Socioeconomic and Racial/Ethnic Differences in Prescription Adderall Use Among U.S. Adolescents: NHANES 2009–2018

Background : Attention-deficit/hyperactivity disorder (ADHD) is a common neurodevelopmental disorder among U.S. adolescents, and stimulant medications remain a primary treatment modality. Although disparities in ADHD diagnosis and treatment have been documented, nationally representative evidence specifically characterizing patterns of Adderall (amphetamine/dextroamphetamine) use across socioeconomic and racial/ethnic groups remains limited. Objective : To examine the prevalence of Adderall use and identify factors associated with use among U.S. adolescents. Methods : We conducted a cross-sectional analysis of adolescents aged 12–19 years using data from the National Health and Nutrition Examination Survey (NHANES) 2009–2018. Adderall use was identified from prescription medication files. Survey-weighted prevalence estimates were calculated, and multivariable survey-weighted logistic regression was used to assess associations with income-to-poverty ratio (PIR), ADHD diagnosis, age, sex, insurance status, and race/ethnicity. Results : The multivariable regression model included 5,902 participants with complete covariate data, and Adderall use was overall rare. Survey-weighted prevalence differed across socioeconomic and racial/ethnic groups. In adjusted analyses, PIR was inversely associated with Adderall use; each one-unit increase in PIR was associated with a 37% reduction in the odds of use (OR 0.63, 95% CI 0.48–0.83). ADHD diagnosis was not significantly associated with Adderall use (OR 0.97, 95% CI 0.32–2.98). Age, sex, and insurance status were also not significantly associated with use. Compared with Non-Hispanic White adolescents, Non-Hispanic Black (OR 0.23, 95% CI 0.06–0.97) and Hispanic adolescents (OR 0.12, 95% CI 0.02–0.65) had significantly lower odds of Adderall use. Results were robust in sensitivity analyses. Conclusions : Adderall use among U.S. adolescents was uncommon and demonstrated socioeconomic and racial/ethnic disparities. Higher socioeconomic status was associated with lower odds of use. These findings highlight the complex relationship between socioeconomic factors and stimulant medication use in adolescents.