One in 10 Virginia Elementary School Students Receives ADHD Treatment

From the WebMD Archives

Nov. 16, 1999 (New York) -- ADHD (attention deficit hyperactivity disorder) appears to be reaching epidemic proportions in Virginia. A report published in a recent issue of the American Journal of Public Health delivers alarming news: in two Virginia cities, between 8% and 10% of children in grades two to five receive medication for ADHD at school.

"We found the rate of ADHD medication use in two school districts in Virginia was ... two to three times higher than national estimates of the disorder," Gretchen B. LeFever, PhD, who headed the reporting team, tells WebMD. "Although we can't generalize from these findings to what's going on across the country, the DEA [Drug Enforcement Agency] suggests there are regions within almost every state that look similar to our region in Virginia."

LeFever is with the center for pediatric research at Children's Hospital of The King's Daughters, affiliated with the Eastern Virginia Medical School in Norfolk.

In the study, information was gathered during the 1995-1996 school year on almost 30,000 public school children in grades two to five in the two cities. One city was larger and poorer overall and had a higher percentage of black inhabitants. The health-related information was merged with 1990 U.S. Census information, which contained specific regional data. The researchers then looked through school records to identify those children taking medication for ADHD from a school nurse.

While the overall proportion of children taking ADHD medication was 8% to 10%, the percentage increased as children got older. By the fifth grade, almost 20% of boys were taking ADHD medication at school.

One of the most surprising findings, according to LeFever, is the high rate of medication use in the more affluent school districts, especially among children who were young for their grade. Almost 63% of these children in one city were being treated for ADHD. "This is an extraordinary figure. It suggests parents, health professionals, teachers, or some combination of those may have important misunderstandings," LeFever says, about what constitutes 'normal' inattention for grade-school children.

"It raises a lot of questions as to whether immaturity is being seen as a . . . disorder instead of part of the normal developmental process," LeFever tells WebMD.

The report also showed that white children are more likely to be treated for ADHD than their black classmates, a finding supported by other studies of the extent to which ethnic background affects whether children receive needed psychiatric treatment. "One of their more interesting findings is, why do [white] children get evaluated and treated and [black] children do not?" Dan Connor, MD, tells WebMD in an interview seeking an independent opinion of the report. Connor is director of pediatric psychopharmacology at the University of Massachusetts Medical School in Worcester.

Connor adds that while the report produced interesting findings, the experiences of two school districts can?t be generalized to the entire population. He also believes that, in general, "ADHD is underdiagnosed and undertreated" in U.S. children.

Peter Jensen, MD, associate director for child and adolescent research at the National Institute of Mental Health in Bethesda, Md., agrees with Connor. He says that concerns about overprescribing of stimulants for ADHD are unwarranted. "Based on the national data, it is likely that only about half of ADHD children are being treated [with medication]," Jensen tells WebMD.

Concerning the high rates reported in Virginia, Jensen says, "There are bound to be site-to-site and regional variations, so all regional variations should be put in that perspective."

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