Time to Medication in School-Age Children with ADHD: Assessing the Effect of Sociodemographic and Clinical Factors
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Objective
To assess the timing of attention-deficit/hyperactivity disorder (ADHD) medication prescriptions in relation to the ADHD diagnostic visit in school-aged children seen in developmental-behavioral pediatrics (DBP) clinics and to investigate which sociodemographic and clinical factors affect the timing of medication prescription.
Method
We retrospectively analyzed electronic health records from Stanford’s DBP clinics of children 6-12-years-old seen between 2016 and 2024. ADHD cohort included patients with an ICD-10 ADHD diagnosis and with ≥1 month follow-up. Andersen Health Care Utilization model informed selection of predisposing (age, sex, race/ethnicity), enabling (insurance, clinician type), and need (ADHD subtype, comorbidities) factors. Primary outcome: Time from first ADHD diagnosis to first ADHD medication prescription within 1 year of diagnosis. Cox regression model assessed associations between sociodemographic and clinical factors and study outcome.
Results
Of 823 patients with ADHD, 623 (75.7%) were male; average age at first ADHD diagnosis was 8.2 years (SD=1.5). Of 823 patients, 484 (58.8%) were prescribed medications within 1 year of diagnosis. The average number of days from ADHD diagnosis to first prescription was 51 days (median=4). Longer time to medication prescription was associated with Asian race/ethnicity (predisposing), psychologist clinician (enabling), 1-2 or ≥3 comorbidities (need). Shorter time to prescription was associated with older patient age (predisposing), ADHD combined and hyperactive/impulsive subtypes (need).
Conclusion
Asian race/ethnicity and, unexpectedly, multiple comorbidities, were associated with later ADHD medication prescription by DBPs in school-age children. Further investigation is necessary to understand patient, family, and clinician factors that influence medication initiation in these patient subgroups.
