Statistics Confirm Rise in Childhood ADHD and
Medication Use Education World
news editor Diane Weaver Dunne examines the rise in the
number of prescriptions written for stimulant medication
to treat ADHD -- an increase of 500 percent since 1991,
according to the Drug Enforcement Administration.
Included: Highlights of research tracking the rise of
childhood ADHD and medication use.
Recent research investigations confirm what school
administrators and teachers have realized for many
years: The number of kids taking psychotropic medication
has increased substantially in recent years. That
increase is consistent with the rising number of kids
diagnosed with ADHD.
Psychotropic medications treat a variety
of behavior, emotional, and mental disorders,
children treated with medication for ADHD are prescribed
stimulant medication, such as methylphenidate (Ritalin
is the brand name). Stimulants increase nervous system
alertness by stimulating neurotransmitters in the brain,
according to the Academy
of Child and Adolescent Psychiatry (AACAP). When
used, the stimulant helps a child who has ADHD focus and
reduces the child's excess fidgeting and hyperactivity.
Highlights of Research on Increases in Drug
Treatment for Childhood ADHDThe following
are statistics detailed in the story.
*The number of preschool children
being treated with medication for ADHD tripled
between 1990 and 1995.
*The number of children ages 15 to 19
taking medication for ADHD has increased by 311
percent over 15 years.
*The use of medication to treat
children between the ages of 5 and 14 also
increased by approximately 170 percent.
*White, suburban elementary children
are given medication to treat ADHD at more than
twice the rate of African American students.
*Methylphenidate (commonly known as
Ritalin) is manufactured at two and a half times
the rate of a decade ago.
*The majority of children and
adolescents who receive stimulants for ADHD do
not fully meet the criteria for ADHD.
*Many children who do meet the
criteria for ADHD are not being treated.
*About 80 percent of the 11 million
prescriptions written for methylphenidate
(Ritalin is the brand name) each year are
written for children.
The increase in the number of prescriptions doctors
write for treating ADHD is staggering. According to the
Testimony of Terrance Woodworth, a deputy director
of the Drug Enforcement
Administration, the number of prescriptions written
for methylphenidate has increased by a factor of five
since 1991. About 80 percent of the 11 million
prescriptions doctors write for that medication each
year treat childhood ADHD, he said. In addition,
production of Adderall and Dexedrine, also used to treat
ADHD, has risen 2,000 percent in nine years.
The increasing use of stimulant medication to treat
ADHD in the United States differs significantly from
practices in the rest of the world, according to United
Nations data, Woodworth said. The U.S. produces and
consumes about 85 percent of the world's production of
The significant increase in stimulant medication
prescribed to children has raised concerns that our
society is choosing quick-fix remedies to treat ADHD.
"How we deal with our kids' problems reflects our
thinking and a much larger problem in our culture," said
Diller, who practices behavioral pediatrics in
California and is author of Running on Ritalin: A
Physician Reflects on Children, Society and Performance
in a Pill (Bantam Books, 1998).
Although Diller prescribes stimulant medication for
children with ADHD, he questions the large number of
children currently on the medication in the United
INCREASED DRUG USE FOR KIDS OF ALMOST ALL AGES
The use of stimulant medication is not seen just in
school-aged children. The number of preschool children
using stimulant medication for ADHD has increased
significantly as well. A study, Trends
in the Prescribing of Psychotropic Medications to
Preschoolers, published in the Journal of the American
Medical Association last February, found that
psychotropic medication use tripled in preschool
children ages two to four over a five-year span.
The researchers also stated that though the use of
methylphenidate had significantly increased among all
age groups, it had increased by 311 percent for 15-
through 19-year-olds during the past 15 years. Use among
children ages 5 to 14 increased by approximately 170
SURGEON GENERAL CONCURS
Surgeon General David Satcher also substantiates the
significant increases in stimulant medication use with
children, attributing the rise to better diagnosis and
treatment of the disorder.
According to Mental
Health: A Report of the Surgeon General (Chapter 3),
methylphenidate is manufactured today at two and a half
times the rate it was a decade ago. The report also
notes that though the overall numbers are up, treatment
rates are lower for some groups, including girls,
minorities, and children receiving care through public
The report sites a 1998 study by researchers Adrian
Angold and E. Jane Costello, who found that the majority
of children and adolescents who receive stimulants for
ADHD do not fully meet the criteria for ADHD. They also
found that many children who do meet the criteria for
ADHD are not being treated.
Peter Jensen, who has headed major National Institute of
Mental Health (NIMH) studies on ADHD and is an
assistant professor of psychiatry at Columbia
University, agrees with Angold and Costello's findings
that the majority of children receiving stimulant
medication may not fully meet the criteria.
"It's likely there is a bit of both [under diagnosis
and over diagnosis]," Jensen told Education World. "This
always happens when public awareness increases that
there could be some over diagnosis. But under diagnosis
and under treatment are still happening."
The large increases in the use of psychotropic
medications are consistent with the rise in the number
of children being diagnosed with emotional and
behavioral problems. Another study, Increasing
Identification of Psychosocial Problems: 1979-1996,
published in the journal Pediatrics in June 2000,
found the number of children identified with
psychosocial problems nearly tripled between 1979 and
1996. The number of children diagnosed with emotional or
behavioral problems jumped from 6.8 percent to 18.7
percent among four- to 15-year-olds. Attention problems
showed the greatest increase, consistent with a
significant rise in the number of prescriptions for
ADHD, up from 32 percent to 78 percent.
MORE SUBURBAN WHITE KIDS ON MEDS
The disparity of treatment noted by the surgeon
general was further confirmed in a study funded by the
Maryland Department of Education. The researchers found
that white, suburban elementary school children are
using medication for ADHD more than twice the rate of
African American students. The study, Stimulant
Treatment in Maryland Public Schools, was published
in the September 2000 issue of the journal
Of the 3 percent of the Maryland students who use
medication to treat ADHD, the study found that more boys
are treated for the disorder than girls. The study also
found that about half the children receiving
methylphenidate had special education status, also
consistent with the Angold and Costello study cited by
Surgeon General Satcher.
"You don't have to be ADHD to be on stimulants," said
Daniel Safer, who wrote the report for the Maryland
Department of Education. "Other kids may benefit from
stimulants, which are quite safe."
Safer, adjunct associate professor of pediatrics and
psychiatry at the Johns Hopkins Medical Institutions,
said the Maryland data also raise questions about access
to medical systems and how cultural attitudes play a
role in whether parents agree to put their child on
INCREASED CRITERIA AND AWARNESS = MORE ADHD
Safer explains that the expanded criteria of symptoms
for ADHD along with increased awareness of those
symptoms are why more children are being diagnosed with
ADHD. The criteria were broadened in 1994 by the American Psychiatric
Howard Abikoff, the Pevaroff Cohn professor of child
and adolescent psychiatry and director of research at
the New York University Child Study Center, agrees with
Safer that there are a number of factors why more kids
are being diagnosed with ADHD. However, he defends the
broader APA criteria for ADHD. Although the criteria for
ADHD have been expanded, lots of work went into
pinpointing the appropriate symptoms for ADHD, he said.
"Those criteria didn't just pop out of our heads," he
said. "There were a number of field trials during the
late 1980s and 1990s to study the disorder. The criteria
that were chosen are based on comprehensive research and
data. The bottom line is that it was not done by the
seat of our pants, but by evaluating data collected on
large samples of children."
Diane Weaver Dunne
2000 Education World
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