Child characteristics and receipt of stimulant medications: a population-based study.
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.
Miller
Anton R
AR
Department of Pediatrics, University of British Columbia, Vancouver, BC, Canada. amiller@cw.bc.ca
Kohen
Dafna
D
Johnston
Charlotte
C
D001289:Attention Deficit Disorder with Hyperactivity / Q000188:drug therapy / Q000523:psychology*; D000697:Central Nervous System Stimulants / Q000627:therapeutic use*; D002648:Child; D002652:Child Behavior; D005260:Female; D006306:Health Surveys; D006801:Humans; D016015:Logistic Models; D008137:Longitudinal Studies; D008297:Male; D008774:Methylphenidate / Q000627:therapeutic use*; D011237:Predictive Value of Tests; D012919:Social Behavior
D000697:Central Nervous System Stimulants; D008774:Methylphenidate