ADHD Diagnosis and Timing of Medication Initiation Among Children Aged 3 to 5 Years

This study found that a substantial proportion of preschoolers diagnosed with ADHD started medication within 30 days, often before behavioral therapy was attempted. Racial and insurance disparities were evident, with White children and those with public insurance more likely to receive early medication. Follow-up rates after medication initiation appeared low, but likely underestimated due to limitations in data capture.

Dr. Brink reported receiving grants from Nationwide Children's Hospital during the study. Dr. Harris reported receiving research support from lonis Pharmaceuticals, Grace Science Foundation, and Lou Foundation; personal fees for consulting from Shionogi, Inc, and Key Quest Health; and honoraria from UpToDate outside the submitted work. Dr. Wallis reported being a paid consultant to Healthy Steps and Thomas Jefferson University and serving as an expert witness for Kline Spector, LLC.

This is a multi-site retrospective study using a large sample size providing valuable insights into real-world ADHD management in preschoolers. However, its reliance on diagnostic codes, potential underestimation of follow-up rates, and lack of information on PCP recommendations for behavioral treatment limit the strength of the conclusions. The disclosed conflicts of interest also warrant consideration.