Stimulant medication in pre‐school children in New South Wales

Aims:  The aims of this study were: (i) to examine the annual treatment rate of children under 4 years from 1997 to 2006; (ii) to compare their treatment rate and attrition with that of children starting treatment at the modal age; (iii) to describe the clinical characteristics of children aged less than 4 years and their response to stimulant medication for the treatment of attention‐deficit hyperactivity disorder. Methods:  Retrospective study of electronic prescription and authority records of the New South Wales Department of Health and a review of clinical reports. Results:  The annual treatment initiation rate for children under 4 years showed a progressive decline over the decade. In 2001, 13.6% of the children starting treatment were aged 7 years (modal age); those aged <4 years represented 1.1% of the total. There was no significant difference in attrition rate between these two groups. For those aged <4 years with clinical reports available ( n = 235), oppositional behaviour and developmental problems were reported frequently (78 and 43%, respectively). Non‐pharmacological interventions were implemented in 77% and non‐stimulant medications were prescribed in 50%. For 76% of children, an improvement in behaviour was reported after stimulant therapy. Conclusions:  Children treated with stimulant medication aged <4 years were a small subgroup with a high rate of co‐morbidity. The majority were perceived to have a favourable response to stimulant medication. However, there was a disturbingly high rate of prescribing of other psychotropic medications of known toxicity and unproven efficacy.