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Use of psychostimulants to treat ADHD will be examined
‘Stakes are too high’ not to offer children best available treatment, campus expert asserts

| 17 March 2004

A $900,000 federal grant over the next three years will help Berkeley researchers understand the economic issues and policy decisions surrounding the use of medications to treat attention deficit hyperactivity disorder (ADHD), the most commonly diagnosed behavioral disorder in children today.

The grant from the National Institute of Mental Health (NIMH) will support market analysis of the economic, demographic, state regulatory, school policy, health system and other factors influencing the supply and demand for psychostimulants. The researchers will track shipments of the drugs to the pharmacies dispensing them to better understand which communities are utilizing the psychostimulants, and why that use varies greatly from one region to the next.

In addition, the investigators will have access to records of an estimated 14,000 children enrolled with Kaiser Permanente’s Northern California practice to obtain a more detailed picture of those who are diagnosed with ADHD, including information on race, ethnicity, birth characteristics, family history and place of residence.

According to a 2002 report by the U.S. Centers for Disease Control and Prevention, more than 3.5 percent of school-age children in the country are diagnosed with ADHD, and more than half of them regularly take psychostimulant medication, predominantly Ritalin or its longer-acting formulations.

Previous studies have found that, between 1990 and 2001, the number of people, mostly children, diagnosed with ADHD grew fivefold, from 900,000 to 4.5 million. That rise roughly coincided with policy changes from the Department of Education that allowed children with ADHD to receive special accommodations at school.

There has also been concurrent growth in the use of psychostimulant medications to treat the disorder, with the number of prescriptions for Ritalin and related drugs rising at least 50 percent in the past decade.

“Whether these drugs are being overused or underused is a subject of intense debate,” said Richard Scheffler, professor of health economics and public policy and principal investigator of the grant. “We expect this research to provide some solid data so that parents, educators, and clinicians can better meet the needs of children with ADHD.”

In response to the controversy over the use of medication for ADHD, some states have enacted laws that limit the extent to which schools can pressure parents to put their children on psychostimulants. In Connecticut, for example, it is now illegal for school staff members to discuss ADHD drug treatments with parents, and similar legislation has been introduced in at least five other states.

It may not be surprising, then, that use of these treatments varies dramatically across state and city borders. Data from the federal Drug Enforcement Agency show that distribution rates of psychostimulant drugs vary up to threefold across states and tenfold within states. Studies have also found that in some communities, 10 to 20 percent of schoolchildren are receiving psychostimulants for ADHD compared with almost no children in other areas.

“What’s going on here is either an epidemic or an incredible uncertainty about ADHD diagnosis, and we ought to be concerned about it,” said Scheffler, who is also director of Berkeley’s Petris Center on Healthcare Markets and Consumer Welfare.

For the project, Scheffler is collaborating with professor of psychology Stephen Hinshaw, one of the country’s leading experts on the causes, treatments, and long-term outcomes of ADHD.

“Because ADHD is a behavioral and emotional disorder that is based in the brain, some people are skeptical of the diagnosis — which does not involve a cut-and-dried blood test — and of the use of drugs to treat it,” said Hinshaw, co-principal investigator of the grant. “The rates of medication for childhood asthma have also increased dramatically in the last 20 years, but we don’t hear a public outcry about aggressive treatment for asthma the way we do for ADHD.”

Yet making sure children with ADHD get proper treatment is just as critical, said Hinshaw. He points out that ADHD, when left untreated, can have a significant impact on a child’s future growth and development.

“Used correctly, medications may help correct abnormal brain development,” said Hinshaw. “Used incorrectly, they may be adding to the problems, so this needs to be studied very carefully.”

Studies have shown that untreated children with ADHD have a higher risk for delinquency, school failure, underemployment, and accidental injuries than do their non-disordered peers.

“The time to treat ADHD is when the child is still young and when the brain is developing very quickly,” said Hinshaw. “These are kids that deserve the best treatments available, and we need to make sure they are delivered equitably, and with quality care. The stakes are too high for us not to.”