Adolescents Treated for Attention-Deficit/Hyperactivity Disorder in Pediatric Primary Care: Characterizing Risk for Stimulant Diversion

Abstract

Objective: To describe the clinical and psychosocial characteristics, and their hypothesized interrelations, as it pertains to risk for stimulant diversion (sharing, selling, or trading) for adolescents in pediatric primary care treatment for attention-deficit/hyperactivity disorder.

Methods: Baseline data for 341 adolescents in a cluster-randomized controlled trial of stimulant diversion prevention in pediatric primary care (NCT_03080259) were used to (1) characterize diversion and newly measured risk factors, (2) examine their associations with age and sex, and (3) test whether associations among risk factors were consistent with model-implied predictions. Data were collected through multi-informant electronic surveys from adolescents and parents.

Results: Diversion was rare (1%) in this sample (Mage = 15, SD = 1.5, 74% male participants). Older age was associated with being approached to divert (r = 0.25, p < 0.001) and higher risk on variables pertinent to stimulant treatment, such as treatment disclosure (r = 0.12, p < 0.05), tolerance for stimulant misuse and diversion (r = 0.17, p < 0.05), and peer norms favorable to stimulant misuse and diversion (r values = 0.15-0.34, p < 0.001). Sex differences were minimal. Variables from our conceptual model and specific to stimulants (e.g., perceived likelihood of negative consequences from diversion and schoolmate stimulant misuse/diversion) were related in multivariable regressions to hypothesized immediate precursors of diversion (e.g., diversion intentions).

Conclusion: Although diversion was rare for these primary care-treated adolescents, risk levels appear to be higher for older adolescents. Prevention may be most effective by capitalizing on current psychosocial strengths and discussing stimulant-specific attitudes, behaviors, and social norms before vulnerability to diversion increases in the final years of high school and into college.

Trial registration: ClinicalTrials.gov NCT03080259.

Conflict of interest statement

Disclosure: The authors declare no conflict of interest.

Copyright © 2021 Wolters Kluwer Health, Inc. All rights reserved.

Figures

Figure 1.

Conceptual Model of Diversion Risk Note. Selected universal health risk factors are included due to their presumed proximal influence: attitudinal intolerance of deviance, friend substance use and delinquency, friend intolerance of substance use and delinquency. Other distal and/or universal health risk factors (e.g., sensation-seeking, religiosity) are excluded from the figure for simplified presentation (see Supplement 1, Table 2, and Results).

Figure 2.

Flow of Participant Recruitment Note. EMR = Electronic Medical Record. In addition to confirming medical record-identified inclusion criteria (age, ADHD diagnosis, stimulant-treated for ADHD at practice), practice staff screened for the following exclusion criteria: sibling in the study, stimulant prescribed by a psychiatrist outside of the practice, home-schooled, no legal parent or guardian who could consent to participate, unable to complete survey without parent/guardian assistance.