A new government report finds that using prescribed stimulants to treat attention-deficit hyperactivity disorder (ADHD) has grown steadily, though slowly.
However, researchers note that utilization of stimulant medication varies by geographic region and by ethnicity, and that use in some regions and for some age groups, is decreasing.
The study, conducted by the National Institutes of Health (NIH) and the Agency for Healthcare Research and Quality (AHRQ), is published in the American Journal of Psychiatry.
ADHD is now recognized as one of the most common childhood disorders, and can continue through adolescence and adulthood.
The condition is frequently treated with stimulants such as methylphenidate (e.g., Ritalin), amphetamines (e.g., Adderall) or other types of medications. Behavioral therapies can also be effective.
Use of stimulant prescriptions surged during the 1990s before slowing in 2002. According to researchers, recent reports suggest that the prescribed use of these medications and the diagnosis of ADHD have continued to rise.
Based on the Health Resources and Services Administration’s National Survey of Children’s Health, the percentage of children age 4-17 years diagnosed with ADHD increased from 7.8 percent in 2003 to 9.5 percent in 2007.
“Stimulant medications work well to control ADHD symptoms, but they are only one method of treatment for the condition. Experts estimate that about 60 percent of children with ADHD are treated with medication,” said co-author Benedetto Vitiello, M.D., of NIH’s National Institute of Mental Health (NIMH).
In the current survey, Dr. Vitiello and Samuel Zuvekas Ph.D., of AHRQ examined data from a nationally representative annual survey of U.S. households, to determine prescribed stimulant use among children under age 19 from 1996-2008.
They found a slow but steady increase—from 2.4 percent in 1996 to 3.5 percent in 2008.The rate grew an average of 3.4 percent each year, which is substantially less than the growth rate between 1987 and 1996, which averaged about 17 percent per year.
The investigators discovered prescriptions are used most often among 6-12-year-olds. However, the fastest growth of prescribed use occurred among 13-18-year-olds.
“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,” said Vitiello.
Prescription use among preschoolers remained very low and in fact decreased between 2002 and 2008, suggesting that stimulant use among very young children continues to be disfavored.
Boys continued to be three times more likely to be prescribed a stimulant than girls, and use among white children continued to be higher than among black or Hispanic children (4.4 percent in 2008 among whites, compared to 2.9 percent in blacks and 2.1 percent in Hispanics).
A new finding is the growth of prescribed stimulant use among racial and ethnic minorities, likely suggesting more recognition of ADHD and acceptance of psychopharmacological treatment among these groups. In addition, investigators discovered utilization 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.
In comparison, rates in the Northeast increased from 2.7 percent in 2002 to 4.6 percent 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,” said Zuvekas.
All in all, 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, concluded the authors.
“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,” they said.