Medication use in children aged 6-17 years for selected behavioral and emotional conditions and its association with preterm birth: 2011-2012 National Survey of Children's Health (NSCH) Open Access

Morris, John Chadwick (2015)

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Background: Prematurity is associated with an increased risk of mental health disorders such as Attention-Deficit Disorder/Hyperactivity Disorder (ADD/ADHD), anxiety, and depression in children. Consequently, preterm birth may be associated with increased psychotropic medication use among school-aged children. We hypothesize that prematurity is associated with an increased risk of medication use for 1) ADD/ADHD and 2) emotions, concentration, or behavior (ECB) in children.

Methods: Using a nationally-representative sample of non-institutionalized school-aged children aged 6-17 years from the 2011-2012 National Survey of Children's Health (NSCH) (n=42,178), we examined the prevalence, among these children, of maternal-reported medication use for 1) ADD/ADHD at the time of the interview, and 2) ECB within the 12 months prior to the interview. We also examined the association between prematurity and medication use for these conditions. We calculated adjusted odds ratios (aOR) and 95% Confidence Intervals (CI) using multivariate logistic regression analysis accounting for the complex survey design. We examined interaction and stratified our findings by sex.

Results: Overall, an estimated 6.9% (2.2 million) and 9.9% (3.2 million) of children in the U.S. used medication for ADD/ADHD and ECB, respectively, during the study period. Among these children, about 15% were born prematurely. After adjusting for potential confounders, children born preterm were at a significantly higher risk of current use of medications for ADD/ADHD (aOR=1.38; 95% CI=1.10-1.72) and use of medications for ECB during the year prior to the interview (aOR=1.37; 95% CI=1.13-1.66) compared to term-born children. Additionally, sex modified the association between prematurity and use of ADD/ADHD medications. Preterm boys had a significantly higher risk of current ADD/ADHD medication use compared to term-born boys (aOR=1.68; 95% CI 1.28-2.19); while the same association was non-significant among girls (OR=0.85, 95% CI 0.59-1.22).

Conclusion: Our findings provide nationally-representative prevalence estimates of medication use for ADD/ADHD and ECB among school-age children. We present novel insights into the association between preterm birth and medication use for these conditions. Our study findings highlight the role of prematurity on childhood mental health, and point to the need for further understanding of differences in prescription patterns and long-term effects of these medications in U.S. school-aged children.

Table of Contents

Extended Introduction. 8

Manuscript Introduction. 25

Methods. 38

Statistical Analysis. 41

Results. 43

Manuscript Discussion. 48

Extended Discussion. 54

References. 56

Figure 1. 60

Table 1. 61

Table 2. 62

Table 3. 63

Appendix Table A. 64

Appendix Figure A. 65

Appendix Figure B. 66

Appendix I NSCH Weighting and Variance Estimation. 67

Appendix II SAS Code. 68

Appendix III 2011/2012 NSCH Survey Questions. 85

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