{"doi":"10.1101/2025.05.28.25328526","title":"Timing of Medication Treatment in Children 3-5-Years-old with ADHD: A PEDSnet Study","abstract":"Importance: Early identification and treatment of Attention-Deficit/Hyperactivity Disorder (ADHD) symptoms in preschool-age children is important for mitigating social-emotional and academic problems. Clinical practice guidelines recommend first-line behavior intervention before considering medication treatment for children 4-5-years-old. Objective: To assess variation in rates of ADHD identification and rates and timing of medication treatment in children 3-5-years-old in primary care settings across eight US pediatric health systems and to identify patient factors associated with the time from diagnosis to prescription. Design: Retrospective cohort study of electronic health records. Setting: Primary care clinics affiliated with eight academic institutions participating in the PEDSnet Clinical Research Network. Participants: Children 3-5-years-old seen in primary care between 2016-2023. Exposure: ADHD diagnosis at age 4-5 years. Main Outcomes and Measures: Outcomes: (1) rate of ADHD diagnosis; (2) rate of stimulant and non-stimulant prescription after diagnosis before age 7, (3) time from first ADHD-related diagnosis (including symptom-level diagnoses) to medication prescription. Independent variables: institution, year of diagnosis, patient age, sex, race/ethnicity, medical insurance, and presence of comorbidities. Results: Of 712,478 children seen in primary care at ages 3-5 years, 9,708 (1.4%) received an ADHD diagnosis at age 4-5 years (range 0.5-3.1% across institutions). Of those with ADHD, 76.4% (n=7414) were male, 39.0% (n=3782) were White. Of 9,708 preschool-age children with ADHD, 68.2% (6624) were prescribed ADHD medications before age 7, 42.2% (n=4092) were prescribed medications within 30 days of the first documentation of an ADHD-related diagnosis (range 26.0-49.0% across institution). Asian (aHR 0.50, CI 0.38-0.65), Hispanic (aHR 0.75, CI 0.70-0.81), and Black (aHR 0.90, CI 0.85-0.96) children with ADHD were less likely to be prescribed medication early compared to White children. Older (aHR 1.64, CI 1.57-1.72), male (aHR 1.74, CI 1.11-1.24) and publicly insured (aHR 1.10, CI 1.04-1.17) patients were more likely to be prescribed medication early compared to younger, female and privately insured patients, respectively. Conclusion and Relevance: Many preschool-age children with ADHD seen in primary care in 8 large pediatric health systems were prescribed medications at or shortly after the first documented diagnosis. Future analysis of clinical documentation is needed to understand the reasoning behind early prescription patterns.","journal":"medRxiv","year":2025,"id":567053,"datarank":0.0,"base_score":0.0,"endowment":0.0,"self_citation_contribution":0.0,"citation_network_contribution":0.0,"self_endowment_contribution":0.0,"citer_contribution":0.0,"corpus_percentile":null,"corpus_rank":null,"citation_count":0,"citer_count":0,"citers_with_citation_signal":0,"citers_with_endowment":0,"datacite_reuse_total":0,"is_dataset":false,"is_dataset_confidence":0.9568,"is_data_producer":false,"deposit_databanks":null,"is_oa":true,"file_count":0,"downloads":0,"has_version_chain":false,"published_date":"2025-01-01","fair_score":null,"fair_percentile":null,"algorithm_id":"datarank_citation_only_1hop_v6","ranking_scope":"data_only","authors":[{"id":1230446,"name":"Ingrid Luo","orcid":"0009-0005-6649-962X","position":1,"is_corresponding":false},{"id":785240,"name":"Rodrigo Azuero-Dajud","orcid":null,"position":2,"is_corresponding":false},{"id":393483,"name":"Heidi M. Feldman","orcid":"0000-0002-4435-0913","position":3,"is_corresponding":false},{"id":1140690,"name":"Farah W. Brink","orcid":"0000-0002-9954-4889","position":4,"is_corresponding":false},{"id":525115,"name":"Tanya E. Froehlich","orcid":"0000-0002-4471-289X","position":5,"is_corresponding":false},{"id":558877,"name":"Holly K. Harris","orcid":"0000-0001-5512-755X","position":6,"is_corresponding":false},{"id":741941,"name":"Kristin Kan","orcid":"0000-0002-5739-3306","position":7,"is_corresponding":false},{"id":1093247,"name":"Kate E. Wallis","orcid":"0000-0002-2842-9197","position":8,"is_corresponding":false},{"id":1397810,"name":"Kaitlin Whelan","orcid":"0000-0001-6902-9651","position":9,"is_corresponding":false},{"id":1398360,"name":"Lisa Spector","orcid":null,"position":10,"is_corresponding":false},{"id":892037,"name":"Christopher R. Forrest","orcid":"0000-0002-2934-9690","position":11,"is_corresponding":false},{"id":1230445,"name":"Yair Bannett","orcid":"0000-0001-5134-3300","position":0,"is_corresponding":true}],"reference_count":37,"raw_metadata":null,"created_at":"2026-07-19T02:56:40.491968Z","pmid":"40492095","pmcid":null,"fwci":null,"citation_percentile":null,"influential_citations":0,"oa_status":null,"license":null,"views":0,"total_file_size_bytes":0,"version_count":0,"fair_f":null,"fair_a":null,"fair_i":null,"fair_r":null,"fair_zscore":null,"fair_rationale":null,"fair_model":null,"fair_agent_version":null,"fair_fulltext_source":null,"fair_has_llm":null,"fair_computed_at":null,"clinical_trials":[],"software_tools":[],"db_accessions":[],"linked_datasets":[],"topics":[]}