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The Extent of Drug Therapy for Attention-Deficit/ Hyperactivity Disorder Among Children in Public Schools

By: Gretchen B. LeFever, Keila V. Dawson, and Ardythe L. Morrow

Research question

The purpose of the study was to determine if the prevalence rate for use of medication with ADHD children was the same in different communities. The authors state:

"No national study of the proportion of children diagnosed with or treated for ADHD has been conducted. Studies involving children and youth in various regions of the United States and other countries have yielded ADHD prevalence estimates ranging from 1% to almost 26%…Despite the lack of national prevalence data, the prevailing expert opinion is that between 3% and 5% of US children have the disorder and that fewer that 3% of school-aged children receive medication for ADHD."

Method

All public school students in enrolled in grades 2 through 5 in two districts in Virginia were included in the study. Health records of students who were routinely administered medication during school hours were used to identify children with identified ADHD. School records were reviewed to make certain each child had a signed prescription note from a doctor stating a need for medication based on a diagnosis of ADHD.

Students were also classified according to age for grade. Children who were younger than expected age for grade were in one group; same as age for group in another and older than age for grade in a third group.

Results

  • 90% of the children receiving medications were given mythylphenidate (Ritalin).
  • The percentage of children receiving medication increased with age.
  • The overall proportion of students receiving medication in school for ADHD was 8% in one school and 10% in the other.
  • Proportion of medication use were consistent in the two systems for gender and race; 17% of White boys, 9% of Black boys, 7% White girls, 3% Black girls received medication for ADHD.
  • In City A there was a 3.7% use of medication in children who were young for grade as contrasted with 12.4% for those who were old for grade. In City B, 62.7% of the young for grade with diagnosed ADHD used medication; and 10% of old for grade used medication.

Limitations of the study

  • Though medical diagnosis was used, ADHD diagnosis is not a precise art. Some clinicians may use behavioral acting out, which could be due to many factors as evidence of ADHD.
  • There were some indications that neighborhood, which may relate to socioeconomic status, may have affected rate of the use of medication.

Conclusion

The authors conclude that despite the limitations of the study, "the high prevalence rates suggest that ADHD was overdiagnosed and overtreated in some groups of children."

Click to see graph

Table 1. Characteristics of 2 Virginia cities in which prevalence of drug therapy for ADHD was studied, 1995-1996*
  City A City B
Demographic Characteristics
Median household income, $ 24,601 36,271
Individuals living in poverty, %

All

17 6

Black

29

13

White

7 4

Children < 18 y

27 8
Adults males in military service, % 3 11
Students enrolled in public school, % 91 88
School District Characteristics    
Students in public school, No. 183,000 75,819
Average expenditure per student, $ 4,856 4,278
Military families, % NA 32
Students in grade 2-5, No. 5,767 23,967
Percentage of students in grade 2-5 receiving ADHD medication in school    
No. in group (% receiving medication)    
By race and sex    

Black boys

1,905(9.1) 2,839(8.9)

White boys

1,006(16.8) 8,585(16.6)

Black girls

1,941(3.3) 2,740(2.8)

White girls

841(6.7) 8,153(6.8)

All

5,693(8.2) 22,217(9.9)
By age-for-grade category    

Young for grade

295(3.7) 770(62.7)

Expected age for grade

5,230(8.2) 22,297(8.0)

Old for grade

234(12.4) 878(10.1)

*City-specific data were drawn from the 1990 US Census. All other data were obtained from school district databases.

Table 2. Odds Ratios (ORs) for Use of medication for ADHD among public school students in grades 2 through 5, by selected characteristics: Virginia, 1995-1996
  City A (n=5,767) OR (95% Cl) City B (n=23,967) OR (95% Cl)
Male 3.0 (2.42, 3.70)* 2.8 (2.52, 3.05)*
White

2.1 (1.74, 2.54)*

2.2 (2.03, 2.41)*
Young for grade 0.4 (1.28, 4.33)* 20.8 (17.86, 24.27)*
Old for grade 1.6 (1.09, 2.43)* 1.0 (0.82, 1.29)

* Significant at P<0.001.

(1999) LeFever, Gretchen B. Ph.D.; Dawson, Keila V. MEd; Morrow, Ardythe L. Ph.D., American Journal of Public Health, 1359-1364.