Are stimulants overprescribed? Treatment of ADHD in four US Communities

Objective: To address rising concerns about the possible overdiagnosis of a ttention-deficit hyperactivity disorder (ADHD) and overtreatment with stimu lants, To date, almost no studies have examined ADHD in unbiased community- based studies, ascertaining both the prevalence of the diagnosis within non referred populations and the extent to which various treatments (i.e., stim ulant medication, mental health treatments, and educational interventions) are used. Method: As a part of the Methods for the Epidemiology of Child an d Adolescent Mental Disorders (MECA) Study, the authors examined epidemiolo gical survey data obtained from 1,285 children and their parents across 4 U .S. communities. Analyses examined the frequency of children's ADHD diagnos is, the extent to which medications were prescribed, as well as the provisi on of other services (e.g., psychosocial treatments, school-based education al interventions). Results: Findings indicated that 5.1% of children met fu ll DSM-III-R ADHD criteria across the pooled sample. Only 12.5% of children meeting ADHD criteria had been treated with stimulants during the previous 12 months. Some children who had been prescribed stimulants did not meet f ull ADHD diagnostic criteria, but these children manifested high levels of ADHD symptoms, suggesting that the medication had been appropriately prescr ibed, Children with ADHD were generally more likely to receive mental healt h counseling and/or school-based interventions than medication. Conclusions : Medication treatments are often not used in treating ADHD children identi fied in the community, suggesting the need for better education of parents, physicians, and mental health professionals about the effectiveness of the se treatments. On the basis of these data it cannot be concluded that subst antial "overtreatment" with stimulants is occurring across communities in g eneral.