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Supplemental Information

SUPPLEMENTAL TABLE 4 Psychotropic Drug Categories and Medications Drug Category Individual Medications Antidepressants SSRIs Citalopram, escitalopram, fluoxetine, fluvoxamine, olanzapine and fluoxetine, paroxetine, sertraline Nontricyclic amine serotonin and Duloxetine, desvenlafaxine, levomilnacipran, norepinephrine reuptake inhibitors venlafaxine Tricyclic amine serotonin and norepinephrine Amitriptyline, amitriptyline and chlordiazepoxide, reuptake inhibitors amitriptyline and perphenazine, clomipramine, desipramine, doxepin, imipramine, nortriptyline, protriptyline Serotonin antagonist and reuptake inhibitors Nefazodone, trazodone Norepinephrine and dopamine reuptake Bupropion inhibitors Noradrenergic and specific serotonin Mirtazapine antidepressants SSRI and serotonin-1A receptor partial agonist Vilazodone Antipsychotics First-generation antipsychotics Chlorpromazine, fluphenazine, haloperidol, loxapine, perphenazine, prochlorperazine, thioridazine, thiothixene, trifluoperazine SGAs Aripiprazole, asenapine, brexpiprazole, clozapine, iloperidone, lurasidone, olanzapine, paliperidone, quetiapine, risperidone, ziprasidone Mood stabilizers Carbamazepine, lamotrigine, lithium, oxcarbazepine, valproate Anxiolytics Benzodiazepines Alprazolam, chlordiazepoxide, clonazepam, diazepam, lorazepam, oxazepam Nonbenzodiazepines Buspirone, hydroxyzine, pregabalin Hypnotics Benzodiazepines Estazolam, flurazepam, temazepam, triazolam Nonbenzodiazepines Eszopiclone, zaleplon, zolpidem

PEDIATRICS Volume 146, Number 1, July 2020 1 SUPPLEMENTAL TABLE 5 National Estimated Visit Rates of ADHD Monotherapy and ADHD or Psychotropic Polypharmacy Stratified by Age Age Group, y ADHD Visits (Unweighted Count), n ADHD Visits Made by Given Age Group, % (95% CI) ADHD Polypharmacy Psychotropic Polypharmacy 2–3 55 7.7 (2.7–20.0)a 36.5 (19.2–58.2)a 4–5 255 17.3 (11.6–24.9) 23.9 (13.6–38.7) 6–11 3274 18.6 (15.6–22.2) 20.5 (17.4–24.1) 12–18 2943 16.1 (13.3–19.4) 36.9 (32.8–41.1) 19–24 963 4.9 (2.6–9.1) 45.7 (40.5–50.9) a The percent was estimated from a sample size #30. The estimation may not be reliable.

SUPPLEMENTAL TABLE 6 National Estimated Rates of Psychotropic Polypharmacy by Age in Ambulatory Visits With an ADHD Medication Prescription Age Group, y ADHD Visits (Unweighted Count), n Ambulatory Visits With an ADHD Medication Prescription and Concurrent Psychotropic Prescription, % (95% CI) SSRI SGA 2–3 55 0.03 (0.004–0.25)a 17.8 (5.5–44.4)a 4–5 255 0.8 (0.3–2.4) 17.4 (8.3–33.1) 6–11 3274 7.6 (5.7–10.0) 9.2 (7.7–11.1) 12–18 2943 19.4 (15.9–23.5) 14.3 (11.6–17.4) 19–24 963 20.8 (16.9–25.2) 11.1 (8.8–13.8) Total 7490 14.4 (12.1–17.0) 11.8 (10.1–13.7) a The percent was estimated from a sample size #30. The estimation may not be reliable.

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SUPPLEMENTAL TABLE 7 Number of Sample Visits (Unweighted Count) Variable ADHD ADHD Psychotropic Monotherapy, n Polypharmacy, na Polypharmacy, na Sex Male 2868 930 1722 Female 1239 311 955 Age group, y 2–330619 4–5 166 52 50 6–11 1986 668 870 12–18 1469 469 1246 19–24 456 46 492 Payer type Private 1908 403 1082 Medicaid 1677 672 1189 Other 522 166 406 Geographic region Northeast 747 272 605 Midwest 1252 341 835 South 1509 468 799 West 599 160 438 Receipt of mental health counselingb No 3676 985 2067 Yes 431 256 610 Receipt of psychotherapyc No 3591 976 1911 Yes 516 265 766 Prescriber Pediatrician 1216 281 267 Psychiatrist 579 337 927 Others 2312 623 1483 a ADHD polypharmacy visits and psychotropic polypharmacy visits are not mutually exclusive. b Mental health counseling includes general advice and counseling about mental health issues and education about mental disorders. It includes referrals to other mental health professionals for mental health counseling but excludes psychotherapy; survey recording data differentiate between 0 (no services reported) and 1 (services reported). c Psychotherapy includes all treatment involving the intentional use of verbal techniques to explore or alter the patient’s emotional life to effect symptom reduction or behavior change; survey recording data differentiate between 0 (no services reported) and 1 (services reported).

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