Use of Stimulants for ADHD Continues to Climb

Stimulants such as Ritalin and Adderall to treat attention deficit hyperactivity disorder (ADHD) were prescribed at rates that increased steadily from 1996 to 2008, according to a study conducted by the National Institutes of Health (NIH) and the Agency for Healthcare Research and Quality (AHRQ).

But it is important to remember that they are not the only tool that clinicians can use, said Benedetto Vitiello, MD, of NIH’s National Institute of Mental Health (NIMH), a co-author of the study, which was published online ahead of print in the American Journal of Psychiatry.

“Stimulant medications work well to control ADHD symptoms, but they are only one method of treatment for the condition. Experts estimate that about 60% of children with ADHD are treated with medication,” Vitiello said in a statement released by NIH.

For the study, Vitiello and Samuel Zuvekas, PhD, of AHRQ examined data from the Medical Expenditure Panel Survey, a nationally representative annual survey of US households sponsored by AHRQ. Its goal was to determine prescribed stimulant use among children under age 19 from 1996-2008.

The researchers found a steady increase from 2.4% in 1996 to 3.5% in 2008. Use of the drugs grew at an average of 3.4% each year, which is substantially less than the growth rate between 1987 and 1996, which averaged about 17% per year.

Prescription use among children aged six to 12 was highest, going from 4.2% in 1996 to 5.1% in 2008. But the fastest growth of prescribed use occurred among those aged 13 to 18, which went from 2.3% in 1996 to 4.9% in 2008. “This continuous increase among teens likely reflects a recent realization that ADHD often persists as children age. They do not always grow out of their symptoms,” Vitiello said.

Prescription use among preschoolers remained very low at 0.1% from 2004 onward and decreased between 2002 and 2008, suggesting that stimulant use among very young children continues to be disfavored.

But boys continued to be three times more likely to be prescribed a stimulant than girls, and use among white children (4.4% in 2008) continued to be higher than among black (2.9%) or Hispanic children (2.1%).

In addition, rates were substantially lower in Western states compared to other regions of the nation, with no increase in recent years, a finding consistent with other studies. Rates in the Northeast, however, increased from 2.7% in 2002 to 4.6% in 2008.

“These persistent differences in prescribed stimulant use related to age, racial and ethnic background, and geographical location indicate substantial variability in how families and doctors approach ADHD treatment throughout the United States,” Zuvekas said.

The researchers concluded that when comparing the rates of prescribed use with the estimated prevalence of ADHD diagnosis, it appears that many children with ADHD are not treated with stimulants. “The children with the most severe symptoms are more likely to be taking stimulants. Those with milder symptoms are more likely being treated with psychosocial treatments or other non-stimulant medications.”

SourcePrescribed Stimulant Use For ADHD Continues to Rise Steadily [National Institutes of Health]