Abstract:
Background
Children and adolescents with attention–deficit hyperactivity disorder (ADHD) have a higher likelihood of contact with child welfare services (CWS). Evidence on whether pharmacological treatment of ADHD reduces such contact is limited.
Aims
To estimate the causal effect of pharmacological treatment of ADHD on CWS contact.
Method
In this quasi-experimental study, we used nationwide registry data covering all individuals aged 5–14 years and diagnosed with ADHD during 2009–2011 in Norway. We used linear probability models and instrument variable analyses to estimate the associations and causal effects of pharmacological treatment on CWS contact up to 4 years after diagnosis. As instrument variable analysis uses natural variation in treatment decisions between clinics as pseudo-randomisation, estimates inform effects for children and adolescents at the margin of treatment, i.e. patients whose treatment is more influenced by variation in treatment practice, e.g. due to less severe or atypical symptom presentation.
Results
A total of 5930 children and adolescents aged 5–14 years were diagnosed with ADHD between 2009 and 2011 (mean (s.d.) age 10.1 (2.4) years; 4380 males (73.9%)). Instrument variable analyses showed a reducing effect of pharmacological treatment on the use of supportive interventions by 11.9 percentage points (95% CI: −20.12, −3.80) and out-of-home-placement by 3.30 percentage points (95% CI: −6.44, −0.15) at 2-year follow-up. This corresponds to the numbers needed to treat estimates of 8 and 30, respectively.
Conclusions
Pharmacological treatment of ADHD reduces CWS contact among children and adolescents at the margin of treatment, lowering the probability of receiving supportive interventions and out-of-home placements. Findings suggest that medication reduces behavioural symptoms, which may improve the family coping mechanism and reduces the need for CWS involvement.