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Objective: The aim of this study was to describe rates of attention-deficit/hyperactivity disorder (ADHD) medication treatment and relevant school services use during a 2-year period, and to examine independent predictors of these interventions.

Method: Parent and child interviews (n = 266) and follow-up 12-month telephone surveys (n = 220) were conducted among a high-risk sample, selected from a districtwide, stratified, random sample of elementary-school students screened for ADHD risk. Medication treatment status and school services use were assessed from multiple sources, and their predictors were identified by logistic regression modeling, adjusting for sociodemographic and parental characteristics, as well as clinical-need variables.

Results: Approximately one third (35%) of the children received ADHD medications during a 2-year period, and of those treated at Time 2, approximately one third (36%) were no longer on medications at Time 3. Boys were more than twice as likely to receive ADHD medication as girls. Approximately one quarter (28%) of the children accessed school services and continued their use over 2 years. African-American youths were more likely to receive school services than were Caucasian children.

Conclusions: In this elementary school–district high-risk sample, care for ADHD was remarkable for underuse and attrition of medication treatment, as well as poor linkage to relevant school services. Interventions to improve ADHD care should include supports to access and sustain medication treatment, as well as link with school services, especially for girls.