Attention disorder care gets hard look
UC profs study social, economic reasons behind choice to medicate kids diagnosed with ADHD
By Rebecca Vesely, STAFF WRITER
An unusual study is under way at the University of California, Berkeley that could help parents, doctors, teachers and lawmakers better grasp the economic and social reasons why some kids are receiving drug therapy for attention deficit hyperactivity disorder, or ADHD.
Dr. Richard Scheffler, a UC Berkeley professor of health economics and public policy, and Dr. Stephen Hinshaw, a psychology professor and lead-
ing expert on ADHD, last month received a $900,000 grant from the National Institute of Mental Health for the three-year project.
Unlike most studies that look at the effects of psychostimulant drugs — such as Ritalin — on kids diagnosed with ADHD, researchers aim to uncover the economic and policy issues behind prescription trends.
“There’s enormous variation in the use of these drugs across state lines and communities,” Scheffler said.
ADHD is the most commonly diagnosed behavioral disorder in children. In the decade lead-
ing up to 2001, the number of people — mostly children — diagnosed with ADHD grew fivefold, from 900,000 to 4.5 mil-
lion, according to the National Centers for Disease Control and Prevention. That rise coincided with national policy changes
that allowed children with ADHD to receive special accommodations at school.
At the same time, the num-
ber of prescriptions for Ritalin, Adderall and other psychostimulants to treat ADHD rose by about 50 percent over the past decade.
Using data from the U.S. Drug Enforcement Agency, researchers will track shipments of these drugs to the pharmacies dispensing them to see which communities are heavy prescribers.
In addition, they will drill down into those communities and examine underlying policy decisions, teacher influence and health care issues, such as access to child psychiatrists.
Clinical research isn’t telling the whole story, Hinshaw said. “All this research is taking place against a backdrop of quickly changing market forces and treatment practices,” he said.
Some states have enacted legislation that limits school influence in drug treatment.
To get a better picture of treatment and diagnosis, UC Berkeley researchers will have access to the medical records of 14,000 children enrolled with Kaiser Permanente Northern California.
This piece of the puzzle is key, the researchers said, because the patient records will include information about race, ethnicity, family history, area of residence and compliance in drug therapy.
“Are poorer kids being underdiagnosed and rich kids being overmedicated? We hope to get a sense of that,” Scheffler said.
The study is the first of its kind — and atypical of what the National Institutes of Mental Health usually funds, a spokesman for the federal grant-making and research institute said, because of the focus on sociology and economics of drug therapy.
Skepticism about drug treatment for ADHD relates to the ambiguous nature of diagnosis and stigma surrounding mental illness, Hinshaw said.
There is no test for ADHD. Rather, diagnosis is based on observed behavior and family and medical history.
When left untreated, ADHD can have a significant effect on a child’s growth and development. Studies have shown that untreated children with ADHD have higher rates of school failure, underemployment, illicit drug and alcohol use and accidental injuries.
“The problem is many practitioners don’t follow well-established guidelines for diagnosis and treatment,” Hinshaw said. “There’s a brief pediatric visit and sporadic follow-up and monitoring. Some kids are diagnosed too quickly and some, such as girls or inner city children, may get ignored and underdiagnosed. You need an accurate diagnosis first.”
Contact Rebecca Vesely at
[Oakland Tribune Mon April 5, 2004]