Two studies this month examine treatment for attention-deficit hyperactivity disorder (ADHD). Several new options for treating ADHD with medications have been used in the past 15 years, including intermediate- and long-acting stimulants and second-generation antipsychotics. Little is known, however, about how new approaches have changed treatment patterns and spending for children with ADHD. In the lead article, Catherine A. Fullerton, M.D., M.P.H., and colleagues present results of their analysis of ten years of data (1996–2005) for children age three to 17 in Florida's Medicaid program who had a diagnosis of ADHD (N=107,486). The authors found that the proportion treated with ADHD drugs increased only slightly over the period—from 60% to 63%—and that the percentage taking antipsychotics more than doubled—from 8% to 18%. Mental health expenditures for children with ADHD increased 61%, with pharmaceutical spending the fastest-rising component (up 192%). Spending on stimulants increased 157%, and by 2005 long-acting stimulants accounted for 90% of stimulant spending. Antipsychotic spending increased nearly 600%, despite the absence of good data on the efficacy and safety of using second-generation antipsychotics in this population (page 115). To better understand how the care of children with ADHD is initiated and evolves over time, Bradley D. Stein, M.D., Ph.D., and colleagues looked at data for 2,077 Medicaid-enrolled children age six to 12 who started ADHD treatment between October 2006 and December 2007. Forty-five percent began with a psychosocial intervention alone, 41% with medication alone, and 14% with a combination. By the end of the treatment episode, 42% of the first group had added medication. By six months, 40% of all the children had discontinued treatment. As noted by the authors, the frequent changes and high dropout suggest dissatisfaction with initial treatment for ADHD and the need for a closer look at factors underlying these patterns (page 122).