Myth: Stimulant Medications Are Over Prescribed
Stimulant medications are often a front line treatment for ADHD. They can, when used properly, decrease hyperactivity and impulsiveness and increase attention. Numerous studies have been completed showing that stimulant medication, used in conjunction with behavioral therapy, is the most effective way to treat ADHD. The amount of prescriptions for stimulant medication has dramatically increased over the past 20 years. There was a 250% increase between the year 1990 and 1995. So why has this happened?
While reading and researching the topic of whether stimulant medication is over-prescribed for children with ADHD, I began to understand that there is not really a question of whether stimulant medication is over-prescribed. The articles and information that argue that medication is over-prescribed are actually arguing on the validity of ADHD as a real disorder. For example, Dr. Richard Bromfeld wrote on the viewpoint that Ritalin is "being dispensed with a speed and nonchalance compatible to our drive-through culture." Although Dr. Bromfeld admits that some people "probably do merit a diagnosis of ADHD" he further explains, "random violence, drugs, alcohol, domestic trauma and (less horrifically) indulgent and chaotic homes are more obvious reasons for the ADHD-like restlessness that plagues America." Is Dr. Bromfeld discussing the amount of prescriptions written for people with ADHD or is he discussing his apparent disbelief in the diagnosis of ADHD?
According to a study completed in 1999 (Jensen, et.al., 1999), stimulant medications are not being over-prescribed. This study showed that only 12% of children diagnosed with ADHD were being treated with stimulant medications. One third of the children with ADHD received behavioral or some other form of therapy. Less than 25% of the children received special services at school. Based on this study, the majority of children with ADHD received no treatment at all. In addition, small percentages, less than 2% of children that did not meet the criteria of ADHD fully, were receiving stimulant medication.
Why then, are there concerns that stimulant medication is over-prescribed? According to the US Surgeon General (Surgeon General's Report 2001), "Most researchers believe that much of the increased use of stimulants reflects better diagnosis and more effective treatment of a prevalent disorder."
Understanding the recent history behind ADHD could explain, at least partially, the increase in prescriptions written, especially in the early 1990s. In the early 1990s, there was a great debate on the validity of the diagnosis of ADHD. As a mother, I watched many television documentaries and talk shows on the evils of stimulant medications. My son, at this time, had not been diagnosed with ADHD, although he had been having problems in school and at home. I watched these shows because the symptoms and behaviors doctors and parents discussed were the same as I was dealing with. I watched because I knew something was wrong and had not yet been able to find the answers. The vast majority of publicity talked about ADHD not being a "real" disorder, it talked about drugging our children and children turning into zombies. Even so, it was publicity and people began to listen. They began to see that their children were having the same problems. Like me, parents began to say, "Maybe there is something to this." Although the point of many of these programs was to dispel ADHD, it may have had the opposite effect. It provided a name to the behaviors of many children.
ADHD has always existed. In the past it has been known as "Minimal Brain Dysfunction" and "Hyperkinetic Disorder of Childhood." But for the majority of parents, it was unknown. The impact of the publicity in the early 1990s gave parents hope and knowledge. It gave them something to discuss with their doctor. I was one of those parents that went to the doctor and said, "I think this is my child."
Prescriptions for stimulant medication have increased. But it has simply because our knowledge and our understanding of ADHD has increased.
Myths & Misunderstandings, Phyllis Anne Teeter Ellision, Ed.D., National Resource
Center on AD/HD, 2003
Is Stimulant Medication Over Prescribed?, Dr. David Rabiner, 2002
The Debate of Ritalin: Point and Counterpoint, Dr. Richard Bromfeld, Dr. Jerry Wiener, 1999