MONDAY, Feb. 3, 2003 (HealthDayNews) -- Children are prescribed Ritalin and other stimulants at vastly differing rates depending what part of the country they're in.
A study appearing in the February issue of Pediatrics reports that in Louisiana, for instance, such drugs were prescribed four times as often as in the District of Columbia.
The study also found higher use in the South and Midwest compared with the West, and in higher-income communities.
"These are meaningful differences," says Emily Cox, lead author of the study and manager of outcomes research at Express Scripts, one of the nation's largest pharmacy benefit management companies.
The study authors suspect that both overuse and underuse of these drugs are at play. Either scenario could pose risks for the child, Cox says.
Given that 5 percent to 9 percent of the school-age population has attention deficit hyperactivity disorder (ADHD), however, underuse seems a more likely phenomenon, says Dr. Keith Ditkowsky, director of clinical services at the New York University Child Study Center in New York City. "You don't know which children are getting appropriate treatment and which aren't."
"You're talking about a condition that has a relatively high prevalence. It seems that many, many children are not getting treated," he says.
Stimulants are widely prescribed for the treatment of ADHD in children. Methylphenidate, which sells under the brand names Concerta and Ritalin, is the most commonly prescribed in this class.
Cox and her colleagues looked at commercial insurance claims submitted during calendar year 1999 for children between the ages of 5 and 14. Lower-income children (those on Medicaid) were not included in the analysis.
Overall, about 4.3 percent of beneficiaries were prescribed a stimulant. The rate was the highest in Louisiana, at 6.5 percent, and lowest in the District of Columbia, at 1.6 percent.
Children living in the Midwest and South were 1.55 times and 1.71 times respectively more likely than children in the West to be taking at least one stimulant medication. Those in urbanized areas were more likely to be taking a stimulant than their rural counterparts.
Boys were three times more likely than girls to be taking at least one in this class of medication, a narrower gap than was found in earlier studies.
Whites were more likely to be taking Ritalin or one of its cousins than blacks, as were children in households with less than four children.
This study did not specifically address why these variations exist, but a number of hypotheses were put forth.
"Typically what they point to are differences in physician practice style, factors such as the extent to which they use accepted criteria to diagnose children," Cox says. "Because the adult caregivers -- in this case, parents, school administrators, counselors, and teachers -- also play an important role in identifying behavior, differences in expectations may play a role in determining this variation."
There may also be differences in state-controlled substance laws, campaigns to discredit Ritalin, and advertising that targets the consumer directly, the study points out.
This study looks at a relatively homogenous population, namely people subscribing to certain types of insurance plans.
"It would be nice to see the data broadened to the population as a whole so as to get a broader sense of treatment," Ditkowsky says. "If you look at this information, you are not looking at those with the lowest socioeconomic status. We would want to couple with what treatment this population is getting. That would give us something to work with."
More information
Learn more about ADHD and Ritalin from the Children and Adults with Attention Deficit Hyperactivity Disorder and the National Institute of Mental Health.
