Atypical antipsychotic treatment among immigrant and non-immigrant pediatric patients with attention deficit/hyperactivity disorder in British Columbia

This thesis is focused on characterizing differences in pharmacological treatment among immigrant and non-immigrant children with Attention-Deficit/Hyperactivity Disorder (ADHD). Multimodal approaches combining psychosocial and pharmacological interventions are recommended for the treatment of ADHD. Among pharmacological treatments, stimulant medications are among the most common and efficacious drug therapy used to manage ADHD symptoms. However, there are concerns around increasing use of medications, such as atypical antipsychotics, that lack substantive evidence and are not currently approved by Health Canada for the treatment of ADHD. This thesis has two main studies: First, scoping review methodology was used to examine longitudinal trends, prevalence, tolerability, and safety of atypical antipsychotics among children with ADHD. No studies were identified relating to atypical antipsychotic use specific to immigrant children with ADHD, even though this review found that many children with ADHD still receive atypical antipsychotics. Atypical antipsychotic medications are often used to manage psychiatric comorbidity and/or aggressive and impulsive symptoms associated with ADHD. However, there is little evidence regarding the safety and tolerability of atypical antipsychotics to support the use of these medications as a first-line intervention among children diagnosed with ADHD. Second, differences in first-line stimulant and atypical antipsychotic prescribing practices were examined among newly diagnosed immigrant and non-immigrant children with ADHD, living in British Columbia, Canada. Immigrant children were less likely than non-immigrant children to be dispensed a stimulant medication prescription in the 30-days following an incident diagnosis of ADHD. Among children, being older, male, and receiving treatment from a psychiatrist was associated with being dispensed an atypical antipsychotic prescription as a first-line intervention within 30-days of diagnosis. A latent class analysis (LCA) was conducted to account for sources of variability that may be associated with ADHD treatment. A high proportion of children with ADHD were not dispensed any prescription medications. Non-migrant boys had a 68% increased likelihood of being treated with atypical antipsychotics compared to their migrant counterparts. Together, the studies incorporated in this thesis underline the importance of examining relationships between structural determinants of health, health equity, and ADHD-related prescribing practices.Medicine, Faculty ofPopulation and Public Health (SPPH), School ofGraduat