Longitudinal mental health service and medication use for ADHD among Puerto Rican youth in two contexts.
OBJECTIVE
The study describes prevalence and rates of services and medication use and associated factors over time among Puerto Rican youths with attention-deficit/hyperactivity disorder (ADHD).


METHODS
Longitudinal data are obtained on Puerto Rican children ages 5 through 13 years in the south Bronx in New York (n = 1,138) and two metropolitan areas in Puerto Rico (n = 1,353). The Diagnostic Interview Schedule for Children-IV is the diagnostic tool. Five composite measures of risk factors: negative family influences, ineffective structuring, environmental risks, child risks, and maternal acceptance are constructed to relate services and medication use to risk variables.


RESULTS
ADHD prevalence is similar in Puerto Rico and the south Bronx. Overall mental health services, medication, and psychostimulant use is lower in Puerto Rico across three time points. Most participants never received treatment at any time point. More environmental risks, negative child traits, and low maternal warmth are associated with more services, even after adjusting for comorbidity. When risk variables are controlled, the effects of ADHD on services use decrease. Previous treatment is a strong predictor of subsequent treatment.


CONCLUSIONS
Rates of services and medication use are lower in Puerto Rico. Context seems to be more important than ethnicity in predicting mental health services and medication use among Puerto Rican children with ADHD. Other psychiatric diagnoses and general risk variables are important correlates of services and medication use.
Bird
Hector R
HR
Department of Psychiatry, Columbia University, USA. hecbird@aol.com
Shrout
Patrick E
PE
Duarte
Cristiane S
CS
Shen
Sa
S
Bauermeister
José J
JJ
Canino
Glorisa
G
D000293:Adolescent; D001289:Attention Deficit Disorder with Hyperactivity / Q000188:drug therapy* / Q000453:epidemiology*; D002391:Catchment Area, Health; D002648:Child; D002675:Child, Preschool; D004358:Drug Therapy / Q000706:statistics & numerical data*; D005260:Female; D006801:Humans; D008297:Male; D008605:Mental Health Services / Q000706:statistics & numerical data*; D009519:New York City / Q000453:epidemiology; D011647:Puerto Rico / Q000208:ethnology; D011795:Surveys and Questionnaires; D013997:Time Factors