Attention deficit hyperactivity disorder in elementary school children in Rhode Island: associated psychosocial factors and medications used

This study was undertaken to explore psychosocial factors associated with referral for attention deficit hyperactivity disorder (ADHD) evaluation or ADHD diagnosis among elementary school children in Rhode Island, as well as to examine the extent of drug therapy among this population. A survey was distributed to parents/guardians of 2,800 3rd- to 5th-grade public school students in 4 Rhode Island school districts. The average age of the children was 9.0 +/- 1.0 years with 52% girls. Approximately 12% of the students had been referred for ADHD evaluation (RFE). Of these, 52% (6% of all children in the survey) were receiving psychoactive prescription medications daily. While the male:female ratio in the non-RFE group was almost 1:1, there were more boys than girls in the RFE group (male/female ratio of 3:1, p < 0.0001) and in the medicated group (male/female ratio 4:1, p < 0.0001). RFE children and medicated children were older than classroom peers (p < 0.0001), and had a greater degree of school misconduct (p < 0.0001). RFE children and medicated children were significantly less likely to have parents who completed college (p < 0.05), were significantly more likely to have stepparents (p < 0.05), and to be only children (p < 0.05) when compared with their peers. Amphetamine was the most commonly prescribed drug (used by 54% of the medicated children) followed by methylphenidate (43%). Nearly 18% of the medicated children were receiving 1 to 3 additional psychoactive prescription medications on a daily basis. In conclusion, RFE children and children medicated for ADHD were more likely to have a stepparent, have no siblings, and have parents that had not completed college. Amphetamine rather than methylphenidate accounted for the majority of medications used in this study, and simultaneous use of multiple psychoactive medications was reported in 18% of the medicated children.