Time to Medication in School-Age Children with ADHD: Assessing the Effect of Sociodemographic and Clinical Factors

ObjectiveTo 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. MethodWe retrospectively analyzed electronic health records from Stanfords 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. ResultsOf 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). ConclusionAsian 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.