ADHD treatment in primary care: demographic factors, medication trends, and treatment predictors

Background — To determine the prevalence and characteristics of youth with ADHD in Ontario, Canada. To determine the predictors of psychotropic medication prescriptions in youth with ADHD.

Method — This is a cross-sectional retrospective chart abstraction of more than 250 000 medical records from youth aged 1 to 24 in a large geographical region in Ontario, Canada linked to population-based health administrative data. 10 000 charts were randomly selected and manually reviewed using pre-determined criteria for ADHD and comorbidities. Prevalence, comorbidities, demographic indicators and health service utilization characteristics were calculated. Predictors of treatment characteristics were determined using logistic regression modelling.

Results — The prevalence of ADHD was 5.4% (7.9% males, 2.7% females). Youth with ADHD had significant psychiatric comorbidities. The majority (70.0%) of ADHD patients received prescriptions for stimulant or non-stimulant ADHD medication. Antipsychotic prescriptions were provided to 11.9% of ADHD patients, versus 0.9% of patients without ADHD. Antidepressant prescriptions were provided to 19.8% versus 5.4% of patients with and without ADHD, respectively. Predictors of antidepressant prescriptions were increasing age (OR 1.14 95% CI 1.07, 1.21), psychiatric consultation (OR 2.04 95% CI 1.16, 3.58) and diagnoses of both anxiety and depression (OR 18.4 95% CI 8.03, 42.1), whereas the only predictor of antipsychotic prescriptions was psychiatric consultation (OR=3.85, 95% CI 2.11, 7.02).

Conclusions — Youth with ADHD have more psychiatric comorbidities than youth without ADHD. The majority of youth with ADHD received stimulant medications, and a significant number received additional psychotropic medications, with psychiatric consultation predicting medication use.