MEDICATIONS: RECENT TRENDS IN CHILDREN'S STIMULANT PRESCRIPTIONS

March 30, 2006 — The percentage of U.S. children taking stimulants for attention deficit hyperactivity disorder (ADHD) remained at a constant level between 1997 and 2002. These data were collected by the federal government and are summarized in an article in the April 2006 issue of The American Journal of Psychiatry (AJP), the official journal of the American Psychiatric Association (APA).

The article by Samuel H. Zuvekas, Ph.D., Agency for Healthcare Research and Quality, Benedetto Vitiello, M.D., National Institute of Mental Health and Grayson S. Norquist, M.D., M.S.P.H., University of Mississippi Medical Center, "Recent Trends in Stimulant Medication Use Among U.S. Children," comes from the Medical Expenditure Panel Survey. This is a nationally representative survey and included more than 7,000 children in each of the five years. Prescription drug use was determined by the families' responses and pharmacy surveys. The stimulants included were methylphenidate (Ritalin), dexmethylphenidate (Focalin), pemoline (Cylert), amphetamine (Adderall) and dextroamphetamine (Dexedrine, Dextrostat).

"This study provides evidence that the use of stimulants in children is not increasing indiscriminately in the U.S. population. The side effects of stimulant drugs mandate good medical judgment to balance therapeutic effect with risk," stated Robert Freedman, M.D., AJP editor-in-chief. "The fear that serious, but rare, side effects will become common does not appear to be supported by current epidemiological evidence."

In 1997, 2.0 million U.S. children (2.7 percent) were treated with stimulant drugs. In 2002, 2.2 million children were treated (2.9 percent). Rates were highest among children ages 6-12 years old. The rates were also higher for boys, whites, and children with functional impairment than for other children. However, the rates for these subgroups also did not change from 1997 to 2002.

Stimulants are the most commonly prescribed treatments for children with ADHD. They are effective for 70-80 percent of patients. Paradoxically, stimulants diminish motor overactivity and impulsive behaviors in children with ADHD and allow them to sustain attention.

An accompanying editorial by Andrés Martin, M.D., M.P.H., Yale Child Study Center, comments on how doctors and families should regard the current controversies about stimulant use in children: "The past decade clearly has shown potential problems associated with psychotropic use, but it has also provided research that demonstrates the tremendous burden of developmental psychopathology and the availability of effective interventions."