Concurrent stimulant and atypical antipsychotic use among medicaid children and adolescents with attention deficit/hyperactivity disorder

The study examined the prevalence and factors associated with concurrent use of long acting stimulants (LAS) and atypical antipsychotic agents among children and adolescents who initiated LAS medications for Attention Deficit/Hyperactivity Disorder (ADHD). The study involved retrospective longitudinal analysis of 2003-2007 Medicaid Analytical eXtract (MAX) data of four US states. The study focused on children and adolescents aged 6 to 17 years, diagnosed with ADHD, and who initiated LAS from July 2003 to December 2006. Concurrent use was defined as receipt of both medications together at least for 14 days. The study cohort was followed uniformly for one year after the initiation of LAS medications to examine the concurrent use. Descriptive analysis was conducted to examine the utilization pattern. Multiple logistic regression analysis within the conceptual framework of Andersen behavioral model was conducted to examine determinants of concurrent use with LAS use only as a reference group. Among the 61,793 children and adolescents who initiated ADHD treatment with LAS, 11, 866 (19.20%) received LAS and atypical antipsychotics concurrently. Risperidone was frequently used concurrently with LAS in children. The multiple logistic regression revealed that children and adolescents with male gender, black race, and foster care benefits were more likely to receive LAS and atypical antipsychotics concurrently than their counterparts. Moreover, FDA approved indications such as schizophrenia, bipolar disorder, and psychosis and non-approved indications such as oppositional defiant disorder, pervasive developmental disorder, tic disorder, and personality disorder determined the concurrent use. Almost 1 in 5 children and adolescent received LAS and atypical antipsychotics concurrently. In addition to FDA approved indications, non-approved indications determined the concurrent use. There is urgent need to evaluate the safety and efficacy of concurrent use of LAS and atypical antipsychotics in children and adolescents for various indications.