Medication Use and Related Outcomes in Children with ADHD

Abstract

Children with attention-deficit/hyperactivity disorder (ADHD) often experience long-term functional, social, and health-related sequelae. Although substantial evidence supports the effectiveness of stimulant and nonstimulant medications for symptom management, longitudinal patterns of medication use and their associations with child outcomes remain poorly understood. Moreover, the influence of inequities related to sex, race, ethnicity, and social determinants of health (SDOH) on developmental trajectories of functional outcomes in children with ADHD have not been well studied. Research on ADHD-related outcomes has also largely prioritized parent-reported measures of child functioning, with relatively limited consideration of children’s own perspectives. This is the result of well-documented positive bias in child self-report of ADHD-related symptoms and functional challenges; however, it nonetheless represents a gap in understanding of children’s self-perceptions in ADHD. This dissertation will consist of five chapters. Chapter 1 presents the background and conceptual framework. Chapter 2 is a scoping review examining the relationship between timing of ADHD medication initiation and long-term anxiety outcomes. Chapter 3 uses data from the Adolescent Brain Cognitive Development (ABCD) Study® to characterize patterns of medication use over time, identify latent trajectory typologies of child-reported functional outcomes across early adolescence, and examine associations among medication use patterns, social determinants of health, and functional outcome trajectories. Chapter 4 uses ABCD Study® data as well to compare child- and parent-reported outcomes in a matched sample of children with ADHD and a non-ADHD comparison group. Chapter 5 summarizes the findings and discusses implications for future research.