title: Clinical and social factors associated with attention-deficit hyperactivity disorder medication use: population-based longitudinal study.
abstract: BACKGROUND
  The impact of longitudinal psychiatric comorbidity, parenting and social characteristics on attention-deficit hyperactivity disorder (ADHD) medication use is still poorly understood.
  
  
  OBJECTIVE
  To assess the baseline and longitudinal influences of behavioural and environmental factors on ADHD medication use.
  
  
  METHODS
  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.
authors.affiliation: Cédric 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 
authors.forename: Cédric
authors.initials: C
authors.lastname: Galéra
authors.affiliation: Cédric 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 
authors.forename: Jean-Baptiste
authors.initials: JB
authors.lastname: Pingault
authors.affiliation: Cédric 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 
authors.forename: Grégory
authors.initials: G
authors.lastname: Michel
authors.affiliation: Cédric 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 
authors.forename: Manuel-Pierre
authors.initials: MP
authors.lastname: Bouvard
authors.affiliation: Cédric 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 
authors.forename: Maria
authors.initials: M
authors.lastname: Melchior
authors.affiliation: Cédric 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 
authors.forename: Bruno
authors.initials: B
authors.lastname: Falissard
authors.affiliation: Cédric 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 
authors.forename: Michel
authors.initials: M
authors.lastname: Boivin
authors.affiliation: Cédric 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 
authors.forename: Richard E
authors.initials: RE
authors.lastname: Tremblay
authors.affiliation: Cédric 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 
authors.forename: Sylvana M
authors.initials: SM
authors.lastname: Côté
mesh_terms: D001289:Attention Deficit Disorder with Hyperactivity / Q000188:drug therapy*; D002648:Child; D002675:Child, Preschool; D005260:Female; D006801:Humans; D007223:Infant; D008137:Longitudinal Studies; D008297:Male; D016487:Parenting; D010349:Patient Compliance / Q000706:statistics & numerical data*; D012307:Risk Factors; D012919:Social Behavior; D012931:Social Environment; D011795:Surveys and Questionnaires