Influence of Age, Gender, and Living Circumstances on Patterns of Attention-Deficit/Hyperactivity Disorder Medication Use in Children and Adolescents With or Without Intellectual Disabilities.

Abstract

The aim of the study was to determine whether there are differences in psychopharmacological practice for attention-deficit/hyperactivity disorder (ADHD) in children and adolescents dependent on the presence or absence of associated intellectual disability; and if there are, whether the differences are influenced by factors such as age, gender, and living circumstances. A case-control cross-sectional design was used. Each arm of the study had a total of 107 children and adolescents aged 5-18 years. Case participants had diagnoses of having intellectual disability and ADHD; comparison participants had diagnoses of having ADHD, but no intellectual disability. Outcome measurements were (1) concurrent use of medications-single medication event as against concurrent multiple medication events-and (2) type of medication used-stimulants versus nonstimulants. Demographic factors considered were gender, age, and living circumstances. Male-to-female ratio in each group was 90:17. Mean age in the case group was 10.93 years (standard deviation [SD]: 3.39 years) and in the comparison group, 12.34 years (SD: 3.22 years). Seventy percent of the case group lived with their biological families, while 84% of the comparison group did so. In the case group, 7.5% were in residential school placements compared with only 0.9% of the comparison group. There were no statistically significant differences in broad measurements of outcomes between the case and comparison groups. Age appeared to be an important moderating factor for type of medication prescribed. Younger children with intellectual disabilities and ADHD were more likely to be established on nonstimulant medications than those with ADHD and no intellectual disabilities (p = 0.024, odds ratio: 1.8; 95% CI: 1.2-2.7). Being between the ages of 5 and 12 years and having intellectual disability and ADHD are associated with raised likelihood of being prescribed nonstimulant medications for ADHD. This difference is maintained irrespective of gender and living circumstances. Reasons for these differences in prescribing practice require further exploration.