Co-morbidity and patterns of care in stimulant-treated children with ADHD in the Netherlands

Adrianne Faber (1) , Luuk J. Kalverdijk (2) , Lolkje T. W. Jong-van den Berg (3) , Jacqueline G. Hugtenburg (4) , Ruud B. Minderaa (2) , Hilde Tobi (5)

1 SIR Institute for Pharmacy Practice and Policy
2 University Centre for Child and Adolescent Psychiatry
3 Department of Social Pharmacy, Pharmacoepidemiology and Pharmacotherapy
4 Department of Clinical Pharmacology and Pharmacy
5 Social Sciences, Research Methodology Group

This study aimed at investigating the use of psychosocial interventions and psychotropic co-medication among stimulant-treated children with attention-deficit hyperactivity disorder (ADHD) in relation to the presence of psychiatric co-morbidity. Stimulant users younger than 16 years were identified in 115 pharmacies and a questionnaire was sent to their stimulant prescribing physician. Of 773 questionnaires sent out, 556 were returned and were suitable for analysis (72%). The results are based on 510 questionnaires concerning stimulant-treated children for whom a diagnosis of ADHD was reported. Of the 510 children diagnosed with ADHD, 31% had also received one or more other psychiatric diagnoses, mainly pervasive developmental disorder or oppositional defiant disorder/conduct disorder. We found an association between the presence of co-morbidity and the use of psychosocial interventions for the child ( < 0.001) and the parents ( < 0.001). In the ADHD-only group, 26% did not receive any form of additional interventions, while psychosocial interventions varied from 8 to 18% in children with ADHD and psychiatric co-morbidity. The presence of diagnostic co-morbidity was also associated with the use of psychotropic co-medication (overall,  = 0.012) and antipsychotics ( < 0.001). Stimulant-treated youths with ADHD and psychiatric co-morbidity received more psychosocial interventions and psychotropic co-medication than children with ADHD-only. The type of psychosocial interventions and psychotropic co-medication received by the children and their parents, depended on the specific co-morbid psychiatric disorder being present.

Mots clés: Stimulants; Co-morbidity; Attention deficit hyperactivity disorder; Co-medication; Multimodal treatment

Adrianne Faber, Luuk J. Kalverdijk, Lolkje T. W. Jong-van den Berg, Jacqueline G. Hugtenburg, Ruud B. Minderaa, et al.. Co-morbidity and patterns of care in stimulant-treated children with ADHD in the Netherlands. European Child and Adolescent Psychiatry, 2009, 19 (2), pp.159-166. ⟨10.1007/s00787-009-0075-y⟩. ⟨hal-00612998⟩