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Study: Wide Variation in ADHD Med Treatment

Wide Variation and Disparity across States and Counties in Medication Treatment for ADHD

ARLINGTON, Va. (November 1, 2013) — The percentage of U.S. children who are being treated with stimulant medication, primarily for ADHD, varies widely among states and even more widely among counties. Rates of stimulant treatment among adults also vary significantly, according to research presented in the November issue of Psychiatric Services, a journal of the American Psychiatric Association.

In Alaska, .4% of children were receiving stimulant treatment, compared with 5.1% of children in Delaware—a 14-fold difference. Among adults, the rates did not vary as widely —ranging from .2% to 1.2%.  The strongest predictor of treatment was the availability of physicians in the area.  In addition, per-pupil expenditures for special education were positively correlated with treatment of children. Higher treatment prevalence was also associated with socioeconomic factors, including more urban counties, larger proportions of non-Hispanic white residents, less educated populations, and higher poverty rates.

Researchers looked at the prevalence of stimulant treatment among both adults and children at national, state, and county levels during 2008 and explored explanations for wide variations in treatment prevalence. They examined records of more than 24 million stimulant prescriptions for insured and uninsured patients from approximately 76% of U.S. retail pharmacies. “Stimulant treatment” was defined as sustained use of stimulants—not just a single prescription. Data were weighted to reflect the national population.

Across the nation, an estimated 2.5% of children under 18 years of age (3.5% of males and 1.5% of females) and .6% of people 18 or older were receiving stimulant treatment in March 2008.  The majority of children received their prescriptions from pediatricians and family medicine practitioners; only 34% of children in treatment received any of their prescriptions from a psychiatrist and 4% from a neurologist.  Among adults 44% received medications from a psychiatrist and 4% from a neurologist.  

There were only small differences in regional treatment rates for children with the lowest in the Midwest (2.2%) and the highest in the South (2.4%). Living in states with prescription monitoring programs was not correlated with rates of treatment in children or adults.

The study was conducted by Douglas McDonald, Ph.D., and Sarah Jalbert, M.A., M.S., from Abt Associates in Cambridge, Massachusetts. They conclude that the research indicates “wide disparities between established clinical practice guidelines and actual practice, especially in primary care, where most patients prescribed stimulants are treated.” They also note that the national prevalence of stimulant treatment is “far below estimated prevalence of ADHD and lower still than prevalence of all combined conditions treatable with stimulants.”

The American Psychiatric Association is a national medical specialty society whose physician members specialize in the diagnosis, treatment, prevention and research of mental illnesses, including substance use disorders. Visit the APA at

Posted: November 2013