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Ritalin Alert!
by Gretchen LeFever and Dee Dickinson
Children in two southeastern Virginia cities are being treated with drugs for attention deficit and hyperactivity disorder (ADHD) at two to three times the expected rate, according to a local study appearing in the September 1, 1999 issue of the American Journal of Public Health.
Dr. LeFever reports that 8-10% of children in elementary grades in southeastern Virginia routinely received a dose of ADHD medication in school, yet the disorder has been estimated to affect only 3-5% of school-age children in the U.S. according to the National Institutes of Health. Researchers reviewed and verified records of students enrolled in grades two through five who received ADHD medication and found medication use was linked with several social and educational characteristics.
For example, medication was used by three times as many boys a girls and twice as many whites as African American students. Children who were young for their grade were much more likely to be on ADHD medication, which also increased with years in schools. By 5th grade 18-20% of white boys were receiving ADHD medication. The study suggests that criteria for diagnosing ADHD vary widely across the U.S. with some groups being over diagnosed and over treated.
Methylphenidate, also known as Ritalin, is the most common ADHD Questions such as how many other regions have high ADHD rates, why they vary, and how health and educational outcomes vary according to treatment rates remain to be studied.
In her current report, LeFever suggests that in schools where Ritalin is being over prescribed "parents and professionals may have misconceptions about the behavior of young children, which may have contributed to an extremely high percentage of young-for-grade children receiving psychotropic medication. Follow-up studies are needed to address issues such as professionals' appreciation of developmentally appropriate inattention, impulsivity, and hyperactivity; the district's school readiness policies; and use of medication to enhance performance of precocious or academically advanced students."
LeFever also notes that "clinicians may have used a diagnosis of ADHD to describe children with behavioral symptoms associated with other disorders, such as depression, anxiety, learning disabilities, or child abuse. Describing such children as having ADHD may do them a disservice by depriving them of in-depth evaluations and etiologically based interventions that include requisite nonpharmacologic interventions. Inappropriate application of the diagnosis also undermines the legitimacy of the disorder for children with substantiated neurologic problems. The tendency to assume a biological cause of difficult child behavior, without adequately examining potential environmental contributions, has been observed in the related field of child temperament."
In conclusion, Dr. LeFever warns that "because of the paucity of data on the long-term consequences of stimulant medication and the unexplained racial and socioeconomic differences in ADHD treatment, the steady rise in the use of ADHD medication is an important public health issue. Further research is needed to clarify the long-term social, psychological, and biological consequences of ADHD drug therapy; to determine the prevalence of multimodal ADHD treatment; and to provide a framework for design and implementation of educational programs that ensure appropriate use of stimulant medications and nonpharmacologic interventions."
In September 1999, the Center for Disease Control and Prevention (CDC) and the Department, National Center for Environmental Health, and the Department of Education sponsored a conference on Attention Deficit Hyperactivity Disorder: A Public Health Perspective Dr. LeFever and other ADHD experts were invited to the conference to help the CDC establish a public health research agenda with regard to ADHD. Participants emphasized the need for additional population-based studies to determine the prevalence of ADHD nationwide and to identify genetic, environmental and sociological risk factors contributing to the disorder. Hopefully, such studies will identify communities where ADHD is over diagnosed, as well as communities where ADHD may be under diagnosed, and improve our understanding and treatment of children with developmental and behavioral disorders.
The above article was compiled by Dee Dickinson from material sent to New Horizons for Learning by Gretchen B. LeFever, Ph.D.
Dr. LeFever is a practicing Clinical Psychologist and Founding Director of the School Health Initiative for Education (SHINE), a coalition in eastern Virginia comprised of school districts, health care providers, and others dedicated to improving the mental and physical health of school children. She has presented and published a number of papers on the epidemiology, diagnosis, and management of attention deficit hyperactivity disorder (ADHD), and is a nationally recognized expert in child behavioral and developmental disorders. For further information or to report on prevalence of Ritalin treatments in your area, please contact Dr. LeFever at glefever@regent.edu.
© October 1999 New Horizons for Learning
This information is provided by:
Office of State Superintendent of Public Instruction
Special Education
P O Box 47200
Olympia, WA 98504-7200
(360) 725-6088
Fax (360)586-1631
E-mail: dgill@ospi.wednet.edu
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