http://www.trivalleyherald.com/Stories/0,1413,86~10669~2062823,00.html
Article Last Updated: Sunday, April 04, 2004 - 9:13:03 AM PST
Study reviews medicated kids
By Rebecca Vesely, STAFF WRITER
An unusual study is under way at the University of California, Berkeley, that
could help parents, doctors, teachers and lawmakers better grasp the economic
and social reasons why some kids are receiving drug therapy for attention
deficit hyperactivity disorder, or ADHD.
Dr. Richard Scheffler, a UC Berkeley professor of health economics and public
policy, and Dr. Stephen Hinshaw, a psychology professor and leading expert on
ADHD, last month received a $900,000 grant from the National Institutes of
Mental Health for the three-year project.
Unlike most studies that look at the effects of psychostimulant drugs -- such
as Ritalin -- on kids diagnosed with ADHD, researchers aim to uncover the
economic and policy issues behind prescription trends.
"There's enormous variation in the use of these drugs across state lines and
communities," Scheffler said.
ADHD is the most commonly diagnosed behavioral disorder in children. In the
decade leading up to 2001, the number of people -- mostly children -- diagnosed
with ADHD grew fivefold, from 900,000 to 4.5 million, according to the National
Centers for Disease Control and Prevention. That rise coincided with national
policy changes that allowed children with ADHD to receive special
accommodations at school.
Ritalin on the rise
At the same time, the number of prescriptions for Ritalin, Adderall and other
psychostimulants to treat ADHD rose by about 50 percent over the past decade.
Using data from the U.S. Drug Enforcement Agency, researchers will track
shipments of these drugs to the pharmacies dispensing them to see which
communities are heavy prescribers.
In addition, they will drill down into those communities and examine underlying
policy decisions, teacher influence and health care issues, such as access to
child psychiatrists.
Clinical research isn't telling the whole story, Hinshaw said. "All this
research is taking place against a backdrop of quickly changing market forces
and treatment practices," he said.
Some states have enacted legislation that limits school influence in drug
treatment of ADHD. In Connecticut, it's illegal for school staff members to
discuss ADHD treatment with parents.
To get a better picture of treatment and diagnosis, UC Berkeley researchers
will have access to the medical records of 14,000 children enrolled with Kaiser
Permanente Northern California.
This piece of the puzzle is key, the researchers said, because the patient
records will include information about race, ethnicity, family history, area of
residence and compliance in drug therapy.
"Are poorer kids being underdiagnosed and rich kids being overmedicated? We
hope to get a sense of that," Scheffler said.
The study is the first of its kind -- and atypical of what the National
Institutes of Mental Health usually funds, a spokesman for the federal
grant-making and research institute said, because of the focus on sociology and
economics of drug therapy.
Testing for ADHD
Skepticism about drug treatment for ADHD relates to the ambiguous nature of
diagnosis and stigma surrounding mental illness, Hinshaw said.
There is no test for ADHD. Rather, diagnosis is based on observed behavior and
family and medical history.
When left untreated, ADHD can have a significant affect on a child's growth and
development. Studies have shown that untreated children with ADHD have higher
rates of school failure, underemployment, illicit drug and alcohol use and
accidental injuries.
"The problem is many practitioners don't follow well-established guidelines for
diagnosis and treatment," Hinshaw said. "There's a brief pediatric visit and
sporadic follow-up and monitoring. Some kids are diagnosed too quickly and
some, such as girls or inner city children, may get ignored and underdiagnosed.
You need an accurate diagnosis first."