Medication use, social determinants of health, and latent trajectories of functional outcomes in children with attention-deficit/hyperactivity disorder

Introduction: Children with attention-deficit/hyperactivity disorder (ADHD) are at increased risk for adverse long-term outcomes. However, little is known about how ADHD medication use and social determinants of health (SDOH) relate to children’s self-reported functional outcomes over time. Methods: This observational, longitudinal cohort study used data from the Adolescent Brain Cognitive Development (ABCD) Study®. Participants were nine to ten years old at enrollment, and analyses included the first five years of follow-up. Patterns of medication use were operationalized longitudinally. Latent class growth analysis was used to identify trajectory classes of child-reported family conflict, prosocial behavior, and school experiences. Multinomial logistic regression was used to examine associations between medication use patterns, SDOH, and functional outcome trajectory class membership. Results: Half of children used ADHD medication during the five-year period. Among medication users, the most common patterns included early initiation (medication use at study enrollment), stimulant-only use, and discontinuation without later reinitiation. Latent class growth analysis identified three trajectory classes across each functional domain: Resilient, Declining, and Low Improving. Social and structural factors were associated with trajectory membership, including ethnic discrimination, sex, insurance status, race and ethnicity, parental partnership and employment status, and medication type. Medication use patterns were not strongly associated with functional outcome trajectories; however, nonstimulant use (relative to stimulant-only use) was associated with less favorable outcomes. Females were more likely to demonstrate declining trajectories in family conflict and school experiences, whereas males were more likely to demonstrate low improving trajectories in prosocial behavior and school experiences. Ethnic discrimination was associated with less favorable trajectories across functional domains. Conclusions: Functional outcome trajectories in children with ADHD appear to be more strongly associated with social and structural factors than with patterns of medication use. These findings highlight the importance of addressing contextual influences when evaluating long-term functioning among children with ADHD.