More Than Symptoms at Play in Prescribing ADHD Meds to Kids

Megan Brooks

October 17, 2014

The likelihood that a child with attention-deficit/hyperactivity disorder (ADHD) will receive stimulant medication goes beyond their symptoms.

New research shows that low maternal education increases the likelihood that a child with ADHD will receive medication, whereas immigrant status decreases the odds.

"Identifying factors that predict medication use beyond ADHD symptoms is of utmost importance as this knowledge could be used by clinicians in their treatment decisions," Cedric Galera, MD, PhD, from University of Bordeaux Department of Child and Adolescent Psychiatry, in France, and colleagues write.

"Physicians should bear in mind the possible contribution of social characteristics on their practices," they add.

The study was published in the October issue of the British Journal of Psychiatry.

Social Variables

According to the investigators,"the impact of longitudinal psychiatric comorbidity, parenting and social characteristics on ADHD medication use is still poorly understood."

The investigators assessed the impact of behavioral and environmental factors on ADHD medication use in 1920 children in the Quebec Longitudinal Study of Child Development (QLSCD). They used measures of children's psychiatric symptoms, parenting practices, and social characteristics available at baseline and during follow-up to identify individual and family-level features associated with the use of ADHD medication.

They found that use of ADHD medication ranged from 0.2% to 8.6% in patients aged 3.5 to 10 years.

Among the numerous social variables Dr Galera and colleagues examined, two factors were significantly associated with ADHD medication use: low maternal education increased the likelihood of medication use two-fold (hazard ratio [HR], 2.09; 95% confidence interval [CI], 1.38 - 3.18), whereas immigrant status lowered the likelihood of medication use (HR, 0.40; 95% CI, 0.17 - 0.92).

The presence of hyperactivity-inattention was the strongest predictor of ADHD medication use (HR, 2.75; 95% CI, 2.35 - 3.22). Boys were more likely to receive medication than girls (HR, 2.14; 95% CI, 1.44 - 3.18).

Room for Improvement

Commenting on the findings for Medscape Medical News, Dean Elbe, PharmD, BCPP, clinical pharmacy specialist in child and adolescent mental health at BC Children's Hospital in Vancouver, Canada, who was not involved in the research, said the study shows that children with core ADHD symptoms of hyperactivity and inattention are getting treated.

It is "no surprise" that boys are more apt to be treated than girls. "It's theorized that maybe the quieter, inattentive, nonhyperactive ADHD may occur a bit more often in girls, so they kind of fly under the radar a bit," he added.

"There are lots of different reasons why lower education status could be a driver for medication," Dr Elbe said. "Parents may be not willing, able, or maybe they don't have the opportunity to do behavioral interventions, or they may not be offered by clinicians. Behavioral therapy should be applied with pharmacotherapy, not instead of," he said.

"As an industry, as a profession, we need to do better, I think, with maybe simpler behavioral interventions that can be applied by all different cultures, languages, backgrounds, more readily than maybe we are doing right now," Dr Elbe said.

As for the immigration finding, Dr Elbe cautioned that Quebec has a "very unique immigration environment in North America. They have a very large proportion of Europeans, and they preferentially admit French speakers, and particularly from France," he explained.

"In France, ADHD diagnostic rates are far lower than in the US, and they don't use the DSM, so you have to be super careful in generalizing this to virtually anywhere else, because the immigration population is so different than Quebec," said Dr Elbe.

"It's been said that the French view ADHD differently," Dr Elbe added. As an example, he cited a recent blog on the Psychology Today website "provocatively" entitled, "Why French Kids Don't Have ADHD."

Disclosures of the authors' relevant financial relationships can be found in the original article.

Br J Psychiatry. 2014;205:291-7. Abstract


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