Impact of Social Determinants of Health and Professional Guidelines for Pharmacotherapy and Psychotherapy Recommendations for the Treatment of Young Children: A Retrospective Study.

Objective: To examine pharmacotherapy and psychotherapy treatment recommendations among different races and socioeconomic groups of young children. A secondary objective evaluated whether changes in the 2007 American Academy of Child and Adolescent Psychiatry (AACAP) guidelines for attention-deficit/hyperactivity disorder (ADHD) treatment affected community prescribing practices. Hypotheses were that non-White children would be less likely to have psychotherapeutic treatments recommended for mental health issues and children with lower socioeconomic status index scores would be less likely to receive a psychotropic medication prescription. Method: The sample included 1,764 children ages 7 years or younger prescribed at least 1 psychotropic medication for psychiatric indications between 2003 and 2019 identified through the Rochester Epidemiology Project. Data were examined with χ Results: The sample included 29% female, 1.6% Asian, 6.9% Black, 5.3% Hispanic, 7.7% other race/ethnicity, and 79% White participants. The most common psychiatric diagnosis was attention-deficit/hyperactivity disorder (91.6%). The majority of first prescriptions of psychotropic medications were written by primary care physicians or pediatricians (69%) rather than psychiatrists. Recommendations were not affected by patient socioeconomic status, race/ethnicity, or insurance (all Conclusion: Children's socioeconomic status, race/ethnicity, and insurance did not affect treatment recommendations of clinicians. However, children whose first prescription of psychotropic medication was from a primary care physician or pediatrician were less likely to have a recommendation for psychotherapy compared with children who were seen by psychiatrists. Diversity & Inclusion Statement: One or more of the authors of this paper self-identifies as a member of one or more historically underrepresented racial and/or ethnic groups in science. One or more of the authors of this paper self-identifies as a member of one or more historically underrepresented sexual and/or gender groups in science. We actively worked to promote sex and gender balance in our author group.