Maternal Sociodemographic Factors Are Associated with Methylphenidate Initiation in Children in the Netherlands: A Population-Based Study

K Cheung,B Dierckx,H El Marroun,L E Visser,B H Stricker

doi:10.1007/s10578-020-01016-2

Abstract

Multiple factors may contribute to the decision to initiate methylphenidate treatment in children such as maternal sociodemographic factors of which relatively little is known. The objective was to investigate the association between these factors and methylphenidate initiation. The study population included 4243 children from the Generation R Study in the Netherlands. Maternal sociodemographic characteristics were tested as determinants of methylphenidate initiation through a time-dependent Cox regression analysis. Subsequently, we stratified by mother-reported ADHD symptoms (present in 4.2% of the study population). When ADHD symptoms were absent, we found that girls (adjusted HR 0.25, 95%CI 0.16–0.39) and children born to a mother with a non-western ethnicity (compared to Dutch-Caucasian) (adjusted HR 0.42, 95%CI 015–0.68) were less likely to receive methylphenidate. They were more likely to receive methylphenidate when their mother completed a low (adjusted HR 2.29, 95%CI 1.10–4.77) or secondary (adjusted HR 1.71, 95%CI 1.16–2.54) education. In conclusion, boys and children born to a mother of Dutch-Caucasian ethnicity were more likely to receive methylphenidate, irrespective of the presence of ADHD symptoms.

Highlights

Worldwide, 5% of children will develop or have symptoms of attention deficit hyperactivity disorder (ADHD) [1]
When child ADHD symptoms above the cut-off were reported, we found that girls were less likely to receive a methylphenidate prescription than boys (Table 3)
We found that a lower education was significantly associated with a decreased risk of methylphenidate use compared to higher education

Summary

Introduction

5% of children will develop or have symptoms of attention deficit hyperactivity disorder (ADHD) [1]. Stimulant medication is widely used for the treatment of ADHD of which methylphenidate is considered the first choice of pharmacological treatment [2]. When initiating treatment with methylphenidate, the risk of potential negative outcomes (such as major depression and suicidal behavior) may be considered as shown in previous studies [4, 5]. There are clear guidelines with regard to ADHD treatment, symptom severity and functional impairment are not the sole determinants of treatment initiation. Numerous studies have explored other factors that might contribute to the use of stimulant medication in children diagnosed with ADHD [6, 7]. Stimulants are more often prescribed to boys than girls, which can partly be explained by the fact that ADHD is

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