Student-Perceived School Climate Is Associated With ADHD Medication Treatment Among Adolescents in Medicaid

Abstract

Objective: The objective of this study was to evaluate the relationship between school climate and ADHD medication treatment among adolescents in Medicaid in Georgia. Method: School climate and Medicaid claims data were aggregated for 159 GA counties. County-level school climate percentile and medicated ADHD prevalence were calculated. The t tests and regression models evaluated the relationship between school climate, medicated ADHD, and demographics, weighted by county population. Poorer 2008 school climate (<25th percentile) was regressed on 2011 medicated ADHD prevalence, controlling for potential confounders. Results: The prevalence of medicated ADHD was 7.8% among Medicaid-enrolled GA adolescents. The average county-level prevalence of medicated ADHD was 10.0% (SD = 2.9%). Poorer school climate was associated with lower rates of medicated ADHD (p < .0001); along with demographics, these factors accounted for 50% of the county variation in medicated ADHD. Conclusion: School climate is associated with medicated ADHD among adolescents in Medicaid. Additional research may reveal whether high medicated ADHD may reflect a lack of access to non-pharmacological therapies in some communities.

Keywords

school climate ADHD behavioral problems health care utilization medication treatment

Get full access to this article

View all access options for this article.

References

Akinbami

L. J.

Liu

Pastor

P. N.

Reuben

C. A.

(2011). Attention deficit hyperactivity disorder among children aged 5–17 years in the United States, 1998–2009 NCHS data brief (Vol. 70). Hyattsville, MD: CDC National Center for Health Statistics.

American Academy of Child and Adolescent Psychiatry. (2007). Practice parameter for the assessment and treatment of children and adolescents with attention-deficit/hyperactivity disorder. Journal of the American Academy of Child & Adolescent Psychiatry, 46, 894-921.

American Academy of Pediatrics. (2011). ADHD: Clinical practice guideline for the diagnosis, evaluation, and treatment of attention-deficit/hyperactivity disorder in children and adolescents. Pediatrics, 128, 1007-1022.

American Psychiatric Association. (2013). Diagnostic and statistical manual of mental disorders (5th ed.). Arlington, VA: American Psychiatric Publishing.

Barbaresi

W. J.

Colligan

R. C.

Weaver

A. L.

Voigt

R. G.

Killian

J. M.

Katusic

S. K.

(2013). Mortality, ADHD, and psychosocial adversity in adults with childhood ADHD: A prospective study. Pediatrics, 131, 637-644. doi:10.1542/peds.2012-2354

Bussing

Schoenberg

N. E.

Perwien

A. R.

(1998). Knowledge and information about ADHD: Evidence of cultural differences among African-American and White parents. Social Science & Medicine, 46, 919-928.

Casey

M. M.

Thiede Call

Klingner

J. M.

(2001). Are rural residents less likely to obtain recommended preventive healthcare services? American Journal of Preventive Medicine, 21, 182-188. doi:10.1016/S0749-3797(01)00349-X

Centers for Disease Control and Prevention. (2009). School connectedness: Strategies for increasing protective factors among youth. Atlanta, GA: U.S. Department of Health and Human Services.

Centers for Disease Control and Prevention. (2013, April). 2011–2012 National Survey of Children’s Health frequently asked questions. Retrieved from http://www.cdc.gov/nchs/slaits/nsch.htm

10.

Centers for Disease Control and Prevention. (2014). State profile: Georgia. Parent-reported diagnosis of ADHD by a health care provider and medication treatment among children 4-17 years: National Survey of Children’s Health*—2003 to 2011. Retrieved from http://www.cdc.gov/ncbddd/adhd/stateprofiles/stateprofile_Georgia.pdf

11.

Cohen

Geier

V. K.

(2010). School climate research summary (Vol. 1). New York, NY: Center for Social and Emotional Education. Retrieved form http://www.schoolclimate.org/climate/documents/policy/sc-brief-v1.pdf

12.

Connor

D. F.

(2011, August 11). Problems of overdiagnosis and overprescribing in ADHD. Psychiatric Times. Retrieved from http://www.psychiatrictimes.com/adhd/problems-overdiagnosis-and-overprescribing-adhd

13.

de Graaf

Kessler

R. C.

Fayyad

ten Have

Alonso

Angermeyer

. . . Posada-Villa

(2008). The prevalence and effects of adult attention-deficit/hyperactivity disorder (ADHD) on the performance of workers: results from the WHO World Mental Health Survey Initiative. Occupational & Environmental Medicine, 65(12), 835-842. doi:10.1136/oem.2007.038448

14.

DiScala

Lescohier

Barthel

(1998). Injuries to children with attention deficit hyperactivity disorder. Pediatrics, 102, 1415-1421. doi:10.1542/peds.102.6.1415

15.

Doshi

J. A.

Hodgkins

Kahle

Sikirica

Cangelosi

M. J.

Setyawan

. . . Neumann

P. J.

(2012). Economic impact of childhood and adult attention-deficit/hyperactivity disorder in the United States. Journal of the American Academy of Child & Adolescent Psychiatry, 51, 990-1002.e2. doi:10.1016/j.jaac.2012.07.008

16.

Fulton

B. D.

Scheffler

R. M.

Hinshaw

S. P.

Levine

Stone

Brown

T. T.

Modreck

(2009). National variation of ADHD diagnostic prevalence and medication use: Health care providers and education policies. Psychiatric Services, 60, 1075-1083.

17.

Graf

W. D.

Nagel

S. K.

Epstein

L. G.

Miller

Nass

Larriviere

(2013). Pediatric neuroenhancement: Ethical, legal, social, and neurodevelopmental implications. Neurology, 80, 1251-1260. doi:10.1212/WNL.0b013e318289703b

18.

Harpin

V. A.

(2005). The effect of ADHD on the life of an individual, their family, and community from preschool to adult life. Archives of Diseases in Childhood, 90(Suppl. 1), i2-i7. doi:10.1136/adc.2004.059006

19.

Hinshaw

S. P.

Scheffler

R. M.

(2014). The ADHD explosion: Myths, medication, money, and today’s push for performance. Oxford, UK: Oxford University Press.

20.

Hoare

Beattie

(2003). Children with attention deficit hyperactivity disorder and attendance at hospital. European Journal of Emergency Medicine, 10, 98-100.

21.

Hoge

D. R.

Smit

E. K.

Hanson

S. L.

(1990). School experiences predicting changes in self-esteem of sixth- and seventh-grade students. Journal of Educational Psychology, 82, 117-127.

22.

Kuperminc

G. P.

Leadbeater

B. J.

Blatt

S. J.

(2001). School social climate and individual differences in vulnerability to psychopathology among middle school students. Journal of School Psychology, 39, 141-159. doi:10.1016/S0022-4405(01)00059-0

23.

Kuperminc

G. P.

Leadbeater

B. J.

Emmons

Blatt

S. J.

(1997). Perceived school climate and difficulties in the social adjustment of middle school students. Applied Developmental Science, 1, 76-88. doi:10.1207/s1532480xads0102_2

24.

Loe

Feldman

(2007). Academic and educational outcomes of children with ADHD. Journal of Pediatric Psychology, 32, 643-654.

25.

McDonald

D. C.

Jalbert

S. K.

(2013). Geographic variation and disparity in stimulant treatment of adults and children in the United States in 2008. Psychiatric Services, 64, 1079-1086. doi:10.1176/appi.ps.004442012

26.

Merrill

Lyon

Baker

Gren

(2009). Attention deficit hyperactivity disorder and increased risk of injury. Advances in Medical Sciences, 54(1), 20-26.

27.

Morgan

P. L.

Staff

Hillemeier

M. M.

Farkas

Maczuga

(2013). Racial and ethnic disparities in ADHD diagnosis from kindergarten to eighth grade. Pediatrics, 132(1), 85-93. doi:10.1542/peds.2012-2390

28.

National School Climate Council. (2007). School climate. Retrieved from http://www.schoolclimate.org/climate/

29.

Perou

Bitsko

R. H.

Blumberg

S. J.

Pastor

Ghandour

R. M.

Gfroerer

J. C.

. . . Huang

L. N.

(2013). Mental health surveillance among children—United States, 2005-2011. MMWR Surveillance Summaries, 62(Suppl. 2), 1-35.

30.

Robert Wood Johnson. (2014). County health rankings and roadmaps: Data sources and measures. Retrieved from http://www.countyhealthrankings.org/ranking-methods/data-sources-and-measures

31.

Setlik

Bond

G. R.

(2009). Adolescent prescription ADHD medication abuse is rising along with prescriptions for these medications. Pediatrics, 124, 875-880. doi:10.1542/peds.2008-0931

32.

Sommer

(1985). What’s different about truants? A comparison study of eighth-graders. Journal of Youth and Adolescence, 14, 411-422. doi:10.1007/BF02138836

33.

Sylva

(1994). School influences on children’s development. Journal of Child Psychology and Psychiatry, 35, 135-170.

34.

Thapa

Cohen

Guffey

Higgins-D’Alessandro

(2013). A review of school climate research. Review of Educational Research. Advance online publication. doi:10.3102/0034654313483907

35.

U.S. Department of Education. (2014). OSEP center on positive behavioral interventions and supports: Effective schoolwide interventions. Retrieved from http://www.pbis.org/default.aspx

36.

Visser

S. N.

Danielson

M. L.

Bitsko

R. H.

Holbrook

J. R.

Kogan

M. D.

Ghandour

R. M.

. . . Blumberg

S. J.

(2014). Trends in the parent-report of health care provider-diagnosed and medicated attention-deficit/hyperactivity disorder: United States, 2003–2011. Journal of the American Academy of Child & Adolescent Psychiatry, 53, 34-46.e32.

37.

Visser

S. N.

Danielson

M. L.

Bitsko

R. H.

Perou

Blumberg

S. J.

(2013). Convergent validity of parent-reported attention-deficit/hyperactivity disorder diagnosis: A cross-study comparison. JAMA Pediatrics, 167, 674-675. doi:10.1001/jamapediatrics.2013.2364

38.

Way

Reddy

Rhodes

(2007). Students’ perceptions of school climate during the middle school years: Associations with trajectories of psychological and behavioral adjustment. American Journal of Community Psychology, 40, 194-213. doi:10.1007/s10464-007-9143-y

39.

Wolraich

M. L.

Bard

D. E.

Stein

M. T.

Rushton

J. L.

O’Connor

K. G.

(2010). Pediatricians’ attitudes and practices on ADHD before and after the development of ADHD pediatric practice guidelines. Journal of Attention Disorders, 13, 563-572. doi:10.1177/1087054709344194

40.

Yeh

Hough

R. L.

McCabe

Lau

Garland

(2004). Parental beliefs about the causes of child problems: Exploring racial/ethnic patterns. Journal of the American Academy of Child & Adolescent Psychiatry, 43, 605-612.