title: Use of prescription stimulant for Attention Deficit Hyperactivity Disorder in Aboriginal children and adolescents: a linked data cohort study.
abstract: BACKGROUND
  Increasing recognition of Attention Deficit Hyperactivity Disorder (ADHD) among Aboriginal children, adolescents and young adults is a public health challenge. We investigated the pattern of prescription stimulants for ADHD among Aboriginal individuals in Western Australia (WA).
  
  
  METHODS
  Using a whole-population-based linked data we followed a cohort of individuals born in WA from 1980-2005, and their parents were born in Australia, to identify stimulant prescription for ADHD derived from statutory WA stimulant prescription dispensing between 2003 and 2007. Parental link was ascertained through WA Family Connections Genealogical Linkage System. Cox proportional hazards regression (HR) models were performed to determine the association between stimulant use and Aboriginal and non-Aboriginal status.
  
  
  RESULTS
  Of the total cohort of 186,468, around 2% (n = 3677) had prescription stimulants for ADHD. Individuals with both Aboriginal parents were two-thirds (HR 0.33, 95 % CI 0.26-0.42), and with only Aboriginal mother were one-third (HR 0.69, 95% CI 0.53-0.90) less likely to have stimulants, compared to individuals with non-Aboriginal parents. HR in Aboriginals was 62% lower (HR 0.35, 95% CI 0.25-0.49) in metropolitan areas, and 72% lower (HR 0.28, 95% CI 0.20-0.38) in non-metropolitan areas, than non-Aboriginals. The risk for simulant use was four times higher among Aboriginal boys than Aboriginal girls (HR 4.08, 95% CI, 2.92-5.69).
  
  
  CONCLUSIONS
  Aboriginal cultural understanding of ADHD and attitude towards stimulant medication serve as a determinant of their access to health services. Any ADHD intervention and policy framework must take into account a holistic approach to Aboriginal culture, beliefs and individual experience to provide optimal care they need.
authors.affiliation: Centre for Health Services Research, School of Population Health, University of Western Australia, 35 Stirling Highway, Crawley, WA, 6009, Australia. manonita.ghosh@uwa.edu.au.
authors.forename: Manonita
authors.initials: M
authors.lastname: Ghosh
authors.affiliation: Centre for Health Services Research, School of Population Health, University of Western Australia, 35 Stirling Highway, Crawley, WA, 6009, Australia. darcy.holman@uwa.edu.au.
authors.forename: C D'Arcy J
authors.initials: CD
authors.lastname: Holman
authors.affiliation: Centre for Health Services Research, School of Population Health, University of Western Australia, 35 Stirling Highway, Crawley, WA, 6009, Australia. david.preen@uwa.edu.au.
authors.forename: David B
authors.initials: DB
authors.lastname: Preen
mesh_terms: D000293:Adolescent; D001289:Attention Deficit Disorder with Hyperactivity / Q000188:drug therapy*; D000697:Central Nervous System Stimulants / Q000627:therapeutic use*; D002648:Child; D002675:Child, Preschool; D015331:Cohort Studies; D003913:Dextroamphetamine / Q000627:therapeutic use; D004358:Drug Therapy / Q000706:statistics & numerical data*; D005260:Female; D006801:Humans; D008297:Male; D008774:Methylphenidate / Q000627:therapeutic use; D055553:Prescription Drugs / Q000627:therapeutic use*; D016016:Proportional Hazards Models; D012307:Risk Factors; D012737:Sex Factors; D014904:Western Australia; D055815:Young Adult
chemical_list: D000697:Central Nervous System Stimulants; D055553:Prescription Drugs; D008774:Methylphenidate; D003913:Dextroamphetamine