Child/Adolescent Health

White children are about twice as likely to use stimulants as black and Hispanic children

Stimulant medications are typically prescribed for children with attention-deficit/hyperactivity disorder (ADHD) to manage core symptoms such as impulsive behavior, restlessness, and inability to focus attention. These problems often hinder children's academic performance and relationships with peers and parents. White children are about twice as likely to use stimulants as black and Hispanic children, concludes a new study by researchers at the Agency for Healthcare Research and Quality. Julie L. Hudson, Ph.D., G. Edward Miller, Ph.D., and James B. Kirby, Ph.D., examined stimulant use among U.S. children aged 5-17 in the Medical Expenditure Panel Survey between 2000 and 2002.

Overall, 5.1 percent of white children compared with 2.8 percent of black and 2.1 percent of Hispanic children purchased at least one stimulant medication during the year. Stimulants most commonly used by children were methylphenidate (Ritalin® and Concerta®) and amphetamine-dextroamphetamine (Adderall® and Adderall XR®).

Differences in family or individual characteristics accounted for about 25 percent of the differences between whites and Hispanics, but for none of the difference between whites and blacks. Specifically, characteristics such as health insurance, health status, and access to care, for which whites fared better, helped to explain some of the differences between whites and Hispanics.

While the source of any remaining racial/ethnic differences in children's stimulant use is unclear, the authors show that children with otherwise similar reports of mental health problems have very different treatment outcomes with respect to stimulants use depending on their race/ethnicity. They point to other research that suggests these differences may result from cultural differences in how parents respond to behavioral cues of their children or from discrimination in medical treatment and/or access to care. Local school policies and norms may also affect the diagnosis of ADHD in school-age children.

More details are in "Explaining racial and ethnic differences in children's use of stimulant medications," by Drs. Hudson, Miller, and Kirby, in the November 2007 Medical Care 45(11), pp. 1068-1075.

Reprints (AHRQ Publication No. 08-R044) are available from the AHRQ Publications Clearinghouse.

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