/10.1016/j.acap.2012.01.003

      Abstract

      Objectives

      Because of several recent clinical and regulatory changes regarding attention deficit−hyperactivity disorder (ADHD) in the United States, we quantified changes in the diagnosis of ADHD and its pharmacologic treatment from 2000 through 2010.

      Methods

      We used the IMS Health National Disease and Therapeutic Index, a nationally representative audit of office-based providers, to examine aggregate trends among children and adolescents younger than 18 years of age. We also quantified how diagnosis and treatment patterns have evolved on the basis of patient and physician characteristics and the therapeutic classes used.

      Results

      From 2000 to 2010, the number of physician outpatient visits in which ADHD was diagnosed increased 66% from 6.2 million (95% confidence interval 5.5−6.9M) to 10.4 million visits (95% confidence interval 9.3−11.6 million). Of these visits, psychostimulants have remained the dominant treatment; they were used in 96% of treatment visits in 2000 and 87% of treatment visits in 2010. Atomoxetine use decreased from 15% of treatment visits upon product launch in 2003 to 6% of treatment visits by 2010. The use of potential substitute therapies—clonidine, guanfacine, and bupropion—remained relatively constant (between 5% and 9% of treatment visits) during most of the period examined. During this period, the management of ADHD shifted away from pediatricians and towards psychiatrists (from 24% to 36% of all visits) without large changes in illness severity or the proportion of ADHD treatment visits accounted for by males (73%–77%).

      Conclusions

      In 10 years, the ambulatory diagnosis of ADHD increased by two-thirds and is increasingly managed by psychiatrists. The effects of these changing treatment patterns on children’s health outcomes and their families are unknown.

      Keywords

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