Wide Disparities in ADHD Treatment Suggest Flawed Management of the Disorder

CAMBRIDGE, Mass., Aug. 5, 2013 /PRNewswire/ -- The use of amphetamine medications to treat attention deficit hyperactivity disorder (ADHD) in the United States varies widely from state to state and even more dramatically from one county to another, according to a new study by Abt Associates, showing treatment disparities are greater than previously assessed in other studies. The study, published in the advance November 2013 issue of Psychiatric Services, is the first to estimate treatment rates using prescription records of individuals and the first to generate rates at the county level as well as the national and state levels.

"These findings are troubling because they indicate that significant numbers of people with ADHD remain unidentified and untreated while others without the condition may be treated erroneously," said Abt's Douglas McDonald, Ph.D., who with Sarah Jalbert, M.S., conducted the study.

ADHD is a neurological condition characterized by significant difficulties with attention and/or hyperactivity and impulsiveness.  The disorder affects approximately five to 10 percent of children in the U.S., and roughly three to five percent of adults, according to various studies.  McDonald and Jalbert both note that the condition is associated with poor academic and vocational achievement, delinquency, and the presence of other disorders, and that amphetamine stimulant treatment is effective in tempering those risks.

During 2008, of children 18 and under, approximately 1.5 percent of female children and 3.5 percent of male children were treated with stimulant medications, according to the study, and 0.6 percent of adult males and females were treated with stimulants that year. According to the researchers, treatment was defined as an individual receiving more than a 60-day supply of amphetamine medication during the first six months of the year.

Fewer than one percent of children under 18 years of age in Colorado, California, Hawaii and Alaska were treated with amphetamine stimulants in 2008, compared with more than 4 percent in Rhode Island, Kentucky, and South Carolina and 5 percent in Delaware, the study reports.  Treatment rates for adults were generally lower than for children but also ranged widely, from 0.2 percent in Alaska to 1.2 percent in Delaware.   

"We don't know if the prevalence of ADHD differs from one geographic area to another, but it is inconceivable that such differences could be anywhere near to those we see in treatment rates," McDonald said.

The research involved analysis of 24 million prescriptions for stimulants dispensed by 76% of the retail pharmacies in the U.S. in March 2008.  The prescriptions were written to both insured and uninsured patients.  

Treatment rates were strongly correlated with the availability of physicians and, to a lesser extent, with the socioeconomic composition of the resident population.  Treatment rates, say the authors, may also be driven by the marketing of stimulant treatment to physicians and these marketing campaigns may be more pervasive in certain consumer markets.  Teachers, school officials and parents play a role in determining whether to treat children with stimulants, and attitudes about treatment probably differ from one community to another.  

The authors point to a need for better education and training of physicians to improve the identification and treatment of persons with ADHD, especially in primary care, where most patients who are prescribed stimulants are managed.

The study, reported in the Psychiatric Services article, "Geographic Variation and Disparity in Stimulant Treatment of Adults and Children in the United States in 2008," was funded by the National Institute on Drug Abuse.  

About Abt Associates

Abt Associates is a mission-driven, global leader in research and program implementation in the fields of health, social and environmental policy, and international development. Known for its rigorous approach to solving complex challenges, Abt Associates is regularly ranked as one of the top 20 global research firms and one of the top 40 international development innovators.  The company has multiple offices in the U.S. and program offices in nearly 40 countries. www.abtassociates.com

SOURCE Abt Associates