Study Documents Disparities In ADHD Medication Use
White students in Maryland are taking medications for attention deficit hyperactivity disorder much more frequently than their minority peers, says a major study released last week.
In a state-commissioned report with national implications, researchers found that about twice as many white elementary students as African-American students are using medication for the disorder.
And, once those students reach high school, when medication usage drops off, white students are about five times as likely to be using those prescription drugs as black students, the report's authors write in the September issue of Pediatrics, the journal of the American Academy of Pediatrics.
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Dr. Daniel J. Safer, an associate professor in the departments of psychiatry and pediatrics at Johns Hopkins University in Baltimore, declined to draw conclusions from the study's findings.
But he said the new data are likely to be indicative of trends outside Maryland, given the state's diverse mix of inner-city and rural areas.
"It's either cultural factors or access to care [that is responsible for the disparity in medication rates], and I think it's more cultural factors," said Dr. Safer. He co-wrote the report, "Stimulant Treatment in Maryland Public Schools," with Michael Malever, a statistician with the Maryland education department.
One observer drew troubling conclusions, however.
"This is a sign of alert that we are greatly underserving our minority populations," said Beth Kaplanek, the president of the Landover, Md.-based Children and Adults With Attention Deficit Hyperactivity Disorder. More needs to be done to better identify and treat minority youngsters with ADHD, she added.
The study was commissioned by the Maryland legislature in 1997 because lawmakers feared that too many students were taking Ritalin and other psychotropic drugs to treat ADHD. The same worry has festered nationwide, leading the Clinton administration to appoint a commission to recommend better ways to diagnose and treat the condition.
In April 1998, school nurses in Maryland's 24 public school districts were surveyed on the number of students receiving medication for ADHD during school hours.
Out of 816,460 students in Maryland, 20,050, or about 2.5 percent, were given methylphenidate, more commonly known by its brand name, Ritalin, during the survey period. Another 3,721 received other medications for ADHD.
The researchers found that out of 236,739 white elementary students overall, 9,339—or 4.1 percent—took Ritalin, while only 3,091 black elementary students out of 153,447—or 2 percent—used the drug.
Dr. Safer noted that more students could be using medications than the study indicates because of new amphetamine- compound medications.
Doctors have begun prescribing the new drugs because they do not have to be taken as frequently as traditional medications, and thus, a student might not require a dosage during school hours and might not have been counted in the school surveys.
The study has raised more questions than answers, said Vicki Taliaferro, the health- service specialist for the Maryland education department.
"It certainly has brought up some issues," she said. "We need more research, and looking into why we're seeing what we're seeing."
Based on anecdotal evidence, she said, parents of minority children seem to be more skeptical of the ADHD diagnosis and using drugs to control behavior. Parents generally are also subjected to a great deal of misinformation about Ritalin and other drugs, Ms. Taliaferro added.
Over the next few months, an advisory panel created by the Maryland legislature will have to weigh in. The panel, made up of 25 health practitioners, school officials, parents, and lawmakers, will analyze the data and expects to present its findings to Gov. Parris N. Glendening in January.
The study also indicates that the medication trends by race cut across socioeconomic lines. For instance, African-American students in Prince George's County, a middle-class Washington suburb, were treated with ADHD drugs at the same rate as black students in the less affluent Baltimore area.
Moreover, the data show that 53 percent of the students taking ADHD medications received special education services—45 percent had individualized education plans (IEPs), while 8 percent received more general accommodations under the federal Rehabilitation Act, another law concerning students with disabilities.
A 1987 study found that only 25 percent of Maryland students taking medication for ADHD were receiving special education services. Dr. Safer said he was surprised at how much that percentage had increased.
But Ms. Kaplanek of the Landover ADHD group worried that too few students with ADHD are receiving special education services.
"Education is a very important piece for children with ADHD," she said. Many students, she said, might benefit at least from some special education accommodations.
Vol. 20, Issue 2, Page 5Published in Print: September 13, 2000, as Study Documents Disparities In ADHD Medication Use