Prescribing of psychostimulant medications for attention deficit hyperactivity disorder in children: differences between clinical specialties

Objective: To examine differences in psychostimulant prescribing between paecliatricians and child/adolescent psychiatrists for treating children with attention deficit hyperactivity disorder (ADHD) in Western Australia.Design: Using whole-population prescribing data, logistic and linear regressions were used to model the number of children (aged 2-17 years) treated with psychostimulants between August 2003 and December 2004 for ADHD and medication dose prescribed by clinical specialty, controlling for age, sex, body weight, and other medication use.Main outcome measures: Mean number of patients treated by specialty; associations between prescriber specialty and patient characteristics; associations between stimulant dose and patient characteristics and prescriber specialty.Results: 54 paediatricians and 23 child/adolescent psychiatrists prescribed stimulant medications for children with ADHD. The mean number of patients treated (per prescriber) was 159.8 (range, 1-1977) for paediatricians and 34.3 (range, 1-166) for psychiatrists. Boys were 32% more likely to be treated with stimulants by paeciatricians (P= 0.002). Psychiatrists were 2.9 times (95% Cl, 2.4-3.3; P< 0.001) more likely than paediatricians to treat patients with multiple psychotropic medications. When controlled for all other factors, psychiatrists prescribed higher stimulant doses (4.5 mg/clay greater; 95% Cl, 2.0-7.0 mg/day; P< 0.001) than paediatricians.Conclusion: Treatment of children with stimulant medicines for ADHD differed between clinical specialtiets. Paeciatricians treated more patients per prescriber, a greater proportion of boys, and a younger age demographic, but relied less on combined psychotropic pharmacotherapy and prescribed lower stimulant doses than psychiatrists.