Differences in Risk of Injury Between Stimulant-Treated and Untreated ADHD Patients

Segars, Larry W., Differences in Risk of Injury between Stimulant-Treated and Untreated ADHD Patients. Doctor of Public Health (Epidemiology), August 2006, 63 pp, 7 tables, 0 illustrations, references, 78 titles. ADHD is a common psychiatric disorder of childhood and adolescence that also occurs in adults and spans the life of the patient. ADHD is characterized by lack of focus, distractibility, and poor concentration. Limited data have been generated focusing on ADHD patients and the association with an increased risk of injury. Unfortunately, no study has been published evaluating the effect of stimulant treatment for ADHD on the risk of injury requiring ambulatory medical care. This research utilized four concatenated years, specifically 1998-2001, of the National Ambulatory Medical Care Survey (NAMCS). This dissertation is comprised of five chapters beginning with a description of ADHD, its characteristics, diagnosis, and treatment. This overview chapter is followed by a complete review of the literature describing the publication’s which assessed the association between ADHD and the risk of injury. The next chapter is a thorough review of the NAMCS and its methodology. The concatenated dataset captured 889 office visits associated with a diagnosis of ADHD, 666 of which were also related to the prescription of a stimulant for the management of ADHD. Using NAMCS’s weight variable these values produced a national estimate of 21,223,391 office visits associated with the ADHD diagnosis and 15,604,329 office visits associated with the prescription of a stimulant for ADHD. This research determined that there was a borderline statistically significant increased association with the prescription of a stimulant for the treatment of ADHD and the risk of injury requiring treatment in an ambulatory medical care setting. Interestingly, compared to patient’s who recorded their race as Caucasian, patients who recorded their race as “Other”; representing the races of Asian, Native Hawaiian/Other Pacific Islander, or American Indian/Alaska Native, and individuals indicating more than one race, had a statistically significant increased risk of injury necessitating treatment in an ambulatory medical care setting. Potential theories for this unique finding, along with the limitations of this research, are provided in the final discussion chapter.