title: Differences in ADHD medication usage patterns in children and adolescents from different cultural backgrounds in the Netherlands.
abstract: OBJECTIVE
  Differences in incidence and prevalence of ADHD medication use between ethnic groups have been reported. Goal of this study was to determine whether there are also differences in usage patterns of ADHD medication among native Dutch children and adolescents and those with a Moroccan, Turkish and Surinam cultural background in the Netherlands between 1999 and 2010.
  
  
  METHODS
  In a cohort of ADHD patients <19 years (N = 817) incident use and discontinuation of ADHD medication were measured for ethnicity and adjusted for age, gender and socio-economic status.
  
  
  RESULTS
  A significant higher proportion of ADHD-diagnosed patients from Moroccan (32 %) and Turkish (42 %) cultural background never used ADHD medication compared to Dutch natives (21 %). One-fifth of native Dutch and Turkish patients already used ADHD medication before the ADHD diagnosis date. Discontinuation of ADHD medication within 5 years was significantly higher in Moroccan [HR 2.4 (95 % CI 1.8-3.1)] and Turkish [HR 1.7 (95 % CI 1.1-2.6)] patients. A sensitivity analysis with a zip code-matched comparison between Dutch natives and non-natives showed similar results, suggesting this effect is probably not explained by socio-economic status (SES).
  
  
  CONCLUSIONS
  Differences are found in prescribing and use of ADHD medication between patients with a different cultural background. Native Dutch and Turkish patients start more frequently with ADHD medication before the ADHD diagnose date, which can be an indication of differences in either referral patterns and/or access to care. A higher percentage of patients with a Moroccan and Turkish cultural background never start using ADHD medication at all and discontinuation rate is higher compared to Dutch natives and Surinamese.
authors.affiliation: Youth Division Altrecht, Institute for Mental Health, Nieuwe Houtenseweg 2, 3524 SH, Utrecht, The Netherlands, e.van.den.ban@altrecht.nl.
authors.forename: Els F
authors.initials: EF
authors.lastname: van den Ban
authors.forename: Patrick C
authors.initials: PC
authors.lastname: Souverein
authors.forename: Herman
authors.initials: H
authors.lastname: van Engeland
authors.forename: Hanna
authors.initials: H
authors.lastname: Swaab
authors.forename: Toine C G
authors.initials: TC
authors.lastname: Egberts
authors.forename: Eibert R
authors.initials: ER
authors.lastname: Heerdink
mesh_terms: D000293:Adolescent; D001289:Attention Deficit Disorder with Hyperactivity / Q000188:drug therapy* / Q000208:ethnology; D000697:Central Nervous System Stimulants / Q000627:therapeutic use*; D002648:Child; D003469:Culture; D005006:Ethnicity; D005260:Female; D006801:Humans; D008297:Male; D009018:Morocco / Q000208:ethnology; D009426:Netherlands; D012923:Social Class; D013532:Suriname / Q000208:ethnology; D014421:Turkey / Q000208:ethnology; D028761:Withholding Treatment / Q000706:statistics & numerical data
chemical_list: D000697:Central Nervous System Stimulants