Primary Care Diagnosis and Treatment of Attention-Deficit/Hyperactivity Disorder in School-aged Children: Trends and Disparities During the COVID-19 Pandemic

Importance Little is known about changes in health care in the first year of the pandemic for the large population of school-aged children with attention-deficit/hyperactivity disorder (ADHD), who were especially impacted by lockdowns, school closures, and remote learning. Objective To assess temporal trends in rates of primary care provider (PCP) diagnosis and treatment of school-aged children with ADHD in the first year of the COVID-19 pandemic as compared to pre-pandemic years, and to investigate disparities in care. Method We retrospectively analyzed electronic health records from all primary care visits (in-person and telehealth) of children ages 6-17 years seen between 01/2016 and 03/2021 in a community-based primary healthcare network in California (n=77,298 patients). Study Outcomes: (1) # of primary care visits, (2) # of visits with ADHD diagnosis (ADHD-related visits), (3) # of first ADHD diagnoses, (4) # of PCP prescriptions for ADHD medications (stimulants, alpha-2 agonists, atomoxetine), (5) # of first PCP prescriptions of ADHD medications. Interrupted time-series analysis evaluated changes in rates of study outcomes during 4 quarters of the pandemic year (3/15/2020-3/15/2021) compared to pre-pandemic years. Patient demographic characteristics were compared pre-pandemic to pandemic year. Results In the first quarter (Q1) of the pandemic year, all primary care visits dropped by 62% (CI 54.9-67.2%); ADHD-related visits dropped by 33% (95% CI 22.2-43.6%). In Q2-4, while all primary care visits remained significantly below pre-pandemic rates, ADHD-related visits returned to pre-pandemic rates. Conversely, rates of first ADHD diagnoses remained at half of pre-pandemic rates throughout the year (Q1-4). ADHD medication prescription rates remained stable throughout the pandemic year. The proportion of patients living in low-income neighborhoods who received ADHD-related care (ADHD-related visits and first ADHD diagnoses) were lower during the pandemic year compared to pre-pandemic years. Females comprised a higher proportion of first ADHD diagnoses compared to pre-pandemic years (34% vs. 28%, absolute standardized difference=0.13, p=0.03). Conclusion Ongoing treatment for school-aged children with ADHD was maintained during the pandemic, especially in children from high-income families. Socioeconomic differences in ADHD-related care emphasize the need to improve access to care for all children with ADHD in the ongoing pandemic and beyond.