Clinical and social factors associated with attention-deficit hyperactivity disorder medication use: population-based
Cédric Galéra1, Jean-Baptiste Pingault1, Grégory Michel1
1Cédric Galéra, MD, PhD, University of Bordeaux, Department of Child and Adolescent Psychiatry, Charles Perrens Hospital and INSERM, The Bordeaux School of Public Health (Institut de Santé Publique, d'Epidémiologie et de Développement), Centre INSERM U897, Epidemiology-Biostatistics, Bordeaux, France; Jean-Baptiste Pingault, PhD, Research Unit on Children's Psychosocial Maladjustment, University of Montreal and Sainte-Justine Hospital, Montreal, Canada and INSERM U669, Paris, France; Grégory Michel, PhD, University of Bordeaux, Psychology and Quality of Life, Bordeaux, France; Manuel-Pierre Bouvard, MD, University of Bordeaux, Department of Child and Adolescent Psychiatry, Charles Perrens Hospital, Bordeaux, France; Maria Melchior, ScD, INSERM U1018, Centre for Research in Epidemiology and Population Health, Epidemiology of Occupational and Social Determinants of Health, Villejuif, France; Bruno Falissard, MD, PhD, INSERM U669, Paris, France; Michel Boivin, PhD, International Laboratory for Child and Adolescent Mental Health, Department of Psychology, Laval University, Quebec City, Canada and Institute of Genetic, Neurobiological and Social Foundations of Child Development, Tomsk State University, Russian Federation; Richard E. Tremblay, PhD, Research Unit on Children's Psychosocial Maladjustment, University of Montreal and Sainte-Justine Hospital, Montreal, International Laboratory for Child and Adolescent Mental Health, University of Montreal, Montreal, Departments of Pediatrics, Psychiatry, and Psychology, University of Montreal, Montreal, Canada and School of Public Health, Physiotherapy, and Population Sciences, University College Dublin, Ireland and Institute of Genetic, Neurobiological and Social Foundations of Child Development, Tomsk State University, Russian Federation; Sylvana M. Côté, PhD, Research Unit on Children's Psychosocial Maladjustment, University of Montreal and Sainte-Justine Hospital, Montreal and International Laboratory for Child and
Background:
The impact of longitudinal psychiatric comorbidity, parenting and social characteristics on attention-deficit hyperactivity disorder (ADHD) medication use is still poorly understood.
Aims:
To assess the baseline and longitudinal influences of behavioural and environmental factors on ADHD medication use.
Method:
Survival regressions with time-dependent covariates were used to model data from a population-based longitudinal birth cohort. The sample (n = 1920) was assessed from age 5 months to 10 years. Measures of children's psychiatric symptoms, parenting practices and social characteristics available at baseline and during follow-up were used to identify individual and family-level features associated with subsequent use of ADHD medication.
Results:
Use of ADHD medication ranged from 0.2 to 8.6% between ages 3.5 to 10 years. Hyperactivity-inattention was the strongest predictor of medication use (hazard ratio (HR) = 2.75, 95% CI 2.35-3.22). Among all social variables examined, low maternal education increased the likelihood of medication use (HR = 2.09, 95% CI 1.38-3.18) whereas immigrant status lowered this likelihood (HR = 0.40, 95% CI 0.17-0.92).
Conclusions:
Beyond ADHD symptoms, the likelihood of receiving ADHD medication is predicted by social variables and not by psychiatric comorbidity or by parenting. This emphasises the need to improve global interventions by offering the same therapeutic opportunities (including medication) as those received by the rest of the population to some subgroups (i.e. immigrants) and by diminishing possible unnecessary prescriptions.
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