Are Stimulants Overprescribed? Treatment of ADHD in Four U.S. Communities

Abstract

Objective: To address rising concerns about the possible overdiagnosis of attention-deficit hyperactivity disorder (ADHD) and overtreatment with stimulants.To date, almost no studies have examined ADHD in unbiased community-based studies, ascertaining both the prevalence of the diagnosis within nonreferred populations and the extent to which various treatments (i.e., stimulant medication, mental health treatments, and educational interventions) are used. Method: As a part of the Methods for the Epidemiology of Child and Adolescent Mental Disorders (MECA) Study, the authors examined epidemiological survey data obtained from 1,285 children and their parents across 4 US. communities. Analyses examined the frequency of children's ADHD diagnosis, the extent to which medications were prescribed, as well as the provision of other services (e.g., psychosocial treatments, school-based educational interventions). Results: Findings indicated that 5.1% of children met full DSM-//I-RADHD criteria across the pooled sample. Only 12.5% of children meeting ADHD criteria had been treated with stimulants during the previous 12 months. Some children who had been prescribed stimulants did not meet full ADHD diagnostic criteria, but these children manifested high levels of ADHD symptoms, suggesting that the medication had been appropriately prescribed. Children with ADHD were generally more likely to receive mental health counseling and/or school-based interventions than medication. Conclusions: Medication treatments are often not used in treating ADHD children identified in the community, suggesting the need for better education of parents, physicians, and mental health professionals about the effectiveness of these treatments. On the basis of these data it cannot be concluded that substantial "overtreatment" with stimulants is occurring across communities in general. J. Am. Acad. Child Adolesc. Psychiatry: 1999, 38 (7):797-804. Key Words:attention-deficit hyperactivity disorder, attention deficit, hyperactivity, stimulants, misdiagnosis, services, treatment.Recent media reports indicate that the public has become increasingly concerned about the apparent dramatic rise in the diagnosis of attention-deficit hyperactivity disorder (ADHD) and the prescription of psychostimulant

Training Cognition in ADHD: Current Findings, Borrowed Concepts, and Future Directions

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The Prevalence of Attention-Deficit/ Hyperactivity Disorder among Primary School Students in an Iranian Rural Region

“…Some epidemiological studies of ADHD, in Iran as well as in the rest of the world, have been conducted with clinic-referred samples of children (e.g., Jensen et al, 1999;Rowland, Lesesne, & Abramowitz, 2002) which present difficulties in precisely reflecting the actual epidemiologic rates. Therefore, populationbased prevalence studies are valuable in order to enhance the knowledge about ADHD among different populations in varying regions.…”

Treatment of Attention-Deficit/Hyperactivity Disorder: Overview of the Evidence

“…7,8,66 However, only families assigned to the combined treatment group showed consistently greater benefits than the families in the community treatment group across other outcomes domains (eg, disruptive behavior, parent-child relations, social skills). 7,8,66 Children with ADHD who had coexisting anxiety disorders responded well in both of the treatment groups that included the intensive behavioral interventions.…”

“…The National Institute of Mental Health Collaborative Multisite Multimodal Treatment Study of Children With Attention-Deficit/Hyperactivity Disorder 7,8,66 included 579 children with ADHD (combined subtype) who were assigned randomly to 1 of 4 treatment groups: state-of-the-art medication management, intensive behavioral intervention, a combination of the 2 interventions, and a community treatment control group who received "usual care" (most commonly medication). Outcomes were assessed in multiple domains and included measures reflecting the core symptoms of ADHD as well as measures of co-occurring problems in social skills, parent-child relations, oppositional defiant behavior, internalizing behavior problems (eg, anxiety), and academic achievement.…”