Kids' use of stimulants varies widely nationwide

CHICAGO -- Prescription rates for Ritalin and similar attention deficit disorder drugs vary dramatically nationwide, research suggests, underscoring ambivalence about medication that has been widely praised -- and widely maligned.

While the disorder's prevalence is not thought to vary substantially among geographic groups, the study found rates ranging from 1.6 percent of children's prescriptions examined in Washington, D.C., to 6.5 percent in Louisiana. Significantly higher rates were found in the South and Midwest than in the West.

Overall, about 4 percent of prescriptions examined for children aged 5 to 14 in 1999 were for stimulants including Ritalin.

The study was released Monday in February's Pediatrics. It was done by researchers at Express Scripts Inc., a St. Louis-based pharmacy benefits management company.

Lead researchers Emily Cox and colleagues reviewed a nationally representative sample of company prescription claims for 178,800 children throughout 1999. The claims were for all types of medication.

Ritalin was common

Methylphenidate, including Ritalin, was the most common stimulant prescribed. Dexedrine and other amphetamines were among other drugs used.

Stimulant use was more prevalent among white children and those from higher-income families.

Cox said the rates likely are representative of the nation's commercially insured population. The study did not look at Medicaid claims.

The American Academy of Pediatrics' guidelines for treating attention deficit hyperactivity disorder cite data suggesting between 4 percent and 12 percent of school-age children are affected, or as many as 3.8 million youngsters, most of them boys.

The researchers said that while they did not determine if higher prescription rates represented overuse or if lower rates represented underuse, "both may be occurring."

The variations should be examined "to reduce the risk to children from unnecessary drug therapy as well as the negative health and emotional consequences to children with untreated medical conditions," the researchers said.

Factors that might have contributed to the variations include direct-to-consumer ads, physician practice styles, parents' and teachers' values and anti-Ritalin campaigns, the study said.

The AAP guidelines, issued in 2001, recommend stimulants and behavioral therapy for treating ADHD. The American Academy of Child and Adolescent Psychiatry issued similar guidelines in 1997, two years before the study period.

Critics, including some doctors, worry that the drugs sometimes are promoted by schools and others as a "quick fix" without other appropriate treatment. Also, some parents don't like the idea of giving their children such strong medication.

The AAP's guidelines say stimulants are generally safe and that side effects such as decreased appetite and jitteriness are usually mild and short-lived.

"In areas where only 1 to 2 percent of children are receiving a treatment which is known to be beneficial, we need to ask why," said Dr. David Fassler, a member of the American Academy of Child and Adolescent Psychiatry's governing council.

"Research has clearly documented that this is a condition that exists across countries and across socio-economic groups. There are clearly discrepancies in recognition of the condition and potentially in the approach to treatment," said Fassler, who was not involved in the study.

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