Child characteristics and receipt of stimulant medications: a population-based study
Anton R Miller1, Dafna Kohen, Charlotte Johnston
1Department of Pediatrics, University of British Columbia, Vancouver, BC, Canada. amiller@cw.bc.ca
Insights
Factors beyond ADHD symptoms, like aggression and internalizing behaviors, predict methylphenidate (MPH) prescription in children. Male gender and prior MPH use also increased likelihood, while academic functioning decreased it.
Area of Science:
- Pediatric pharmacology
- Child psychology
- Public health
Background:
- Understanding factors influencing psychostimulant prescription in children is crucial.
- Methylphenidate (MPH), a common psychostimulant, is frequently prescribed for attention-deficit/hyperactivity disorder (ADHD).
Purpose of the Study:
- To identify child-specific factors predicting the prescription of methylphenidate (MPH) in a large population-based sample.
- To explore predictors beyond core ADHD symptoms.
Main Methods:
- Utilized data from the National Longitudinal Survey of Children and Youth (1994-1997).
- Employed logistic regression models to analyze child background, behavioral, and functional characteristics at Time 1 predicting MPH receipt at Time 2.
- Controlled for covariates including prior MPH use and ADHD symptoms.
Main Results:
- Parent and teacher-reported ADHD symptoms were strong predictors of MPH receipt.
- Aggressive behaviors (parent-reported) and internalizing symptoms (teacher-reported) also predicted MPH prescription.
- Male gender and prior MPH use significantly increased likelihood, while higher academic functioning decreased it.
- Prior MPH receipt was the strongest predictor of subsequent MPH prescription.
Conclusions:
- Child characteristics and behaviors beyond ADHD symptoms influence MPH prescription, potentially as indicators of impairment.
- Gender disparities in stimulant medication receipt among children with ADHD warrant further investigation.
- Clinical assessment should consider a broader range of child behaviors and functioning when evaluating for MPH treatment.
Objective:
Predictive factors associated with prescription of psychostimulant drugs to children remain poorly understood. We aimed to identify child-related factors that predict receipt of methylphenidate (MPH: Ritalin) by children in a large population-based study.
Methods:
With data from time 1 (1994-1995) and time 2 (1996-1997) of the National Longitudinal Survey of Children and Youth, we analyzed the role of child background, and behavioral and functional characteristics, all measured at time 1, in predicting receipt of MPH at time 2 in a series of logistic regression models.
Results:
Parent- and teacher-reported attention-deficit/hyperactivity disorder (ADHD) symptoms were consistent and significant predictors of receipt of MPH (odds ratios [ORs] ranging from 5.3-7.0, and from 3.2-4.1, respectively), particularly when concordant. Parent-reported aggressive behaviors (OR 1.91, 95% confidence interval [CI], 1.24-2.96) and teacher-reported internalizing symptoms (OR 3.01, 95% CI, 1.74-5.54) also predicted receipt of MPH, whereas higher levels of academic functioning predicted lower likelihood of receiving MPH (OR 0.54, 95% CI, 0.34-0.85), even after controlling for child background characteristics, ADHD symptoms, and prior receipt of MPH. Across models, male gender predicted a higher likelihood of receiving MPH (ORs ranging from 3.5-4.5) over and above ADHD and other behavioral symptoms. The strongest predictor of MPH receipt across models was prior receipt of MPH (ORs ranging from 83.7-128.3).
Conclusions:
Child characteristics and behavioral symptoms other than ADHD symptoms predict prescription and uptake of MPH, possibly attributable to their serving as clinically convenient indicators of impairment. Gender effects in receipt of stimulant medications among children with ADHD symptoms warrant further investigation.
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