103 Child Characteristics Associated with Receipt of Methylphenidate (Ritalin)

Methylphendidate (MPH; Ritalin) is widely used as part of the management of attention-deficit/hyperactivity disorder (ADHD). However, specific factors associated with its prescription and use are poorly understood.

To examine child-related factors that predict children's receiving MPH.

Secondary data analysis from Cycle 1 (1994/5; “Time 1”) and Cycle 2 (1996/8; “Time 2”) of the National Longitudinal Survey of Children and Youth (NLSCY), a prospective longitudinal study of children's development using a nationally representative sample. MPH use was ascertained from an affirmative answer to the question “Does he/she take the following prescribed medication on a regular basis? Ritalin”. In a series of logistic regression analyses, we examined the role of parent and teacher-reported behavioral and emotional problems, including factor scores on dimensions of Hyperactivity-Inattention (HI), Anxiety; and Aggression-Conduct (AC) problems, parent reported academic achievement, chronic health problems, and child's age, sex, and use of MPH, all measured at Time 1, in predicting receiving MPH at Time 2.

Complete data were available on 2972 children of school age (age M=8.62 yr; SD=1.78; 49.5% male; 2.2% received MPH). In our first model, both parent (OR: 1.25; 95% CI: 1.15–1.35) and teacher (OR: 1.19; 95% CI: 1.10–1.28) ratings of HI predicted MPH use after adjustment for child's age, sex and use of MPH at Time 1. In our second model, parent ratings of Anxiety (OR: 1.16; 95% CI: 1.05–1.28) and AC problems (OR: 1.13; 95% CI: 1.01–1.26) were also found to predict MPH use over-and-above the factors already described, including ratings of HI. Teacher ratings of Anxiety predicted MPH use (OR: 1.18; 95% CI: 1.07–1.30), while AC appeared to have a protective effect (OR: 0.83; 95% CI: 0.73–0.95, an anomalous finding that can be explained as a statistical suppressor effect). In our third model, after controlling for all the above variables, higher level of academic achievement (at Time 1) was found to reduce the likelihood of a child receiving MPH at Time 2 (OR: 0.84; 95% CI: 0.76–0.92), while presence of chronic medical problems was unrelated.

MPH use in children is clearly a function of multiple child-related factors, including symptoms of ADHD as reported by both parents and teachers, and other behavioral, emotional, and academic characteristics not usually considered primary indications for MPH. Clinicians should be aware that many aspects of the child should be considered when stimulant medications are prescribed and that information from multiple sources contributes to decision-making in this area.