Med use widens in kids with ADHD

Children who have attention-deficit hyperactivity disorder often take stimulant medication for their condition. That’s not the full extent of their prescription drug use, though, at least in a substantial minority of cases.

Kids with the condition, ADHD, receive more diagnoses of other behavioral disorders and more prescriptions for nonstimulant psychoactive drugs than their peers without ADHD do, according to an analysis of medical records from a large health maintenance organization in Washington State. Included among the kids’ diagnoses are depression, chronic misbehavior, intense hostility, and bodily tics.

Nonstimulant drugs, usually administered to children with ADHD in addition to Ritalin or other stimulants, consist mainly of antidepressants and blood-pressure medications called alpha agonists, which also diminish aggressive behavior. Little is known about these drugs’ effectiveness and safety, either when prescribed alone or in combination with stimulants, in children who have ADHD, say pediatrician James Guevara of Children’s Hospital of Philadelphia and his coworkers.

During 1997, about 5 percent of the more than 57,000 youngsters ages 3 to 17 in the Washington health plan were identified as having ADHD. A majority of those with ADHD were 11- and 12-year-old boys.

Around three-quarters of those identified as having ADHD received prescriptions for stimulants that are commonly used to treat symptoms of inattention, impulsiveness, and hyperactivity. Furthermore, 18 percent of these children were prescribed a nonstimulant medication, compared with 1.5 percent of kids without ADHD.

Kids taking nonstimulant drugs fell into two groups. The larger group, with 382 kids, took a combination of stimulants and another drug. For reasons that remain unclear, the remaining group received only nonstimulants, Guevara’s group reports in the May Pediatrics.

The presence of depression and anxiety disorders in children with ADHD usually accompanied the prescription of antidepressants. Diagnoses involving chronic misbehavior, intense hostility, and tic disorders frequently occurred among children taking alpha agonists.

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