Stimulant dosage and age, race, and insurance type in a sample of children with attention-deficit/hyperactivity disorder.
OBJECTIVE
The aim of this study was to examine the association of age, race, insurance, and other factors with the prescription of stimulant medications.


METHODS
A retrospective chart review was conducted on 242 subjects, 4.8-19.8 years of age, treated in an urban referral center with a stable dose of stimulant medication for at least 6 months. Subjects were predominantly male (74.8%), African-American (52.9%), and insured by Medicaid (71.0%). The effects of age, race, insurance, gender, cognitive level, additional psychopharmacologic medications, and other factors on prescribed total daily dose (mg/day) and dose by weight (mg/kg/dose) were examined.


RESULTS
Race and insurance type together were associated with specific patterns of stimulant dosage, with higher dosing seen in Medicaid-insured non-African-American children and in privately insured African-American children. Total daily dose increased with age; however, there was an inverse relationship between age and dose by weight. There were no significant associations of gender, cognitive level, use of additional psychopharmacological medications, or other factors with total daily dose or dose by weight.


CONCLUSIONS
The sociocultural factors of race and insurance type were related to dosing of stimulant medications in children. Total daily doses increased with age, while younger children were treated with higher weight-based doses. Attention to these factors should be given in the titration of stimulant medications in the treatment of ADHD. Other factors, including gender, had no specific association.
Lipkin
Paul H
PH
Department of Neurology and Developmental Medicine, Kennedy Krieger Institute, Baltimore, Maryland 21205, USA. lipkin@kennedykriger.org
Cozen
Meira A
MA
Thompson
Richard E
RE
Mostofsky
Stewart H
SH
D000293:Adolescent; D000328:Adult; D001741:Black or African American / Q000706:statistics & numerical data*; D000367:Age Factors; D001289:Attention Deficit Disorder with Hyperactivity / Q000188:drug therapy* / Q000191:economics / Q000453:epidemiology*; D000697:Central Nervous System Stimulants / Q000008:administration & dosage*; D002648:Child; D002675:Child, Preschool; D005260:Female; D006801:Humans; D007348:Insurance, Health / Q000191:economics / Q000706:statistics & numerical data*; D008297:Male; D012189:Retrospective Studies; D012959:Socioeconomic Factors; D044465:White People / Q000706:statistics & numerical data*
D000697:Central Nervous System Stimulants