Time to Medication Initiation in School-age Children With ADHD in Developmental-Behavioral Pediatrics

OBJECTIVE: To 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 clinical and sociodemographic factors affect the timing of medication prescription. METHOD: We retrospectively analyzed electronic health records of children 6 to 12 years old seen between 2016 and 2024 in 6 DBP clinics at Stanford Medicine Children's Health. ADHD cohort included patients with ICD-10 ADHD diagnosis and ≥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, co-occurring conditions) factors. Primary outcome included: time from first ADHD diagnosis to first ADHD medication prescription within 1 year of diagnosis. Cox regression model assessed associations between clinical and sociodemographic factors and study outcome. RESULTS: Of 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, psychologist clinician, and presence of 1 to 2 co-occurring conditions (most commonly anxiety). Shorter time to prescription was associated with older age, and ADHD combined and hyperactive/impulsive subtypes. CONCLUSION: Clinical and sociodemographic factors, including patient race/ethnicity, were associated with timing of medication initiation in school-aged children diagnosed with ADHD in DBP clinics. Future mixed-methods studies are needed to understand factors that influence medication initiation in DBP practice.