ADHD medication prescribed at higher rates to children from poor areas

Children with ADHD who live in poor areas may be significantly more likely to receive medication for their disorder than children with ADHD who live in affluent areas, according to a study conducted in the U.K. and published in BJPsych Open.

“This finding is important because it has implications for those in clinical practice and for policymakers,” Samuel P.T. Nunn, MBChB, MPH, of St. James University Hospital in England, said in a press release. “Further research would inform development of possible interventions to tackle the effects of social deprivation, though progress may be difficult unless the broader social determinants of health are addressed.”

According to Nunn and colleagues, large studies conducted in the U.K. have demonstrated a social gradient in ADHD prevalence, with those in a lower socioeconomic position more likely to have a diagnosis of ADHD. Furthermore, a U.S. study found that being school-aged, white, male, in foster care and a resident of a rural area increased the odds of being treated with psychotropic drugs. Thus, they noted socioeconomic position as a potentially unrecognized and modifiable factor in the receipt of ADHD medication among children and young adults in the U.K.

To determine the role of socioeconomic position in the prescribing of medication for this patient population, the researchers used multivariate logistic regression modeling in a cross-sectional study of 1,354 children and young adults with an ADHD diagnosis. Participants were selected from three centers in Sheffield, England, in 2016. Investigators used gender, religion ethnicity, age, comorbidities and Index of Multiple Deprivation decile as independent variables.

Nunn and colleagues reported a social gradient in the receipt of ADHD medication (P < .01). A one-decile increase of the Index of Multiple Deprivation was associated with 10% lower odds of receipt of ADHD medication (adjusted OR = 0.9; 95% CI, 0.84-0.97).

The researchers noted the unlikelihood of a single explanation for this gradient, but that the result suggested that children from poorer areas are less able to benefit from treatments that don’t include medication, such as parental behavioral management classes. Moreover, parents in poorer areas may have difficulties attending regular classes because of economic insecurity.

“The social gradient in [children and young people’s] receipt of medication represents a novel risk factor that clinicians should aim to modify,” the researchers wrote. “Because a social gradient in the receipt of medication for ADHD exists, those from more deprived backgrounds should be considered especially vulnerable regardless of causality, with clinicians thinking of social deprivation in the same way as an additional comorbidity.” – by Joe Gramigna

Disclosures: The authors report no relevant financial disclosures.