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Increased Methylphenidate Usage for Attention Deficit Disorder in the 1990s
Pediatrics
Abstract
Objective. To estimate the increased use and the prevalence of methylphenidate (Ritalin) treatment of youth with attention deficit disorder (ADD) during the 1990s.
Design. Using time-trend findings from two large population-based data sources, three pharmaceutical databases, and one physician audit, a best-fit estimate of the usage and the usage trends for methylphenidate treatment over the half decade from 1990 through 1995 was sought.
Setting. Five regions in the United States (US) and the nation as a whole.
Patients. Youths on record as receiving methylphenidate for ADD.
Results. The findings from regional and national databases indicate that on average, there has been a 2.5-fold increase in the prevalence of methylphenidate treatment of youths with ADD between 1990 and 1995. In all, approximately 2.8% (or 1.5 million) of US youths aged 5 to 18 were receiving this medication in mid-1995. The increase in methylphenidate treatment for ADD appears largely related to an increased duration of treatment; more girls, adolescents, and inattentive youths on the medication; and a recently improved public image of this medication treatment.
Conclusion. The database findings presented serve to correct exaggerated media claims of a 6-fold expansion of methylphenidate treatment, although they do not clarify the issue of the appropriateness of this treatment.
... More than 10 million prescriptions for MPH were written in 1996 (Vitiello and Jensen, 1997). Recent epidemiological surveys have estimated that 12-month stimulant prescription rates range from 6% in urban Baltimore (Safer et al., 1996) to 7.3% in rural North Carolina (Angold et al., 2000). One epidemiological survey found that up to 20% of white boys in fifth grade in one location were receiving medication for ADHD (LeFever et al., 1999). ...
... Experts have speculated that increased MPH production quotas and prescriptions written could be due to improved recognition of ADHD by physicians, an increase in the prevalence of ADHD (Goldman et al., 1998), or an easing of the standards for making the ADHD diagnosis or a relaxation of the standards for dispensing stimulants. The increase has been attributed to lengthened duration of treatment and the inclusion of children with learning disabilities, more adolescents, more girls, children with ADHD-Inattentive Type, and adults with ADHD (Safer et al., 1996). A 1998 Consensus Development Conference on ADHD sponsored by the National Institutes of Health (NIH Consensus Statement, 1998) found "wide variations in the use of psychostimulants across communities and physicians." ...
... In an international study, an estimated 2.8% of subjects in age group of 5-18 years 2 were receiving methylphenidate. Psychostimulants continue to benefit patients with ADHD through adolescence, and adulthood, and concerns that stimulant medications prescriptions may lead to abuse seem 3,4 unwarranted. Most data have been obtained in literature from studies conducted on sample of school age children with ADHD. ...
... It has been postulated that the slower clearance of methylphenidate in the brain would limit drug reinforcing properties as well as its abuse potential. Psychostimulants continue to benefit patients with ADHD through adolescence and adulthood, and concerns that stimulant medication prescriptions may lead to abuse seem 3 unwarranted. There is little evidence that Methylphenidate abuse is currently a major problem. ...
... Among adolescents, predictors of prescription-drug abuse included being female, poor academic performance and having a history of misuse of other substances (Compton and Volkow 2006;SAMHSA 2006;Schepis and Krishnan-Sarin 2008;Simoni-Wastila et al. 2004). Several studies have reported a recent increase in the number of prescriptions for stimulants issued to young people in the USA (Olfson et al. 2003;Robison et al. 2002, Safer, Zito andFine 1996). This increase is probably due to several factors, including increased diagnosis (Goldman et al. 1998) and a tendency to prescribe longer treatments (Safer, Zito and Fine 1996). ...
... Several studies have reported a recent increase in the number of prescriptions for stimulants issued to young people in the USA (Olfson et al. 2003;Robison et al. 2002, Safer, Zito andFine 1996). This increase is probably due to several factors, including increased diagnosis (Goldman et al. 1998) and a tendency to prescribe longer treatments (Safer, Zito and Fine 1996). ...
... However, this data was collected in the early 1980s. In the 1990s, there was a 2.5fold increase in the prevalence of methylphenidate use in the US (Safer, Zito & Fine, 1996). The more widespread use of medication may mean that teachers are familiar with the benefits of medication so this may no longer be such an issue. ...
p>The aims of this thesis were threefold. First, medication related attitudes and behaviours were identified using in-depth qualitative interviews with parents of children with ADHD. Second, a questionnaire was developed to assess medication related attitudes and behaviours drawing from the data collected in the interview study. Third, the relationships between ADHD related attitudes and behaviours with family factors and cultural factors between the UK and the USA were examined. Parent and child version ADHD Medication Related Attitudes and Behaviours (AMRABs) questionnaires were developed to assess parents’ and children’s perceptions of the benefits, costs, stigma associated with ADHD medication and whether children resisted taking medication. Parents were also asked about the stigma they experience as parents, how flexible they are in administering medication and how competent they are in administering medication consistently. The questionnaires were piloted in ADHD clinics in the UK and USA, on the internet and through ADHD support groups. Participants in the UK consistently reported markedly higher levels of child stigma than participants in the USA. The final study examined relationships between the AMRABs subscales and family factors. The results indicated that child conduct problems were associated with resistance to taking medication. Maternal mental health difficulties were associated with maternal perception of the benefits and costs of taking medication, and with resistance to taking medication. Maternal ADHD and poor parenting self-efficacy were associated with difficulties in administering medication consistently. Family cohesion was predictive of child stigma in the USA, and paternal warmth and high maternal criticism were associated with child stigma in both countries. However, the most significant predictor of child stigma was being from the UK. High SES was associated with higher parental stigma.</p
... Volkow and colleagueshave found that the localization of MPH binding with dopaminergic pathways was "identical" with that of cocaine and a similar "high" was described by patients receiving both drugs intravenously.The sole source of MPH for these patients involved the diversion of prescription medication in most of the cases. [11,12] ...
Attention - Deficit Hyperactivity Disorder (ADHD) is one of the most common childhood behavioral disorders diagnosed in the psychiatry outdoor setting, affecting 5-7% of school - aged children[1]. It is a neuro - developmental disorder that runs a chronic course and causes significant impairments across various domains of day to day functioning. The symptoms of ADHD are divided into two predominant categories: inattention and hyperactivity/impulsivity. Inattention is divided intwo subtypes i.e. focused and sustained/ Executive dysfunction.
... Los psicoestimulantes como el metilfenidato (MPH) y la lisdexanfetamina (LDX); y los no estimulantes como la atomoxetina (ATX) son los fármacos aprobados en España cuya eficacia y seguridad se han experimentado ampliamente 1,2,9,16 . El uso indiscriminado en Estados Unidos de MPH (consumidor del 80% del producido en el mundo) [17][18][19][20][21] y Australia ha hecho que el consumo de psicoestimulantes se ha cuadriplicado y triplicado, respectivamente, desde 1991 hasta 2011, donde 20 de cada 1.000 niños de 4 años son tratados [22][23][24] . Sin embargo, en Europa su consumo es menor por restricciones legales y de prescripción farmacológica 12,19,[25][26][27][28][29] . ...
Introduction: Attention-deficit/hyperactivity disorder (ADHD) is one of the most common behavioural disorders of childhood; its prevalence in Spain is estimated at 5%-9%. Available treatments for this condition include methylphenidate, atomoxetine, and lisdexamfetamine, whose consumption increases each year. Material and methods: The prevalence of ADHD was estimated by calculating the defined daily dose per 1000 population per day of each drug and the total doses (therapeutic group N06BA) between 1992 and 2015 in each of the provinces of Castile-La Mancha (Spain). Trends, joinpoints, and annual percentages of change were analysed using joinpoint regression models. Results: The minimum prevalence of ADHD in the population of Castile-La Mancha aged 5-19 was estimated at 13.22 cases per 1000 population per day; prevalence varied across provinces (P
... In the USA, the total number of children on ADHD medication skyrocketed from 1.5 million in 1995 (Safer & Zito, 1996) to 3.5 million in 2011 (Visser et al., 2014). Sales of prescription stimulants have quintupled in the last decade (Schwarz, 2013), to well over 11 billion in 2015 (www.jsonline.com, ...
A medical approach towards behavioural problems could make professionals without a medical background, like teachers and other educational professionals feel inapt. In this article, we raise six scientifically grounded considerations regarding ADHD, currently the most prevalent childhood psychiatric diagnosis. These “need to knows” show just how misguided and potentially stigmatizing current conceptualizations of unruly behaviour have become. Some examples are given of how teachers are misinformed, and alternative ways of reporting about neuropsychological research are suggested. A reinvigorated conceptual understanding of ADHD could help educational institutions to avoid the expensive outsourcing of behavioural problems that could also—and justifiably better—be framed as part of education’s primary mission of professionalized socialization.
... Previously, the increase in use of ADHD medications was mainly explained by a better recognition of the issue of the disorders, 29 a more positive image of its pharmacological treatments, longer treatments going on during adolescence and an expansion of use among girls. 30 The change in the increasing trend of ADHD drug prescribing in the UK may be explained by the UK reaching a sufficient recognition of the ADHD condition and may mean that most children who need treatment are now reached. Such a decrease or a 'plateau' may also occur when a medication is under suspicion of severe adverse reaction as was observed for antidepressants after warnings on suicidal attempts in children was issued. ...
Objectives
To investigate attention deficit and hyperactivity disorder (ADHD) drug prescribing in children under 16 years old in the UK between 1992 and 2013.
Methods
All patients under 16 registered in the Clinical Practice Research Datalink (CPRD) with a minimum of 1 year of observation time and who received at least one prescription of any ADHD drug between 1 January 1992 and 31 December 2013.Trends in prevalence and incidence of use of ADHD drugs in children were calculated between 1995 and 2013 and persistence in new users was estimated.
Results
The prevalence of ADHD drug use in children under 16 increased 34-fold overall, rising from 1.5 95% CI (1.1 to 2.0) per 10 000 children in 1995 to 50.7 95% CI (49.2 to 52.1) per 10 000 children in 2008 then stabilising to 51.1 95% CI (49.7 to 52.6) per 10 000 children in 2013. The rate of new users increased eightfold reaching 10.2 95% CI (9.5 to 10.9) per 10 000 children in 2007 then decreasing to 9.1 95% CI (8.5 to 9.7) per 10 000 children in 2013. Although prevalence and incidence increased rather steeply after 1995, this trend seems to halt from 2008 onwards. We identified that 77%, 95% CI (76% to 78%) of children were still under treatment after 1 year and 60% 95% CI (59% to 61%) after 2 years.
Conclusions
There was a marked increase in ADHD drug use among children in the UK from 1992 until around 2008, with stable levels of use since then. UK children show relatively long persistence of treatment with ADHD medications compared to other countries.
... The safety and efficacy of these agents have been well established. 34 The use of psychostimulants with co-morbid substance use disorder has not been associated with increased risk of substance abuse. 17,27,30,35,36 For adults with ADHD, the duration of action of psychostimulants is extremely short, therefore requiring frequent dosing. ...
... 1 Among school-age children, this increase in the use of stimulant medication has been documented by a number of researchers. [2][3][4][5] As a result of the increased use of stimulant medication, the American Academy of Child and Adolescent Psychiatry 6 advocated systematic monitoring of medication effects across behavioral domains for children and youth with ADHD. The same need for medication monitoring extends into adulthood if optimal functioning is the desired outcome. ...
An increasing number of treatment plans for individuals with attention-deficit/hyperactivity disorder (ADHD), as well as other disorders, include stimulant medication. The purpose of this study was to investigate the effects of stimulant medications on attention and impulsivity as measured by continuous performance tests (CPTs). The effect of other stimulants (e.g., caffeine, nicotine) on CPT performance was examined as well. Although various versions of the CPT were used in the studies reviewed, the research supports improvements in CPT performance with stimulant treatment. Implications for the use of CPTs in evaluating the effects of medications on attention are discussed. Also presented are implications for control of common substances like nicotine or caffeine when CPT is used and interpreted as a measure of attention.
... There are many other factors that influence community rates of the diagnosis and treatment of ADHD. These include treatment efficacy, parent attitudes, pharmaceutical marketing, school concerns, costs, special education regulations, changes in ADHD patterns with increased age, degree of impairment, positive treatment studies in the literature, and changes in Diagnostic and Statistical Manual of Mental Disorders (DSM) diagnostic criteria (Costello, Copeland, & Angold, 2011;dosReis, Barksdale, Sherman, Maloney, & Charach, 2010;Safer, Zito, & Fine, 1996;Vande Voort et al., 2014;Wolraich, Hannah, Baumgaertel, & Feurer, 1998, 2014. Health care for children with ADHD in the United States is influenced also by such factors as severity of illness, health insurance, family income, and race/ethnicity (Kessler et al., 2012;Zito, Safer, Zuckerman, Gardner, & Soeken, 2005). ...
Objective: It would be useful to compare temporal changes in the diagnostic prevalence of ADHD obtained from identical population surveys with time-trend survey findings based on individual ADHD features. Method: Changes in the diagnostic prevalence of ADHD over time were recorded from parent reports and from physician office visit data. Associated features of ADHD were temporally recorded from standardized teacher, parent, and youth surveys. Results: Time-trend diagnostic findings on ADHD prevalence based on 6 parent surveys and 12 outpatient physician office visit surveys revealed consistent rate increases. By contrast, 26 sets of standard ratings of the primary and associated features of ADHD assessed systematically by different teachers, parents, and students during different years indicated little change. Conclusion: Time-trend national surveys of ADHD in youth over the last two decades reveal consistent increases in its diagnostic prevalence, whereas time-trend findings for individual ADHD-related symptoms remained relatively stable.
En el siguiente texto se ponen en cuestión las profundas falen-cias del modelo neurológico del TDAH y sus principales trata-mientos clínicos. Se propone en cambio un modelo historicista, en que la exposición intensiva a entornos tecnológicos cada vez más avanzados derivó en el surgimiento de nuevos modelos de atención, especialmente en la población joven. Este nuevo tipo de atención resultó adecuado para manejar tecnologías alta-mente interactivas. Fueron precisamente estas generaciones las que se enfrentaron a las modalidades clásicas de enseñanza, que quedaron rápidamente obsoletas ante la violenta oleada de nuevas tecnologías y nuevas formas de comunicación. Se trata de un nuevo tipo de estudiante que se desconcentra fácilmente, que pierde la paciencia, que se vuelve ansioso, en suma, que tiene dificultades sistemáticas para administrar interacciones monótonas. Palabras clave: Trastorno por déficit atencional e hiperactivi-dad, metilfenidato, tecnología, educación. Technological revolutions:
ADHD or new models of attention and learning?
The following text calls into question the deep failures of the neurological model of ADHD and its main clinical treatments. Instead, a historicist model is proposed, in which intensive exposure to increasingly advanced technological environments led to the emergence of new atentional models, especially in the young population. This new kind of attention become suitable to manage highly interactive technologies. It was precisely these generations that were confronted with the classical modalities of education, which quickly became obsolete in the face of the violent wave of new technologies and new forms of communication. This is a new type of student who loses concentration easily, who loses patience, who becomes anxious, in short, who has systematic difficulties managing monotonous interactions. El síndrome por déficit atencional e hiperactividad es uno de los trastornos conductuales más diagnosticado en niños. Sin embargo en la actualidad no existe consenso en el campo cien-tífico sobre este trastorno. No existen pruebas consistentes ni concluyentes que validen el modelo neurológico del TDAH o su origen patológico, ni existen marcadores neurobiológicos para su diagnóstico, el cual se lleva cabo a través de una vaga lista de comportamientos. Los estudios genéticos, que cada cierto tiempo claman haber encontrado un gen candidato para el TDAH, han sido criticados por su irreplicabilidad, por la pre-sencia de sesgos sistemáticos y por sus complejos problemas de fundamento. Una situación similar ocurre con las técnicas de imagenología avanzada, que han sido aplicadas entusiasta-mente sin considerar las dificultades metodológicas, técnicas e interpretativas que conllevan. Por otro lado, los beneficios de la farmacología asociada, al igual que otros inhibidores selectivos de la re-captación de monoaminas, no han logrado superar las pruebas contra-placebo1,2,3,4 y al contrario, muestran preocu-pantes reacciones adversas.5, 6, 7, 8, 74 Estas situaciones contradictorias abren la posibilidad para le-vantar objeciones desde las ciencias sociales y establecer, des-de ahí, una crítica de fundamento al modelo neurológico del TDAH. Pero por otro lado permiten postular tesis plausibles, que involucran los extraordinarios cambios en la interacción indivi-duo-entorno en los últimos 70 años. La primera parte del texto abarca las dificultades para obser-var, medir y comprender lo que se supone que sería el origen y los mecanismos de los trastornos psiquiátricos; una descripción crítica sobre el modelo neurológico del TDAH y los supuestos teóricos que operan como su base; por último, examino la in-eficacia de los fármacos que se usan para su tratamiento. En la segunda parte del texto defiendo la idea de que lejos de ser una condición patológica, el fenómeno conocido como TDAH, no es sino una respuesta adaptativa a la emergencia de los nue-vos entornos tecnológicos. Estos nuevos "ambientes" altamente tecnológicos se hicieron cada vez más distinguibles desde me-diados del siglo XX, y fueron haciéndose cada vez más verti-ginosos, siguiendo un camino sin precedentes hasta nuestros
This is a book of psychiatry at its most practical level. It aims to answer the sorts of questions psychiatrists ask on a daily basis. What treatments are available for the condition that I think this patient has? What is the relative value of each of these treatments? Are there any other treatments that I should be considering if a first approach has failed? Is there any value in combinations of treatment? And, can I be sure that the evidence and recommendations I read are free from bias? The content is organised into three sections covering disease classification, the major treatment modalities and the application of these treatments to the wide range of psychiatric diagnoses. All professionals in mental health want to give the best treatments for their patients. This book provides clinicians with the knowledge and guidance to achieve this aim.
The main challenge of this work was focused on the detection of Methylphenidate (MPH) drug by using a type of MgO nanotubes sensor based on the density functional theory (DFT) calculations. Detecting as well as managing illegal drugs such as Methylphenidate (MPH) is of paramount importance because of the results of their abuse. So, determining MPH in biological samples is also of paramount importance. In this paper, the sensing behavior of MPH and MgO nanotubes (MgONT) was investigated through DFT computations. It was found that the reactivity of the MgONT toward MPH is significant, and the MgONT sensing response is 401.47. There was a considerable change of the highest occupied molecular orbital (HOMO) and the lowest unoccupied molecular orbital (LUMO) energy levels, leading to a reduction in the band gap (Eg) values which caused their electrical conductivity to improve. In addition, the predicted recovery time for desorption of MPH from the MgONT exterior was ∼28.87 ms, which was small. The study showed that the MgONT can be used as an electronic sensor and it be considered am appropriate candidate for MPH delivery in biological systems.
Background:
Attention deficit/hyperactivity disorder (ADHD) is a highly prevalent childhood disorder with symptoms of inattention, impulsivity, and hyperactivity. EEG neurofeedback training (NFT) is a new intervention modality based on operant conditioning of brain activity, which helps reduce symptoms of ADHD in children.
Methods and procedures:
To examine the efficacy of NFT in children with ADHD, an experimental longitudinal design with pre-post comparison was adopted. A total of 30 children in the age range of 6 to 12 years diagnosed as ADHD with or without comorbid conditions were assigned to treatment group (TG; n = 15) and treatment as usual group (TAU; n = 15). TG received EEG-NFT along with routine clinical management and TAU received routine clinical management alone. Forty sessions of theta/beta NFT at the C3 scalp location, 3 to 4 sessions in a week for a period of 3.5 to 5 months were given to children in TG. Children were screened using sociodemographic data and Binet-Kamat test of intelligence. Pre-and postassessment tools were neuropsychological tests and behavioral scales. Follow-up was carried out on 8 children in TG using parent-rated behavioral measures.
Results:
Improvement was reported in TG on cognitive functions (sustained attention, verbal working memory, and response inhibition), parent- and teacher-rated behavior problems and on academic performance rated by teachers. Follow-up of children who received NFT showed sustained improvement in ADHD symptoms when assessed 6 months after receiving NFT.
Conclusion:
The present study suggests that NFT is an effective method to enhance cognitive deficits and helps reduce ADHD symptoms and behavior problems. Consequently, academic performance was found to be improved in children with ADHD. Improvement in ADHD symptoms induced by NFT were maintained at 6-month follow-up in children with ADHD.
Although a sizeable literature studies the effect of Medicaid on health, less is known about its effects on education. We use a discontinuity in Medicaid eligibility based on date of birth and administrative school records to study the effects of expanded Medicaid eligibility during middle childhood, between the ages of 8 and 11. We evaluate effects of this Medicaid expansion on outcomes measured a few years later when the children are 12-14 years old. We find that it is associated with a significant increase in the grade that children are in and a reduction in the likelihood that a child is below grade for age. We do not find any evidence for effects on documented disabilities or absences. Our results underscore that Medicaid has important effects on children's human capital.
This article examines school discipline and violence. First, a distinction is made between different notions of violence. Clarity is brought to the concept of discipline, and an attempt is also made to demonstrate how these concepts of violence and discipline are wed. Second, the article traces approximately four decades of school disciplinary techniques and attempts to explain their growth and decline. The techniques range from corporal punishment of the past to the medicalization of disruptive youths in the present. Third, the conflict resolution and peaceable school movements are surveyed. Fourth, the findings from a number of studies are reviewed to provide a synthesis of the current research and lay the basis for a set of recommendations for constructing orderly school environments and reducing violence.
Attention deficit hyperactivity disorder (ADHD) is a common, debilitating neurodevelopmental disorder associated with inattentiveness, pathological hyperactivity and impulsivity. Despite the mounting human and animal evidence, the neurological pathways underlying ADHD remain poorly understood. Novel translational model organisms, such as the zebrafish (Danio rerio), are becoming important tools to investigate genetic and pathophysiological mechanisms of various neuropsychiatric disorders. Here, we discuss ADHD etiology, existing animal models and their limitations, and emphasize the advantages of using zebrafish to model ADHD. Overall, the growing utility of zebrafish models may improve our understanding of ADHD and facilitate drug discovery to prevent or treat this disorder.
Attention-Deficit Hyperactive Disorder (ADHD) is one of the most common mental health disorders amongst school-aged children with an estimated prevalence of 5% in the global population (American Psychiatric Association, 2013). Stimulants, particularly methylphenidate (MPH), are the first-line option in the treatment of ADHD (Reeves and Schweitzer, 2004; Dopheide and Pliszka, 2009) and are prescribed to an increasing number of children and adolescents in the US and the UK every year (Safer et al., 1996; McCarthy et al., 2009), though recent studies suggest that this is tailing off, e.g., Holden et al. (2013). Around 70% of children demonstrate a clinically significant treatment response to stimulant medication (Spencer et al., 1996; Schachter et al., 2001; Swanson et al., 2001; Barbaresi et al., 2006). However, it is unclear which patient characteristics may moderate treatment effectiveness. As such, most existing research has focused on investigating univariate or multivariate correlations between a set of patient characteristics and the treatment outcome, with respect to dosage of one or several types of medication. The results of such studies are often contradictory and inconclusive due to a combination of small sample sizes, low-quality data, or a lack of available information on covariates. In this paper, feature extraction techniques such as latent trait analysis were applied to reduce the dimension of on a large dataset of patient characteristics, including the responses to symptom-based questionnaires, developmental health factors, demographic variables such as age and gender, and socioeconomic factors such as parental income. We introduce a Bayesian modeling approach in a “learning in the model space” framework that combines existing knowledge in the literature on factors that may potentially affect treatment response, with constraints imposed by a treatment response model. The model is personalized such that the variability among subjects is accounted for by a set of subject-specific parameters. For remission classification, this approach compares favorably with conventional methods such as support vector machines and mixed effect models on a range of performance measures. For instance, the proposed approach achieved an area under receiver operator characteristic curve of 82–84%, compared to 75–77% obtained from conventional regression or machine learning (“learning in the data space”) methods.
A vast body of research and clinical experience about the pharmacological treatment of Attention-Deficit/Hyperactivity Disorder (ADHD) has been gathered over several decades. In this chapter’s review of this literature, we particularly emphasize the role and effects of psychostimulants, the most commonly prescribed medications for children with ADHD and the most extensively studied. We examine the current role of medication in the treatment of ADHD, summarize the contemporary concepts of the neurochemical rationale for the effects of the various drugs used to treat ADHD, and comment on the benefits and limitations of each class of medication. Although we emphasize the clinical implications of existing knowledge about drug effects, we do not provide a guide to clinical practice for the treatment of children with ADHD.
The use of psychotropic medications has increasingly become part of comprehensive treatment plans for children and adolescents. Due to the paucity of research, however, pediatric psychopharmacology is more an art than a science. Most rigorous pharmacological studies have focused on attention-deficit hyperactivity disorder (ADHD), and there are clear indications for stimulants as the primary therapy. However, there are fewer and less rigorous well controlled studies of antidepressants in children and adolescents, and even fewer in number and less well designed studies of antianxiety or anxiolytic medications. Thus, recommendations for using them in treatment are not as clear as for ADHD. Despite the lack of rigorous data, psychotropics are increasingly used. Factors contributing to this trend are diverse, including increasing severity of juvenile psychopathology, school mandates to educate youths who have serious psychiatric disorders, parents, and the inability of communities to manage their children's problems sufficiently, lack of appropriate alternative services, the availability of more effective medications that have relatively benign side effects, and pressure to contain costs from managed care.
This essay examines the contemporary mindfulness movement as a cultural response to a larger problem of attention in the United States. As raw material for both capital (re)production and subjectivity, attention is a zone of indeterminacy and struggle for workers in a so-called immaterial economy. This essay suggests that the rise of concern around “paying attention” from the 1950s onward is driven by post-Fordist labor requirements more than networked technologies. First, it examines mindfulness as a technique of attention management for businesses and gives a broad survey of its current popularity and prevalence in US culture. Second, it proposes viewing techniques of attention like mindfulness through a triple lens of repair: (1) as managerial tools to repair psychic labor capacity for capital; (2) as practices that subjects use to repair alienation; and (3) as sites for reparative reading. Third, the essay illuminates the ties between Eve Sedgwick’s repair and Michel Foucault’s care of the self in order to suggest that resistance to practicing the self is founded on a paranoid defense. Its central argument is that attention is a method in Foucault's care of the self, and, as such, a potential portal into pleasure and political change rather than a mere feedback loop into capital.
Introduction:
Attention-deficit/hyperactivity disorder (ADHD) is one of the most common behavioural disorders of childhood; its prevalence in Spain is estimated at 5-9%. Available treatments for this condition include methylphenidate, atomoxetine, and lisdexamfetamine, whose consumption increases each year.
Material and methods:
The prevalence of ADHD was estimated by calculating the defined daily dose per 1,000 population per day of each drug and the total doses (therapeutic group N06BA) between 1992 and 2015 in each of the provinces of Castile-La Mancha (Spain). Trends, joinpoints, and annual percentages of change were analysed using joinpoint regression models.
Results:
The minimum prevalence of ADHD in the population of Castile-La Mancha aged 5 to 19 was estimated at 13.22 cases per 1,000 population per day; prevalence varied across provinces (p<.05). Overall consumption has increased from 1992 to 2015, with an annual percentages of change of 10.3% and several joinpoints (2000, 2009, and 2012). methylphenidate represents 89.6% of total drug consumption, followed by lisdexamfetamine at 8%.
Conclusions:
Analysing drug consumption enables us to estimate the distribution of ADHD patients in Castile-La Mancha. Our data show an increase in the consumption of these drugs as well as differences in drug consumption between provinces, which reflect differences in ADHD management in clinical practice.
Aims:
Public controversy regarding the potential overdiagnosis and overmedication of children with attention-deficit/hyperactivity disorder (ADHD) has continued for decades. This study used the National Health Insurance Research Database of Taiwan (NHIRD-TW) to explore trends in ADHD diagnosis in youths and the proportion of those receiving medication, with the aim of determining whether ADHD is overdiagnosed and overmedicated in Taiwan.
Method:
Youths (age ≤18 years) who had at least two NHIRD-TW claims records with ADHD diagnosis between January 2000 and December 2011 were selected as the subject cohort. In total, the study sample comprised 145 018 patients with ADHD (mean age at a diagnosis of ADHD: 7.7 ± 3.1 years; 21.4% females). The number of cases of ADHD were calculated annually for each year (from 2000 to 2011), and the number of cases per year who received medication was determined as those with at least one record of pharmacotherapy (immediate-release methylphenidate, osmotic controlled-release formulation of methylphenidate, and atomoxetine) in each year.
Results:
The prevalence rates of a diagnosis of ADHD in the youths ranged from 0.11% in 2000 to 1.24% in 2011. Compared with children under 6 years of age, the ADHD diagnosis rates in children aged between 7 and 12 years (ratio of prevalence rates = 4.36) and in those aged between 13 and 18 years (ratio of prevalence rates = 1.42) were significantly higher during the study period. The prevalence in males was higher than that in females (ratio of prevalence rates = 4.09). Among the youths with ADHD, 50.2% received medications in 2000 compared with 61.0% in 2011. The probability of receiving ADHD medication increased with age. More male ADHD patients received medications that females patients (ratio of prevalence rates = 1.16).
Conclusions:
The rate of ADHD diagnosis was far lower than the prevalence rate (7.5%) identified in a previous community study using face-to-face interviews. Approximately 40-50% of the youths with ADHD did not receive any medications. These findings are not consistent with a systematic public opinion about overdiagnosis or overmedication of ADHD in Taiwan.
Aim:
To describe the prescription of medications for Attention-Deficit Hyperactivity Disorder (ADHD) in the UK between 1995 and 2015.
Methods:
Using the Clinical Practice Research Datalink (CPRD), we defined a cohort of all patients aged 6 to 45 years, registered with a general practitioner between January 1995 and September 2015. All prescriptions of methylphenidate, dexamphetamine/lisdexamphetamine, and atomoxetine were identified and annual prescription rates of ADHD were estimated using Poisson regression.
Results:
Within a cohort of 7,432,735 patients, we identified 698,148 prescriptions of ADHD medications during 41,171,528 person-years of follow-up. Usage was relatively low until the year 2000 during which the prescription rate was 42.7 (95% confidence interval (CI) 20.9 to 87.2) prescriptions per 10,000 persons, increasing to 394.4 (95% CI 296.7 to 524.2) in 2015, corresponding to an almost 800% increase (rate ratio 8.87; 95% CI 7.10 to 11.09). The increase was seen in all age groups and in both sexes but was steepest in boys aged 10 to 14 years. The prescription rate in males was almost 5 times that of females. Methylphenidate remained the most prescribed drug during the 20-year study period, representing 88.9% of all prescriptions in the 6-24 years old, and 63.5% of all prescriptions in adults (25-45 years old).
Conclusions:
Prescription rates of ADHD medications have increased dramatically in the past two decades. This may be due, at least in part, to both an increase in the number of patients diagnosed with ADHD over time and a higher percentage of those patients treated with medication.
Objective:
Identifying factors that moderate subjective response to stimulants is important for understanding individuals at risk for abusing these drugs. Some research suggests that Asians may respond differently to stimulants than other races, but controlled human laboratory research of stimulant administration effects in Asians is scant.
Methods:
In this double-blind counterbalanced within-subject study, healthy stimulant-naïve participants (N = 65; 55% Asian; 63% female; age 18-35) received a single dose of 20-mg oral d-amphetamine or placebo on separate days. At each testing day, subjective measures of abuse liability and cardiovascular assessments were administered at repeated intervals before and after drug administration over a 4-hour period.
Results:
Asians (vs. Whites) demonstrated greater d-amphetamine-induced increases in diastolic blood pressure and ratings of 'Feel High' and 'Like Drug'.
Conclusions:
Asian and White healthy young adults may differ in certain subjective and cardiovascular responses to acute doses of d-amphetamine. Such individual differences could help explain between-person differences in abuse potential of d-amphetamine and other stimulants.
Sources of individual variation in plasma methylphenidate (MP) concentrations during usual clinical use are not established. This was evaluated in a series of patients receiving clinical treatment with MP. A single plasma MP concentration was determined in each of 273 children and adolescents ages 5 to 18 years (mean: 11.1 years) who were clinically good responders to MP for the treatment of attention-deficit hyperactivity disorder. MP was given on a twice-daily schedule (mean dose: 25 mg/day) in 40% of patients and three times daily (mean dose: 39.3 mg/day) in 60%. A nonlinear regression model was applied to estimate overall population values of MP clearance and elimination half-life (t(1/2)) assuming a one-component model with first-order absorption and elimination, and further assuming that clearance is linearly related to body weight. The model incorporated each patient's dosage size and schedule, body weight, and time of the plasma sample. Iterated solutions of best fit were: t(1/2), 4.5 hours (95% confidence interval [CI]: 3.1-8.1 hours), and apparent clearance, 90.7 ml/min/kg (95% CI: 74.6-106.7 ml/min/kg). The model explained 43% of the overall variance in MP concentrations (r(2) = 0.43, P < .001). In a small subsample [N = 16), a second plasma sample was drawn at the same time of day and at the same dose; the correlation between the two concentration values was 0.83. The relatively noninvasive approach used in this study allows the assessment of pharmacokinetic properties of medications under conditions of appropriate clinical use in special populations such as children, adolescents, and the elderly. Journal of Clinical Pharmacology, 1999;39:775-785 (C) 1999 the American College of Clinical pharmacology.
OBJECTIVE: To address the question of the significant increase in methylphenidate (MPD) prescriptions being written and to make recommendations for health care providers involved in providing care for patients with attention deficit hyperactivity disorder (ADHD) and their families. DATA SOURCES: Medline search 1966-1998 for professional articles using the following search terms--methylphenidate, children, adolescents, abuse; Internet search using MPD, Ritalin, and ADHD; and Paper Chase search using methylphenidate. DATA EXTRACTION: The available literature regarding potential abuse or diversion of MPD consists of case reports, review articles, newspaper articles, and a Drug Enforcement Administration (DEA) publication. All available literature sources were used. DATA SYNTHESIS: Although the media and DEA report significant abuse and diversion of prescribed MPD, a review of the available literature did not reveal data to substantiate these claims. Nonetheless, there are reasons to suspect that abuse and diversion occur. A potential contributing factor to abuse is the reported similarities in pharmacodynamics and pharmacokinetics between MPD and cocaine. Recommendations are made to decrease the possibility of abuse and diversion of prescribed MPD. CONCLUSION: A balanced middle ground must be found regarding the benefits of MPD and its abuse potential. Education of clinicians, patients, and family members is key in ensuring that MPD is used appropriately.
Background
Framing answerable clinical questionsSearching for evidenceCritical review of the evidenceFuture research needs
The appearance, the differential diagnosis and the prevalence of bipolar disorder in children and adolescents is discussed. Among adolescents bipolar disorder appears to have a similar prevalence in the US and The Netherlands. However, among children it is frequently diagnosed in the US and hardly in The Netherlands. It is concluded that bipolar disorder tends to start earlier in the US than in the Netherlands. It is hypothesized that this may be related to a higher use of stimulants and antidepressants by US children diagnosed as ADHD or depression, respectively.
This book is a guide to psychotropic drug therapy for children and adolescents. But just how common is the medical prescription of such drugs at the moment? Is it too little or too much? Does clinical application precede scientific verification of safety and efficacy? Are recommendations for patient management generally followed in everyday clinical settings? This chapter examines these and related issues to the extent that available data will allow.
The usefulness of functional analysis procedures for the assessment and treatment of behaviors associated with Attention Deficit Hyperactivity Disorder has been the subject of a number of recent investigations. This article provides a selected review of recent studies and examines potential implications for practice. Conclusions suggest that functional analysis may be particularly useful for identifying behaviors that are (or are not) maintained by social consequences and for the subsequent development of optimal individualized treatments. A review of recent studies in which the researchers have conducted functional analyses while also conducting concurrent medication assessments is also provided. Conclusions illustrate the unique contributions of functional analysis procedures to medication assessments. Subsequent implications for determining the most beneficial uses of medication are discussed. In conclusion, the procedures of a local public-school-based program are described to illustrate the potential for classroom-based applications of general functional assessment procedures to evaluate the effects of behavioral and medication treatments.
Introduction Comorbidity Empirical Data on ADHD and Substance Use Risk Empirical Data on Conduct Disorder/Oppositional Defiant Disorder and Substance Use Risk Externalizing Disorders and Developmental Outcome Conclusion References
Introduction. From spectacles to telescopes, windmills to watches, bicycles to aeroplanes, vaccinations and medicines, to assisted reproduction and synthetic life, and from writing and printing to e-books and computers, the history of humankind has been one of exploration, discovery and innovation. Whether the outcome is to see further, travel faster or resist disease, we humans have welcomed advances in technology, not least because they defy the limits imposed on us by nature and enhance our lives. Today, to add to the list above, there are drugs available that can help focus attention and manipulate information, sharpen memory and promote wakefulness – in other words, enhance many dimensions of cognitive function. Chemical cognitive enhancers (CCEs) refer to drugs that were often originally developed to treat those with cognitive disabilities or neuropsychiatric disorders; however, when used by healthy adults they have been shown to boost brain power. Given our long history of embracing enhancement tools and technologies, it is odd that CCEs have been regarded with such suspicion, given their respectable safety record in clinical applications. (Methylphenidate (Ritalin) has been prescribed for children since the 1980s for a condition that is not life-threatening or painful – attention deficit disorder.) CCEs are referred to, even by critics and sceptics, as ‘enhancement drugs’ or ‘smart drugs’ – names that advertise their beneficial purpose. Yet the dispensation and use of CCEs for non–therapeutic purposes is principally forbidden in the UK by either the criminal law or professional regulatory standards; or indeed societal norms that seek to inhibit use of CCEs, often referring to their use, quite simply, as cheating. In this essay, we explore the role of the criminal law, and indeed other regulative mechanisms, in controlling access to CCEs.
This chapter reviews the current definitions of attention deficit hyperactivity disorder (ADHD) and learning disorders (LD) and considers the current state-of-the art methods for their assessment. It also presents various innovative, nontraditional assessments for ADHD and LD directed by new hypotheses, theories, and discoveries that may shape the revisions of the official definitions and in the future may become accepted methods for the assessment of ADHD and LD. In a categorical system, diagnosis (classification) is based on the presence of abnormal patterns of behavior assumed to be qualitatively different from the pattern of normal behavior in the population, with clear boundaries between normal and abnormal classes that are mutually exclusive and with high within-class homogeneity. The multimodality treatment study of ADHD is an example of the traditional assessment of ADHD in a research setting. Innovative approaches to the diagnosis of ADHD are evolving from the field of cognitive neuroscience. The innovative assessments include an alternative approach based on dimensional descriptions of ADHD and LD that are based on the quantification of attributes distributed continuously across the range of defining behaviors without clear boundaries to define separate categories of psychopathology and normality.
Attention deficit hyperactivity disorder (ADHD) is one of the most common neurodevelopmental syndromes, with recent data suggesting prevalence rates in school-aged children between 8-10% (American Academy of Pediatrics & Subcommittee on Attention-Deficit/Hyperactivity Disorder, 2001; Barbaresi et al., 2002; Katusic et al., 2002; Leibson et al., 2001). Symptom onset is by the age of seven, with symptoms often evident between the ages of three to five years. The accurate diagnosis and effective treatment of ADHD in children can be critical to their academic, social, and interpersonal functioning. However, this is complicated by high rates of comorbid disorders in children with ADHD, including learning disabilities. The role of behavioral and neuropsychological assessment in diagnosis and treatment planning and effective treatment interventions will be discussed in this chapter. Furthermore, cognitive theories of ADHD and neuropsychological research, along with implications for clinical practice and future research will also be discussed. The diagnosis of ADHD ADHD is primarily characterized by two groups of core symptoms: (1) inattention and (2) hyperactive and impulsive behaviors. Currently, the DSM-IV-TR (APA, 2000) categorizes ADHD into three major subtypes: (1) Predominantly Inattentive Type (ADHD-I); (2) Predominantly Hyperactive/Impulsive Type (ADHD-H/I); and (3) Combined Type (ADHD-C), with the latter being the most common. Symptoms include short attention span, distractibility, forgetfulness, disorganization, restlessness, hyperactivity, impulsive responding and talkativeness. Overall, the male-to-female ratio for diagnosis is approximately 2:1 in community surveys (Cohen et al., 1999; Fergusson et al., 1993; Szatmari, Offord & Boyle, 1989).
The number of children in the United States receiving psychiatric diagnoses and taking psychotropic medications rose significantly from the second half of the twentieth century through to today. Accompanying these increased rates of diagnosis and psychotropic medication use have come sometimes intense debates about whether the increases are appropriate, or whether healthy children are being mislabeled as sick and inappropriately given medications to alter their moods and behaviors. While these debates are in part highly technical, concerning questions in epidemiology and pharmacology, they are also infused with ethical questions about the appropriate goals of medicine, the nature of sickness and health, and the obligations we owe to children and families struggling to flourish. This chapter presents four inter-connected observations about the diagnosis and treatment of mood and behavioral disturbances in children that at least partially explain why this area generates concern and controversy, but that also point to important areas of agreement where progress can be made. These observations include that psychiatry can provide an important approach for understanding and responding to children’s mood and behavioral problems provided we remember that it also carries its own complexities and difficulties. Further, forces within and outside psychiatry can influence how diagnoses are made and how treatments are selected, including systemic forces that strongly favor medication over psychosocial treatments, with the result that children too often receive pharmacological treatment only, even when other interventions are supported by evidence, contribute towards long-term flourishing, and reflect families’ deepest value commitments.
Purpose:
This study explores trends in attention-deficit/hyperactivity disorder (ADHD) medications in Taiwan from 2000 to 2011 and whether negative media coverage of Ritalin in January 2010 impacted ADHD prescriptions throughout the country.
Method:
Patients throughout Taiwan who had been newly diagnosed with ADHD (n = 145,269) between January 2000 and December 2011 were selected from Taiwan's National Health Insurance database as subjects for this study. We analyzed monthly and yearly data on person-days of treatment with immediate-release methylphenidate (IR-MPH), osmotic controlled-release formulation of methylphenidate (OROS-MPH), and atomoxetine (ATX) using linear models of curve estimation and the time series expert modeler.
Results:
Of our sample, 57.8%, 28.9%, and 4.3% had been prescribed one or more doses of IR-MPH, OROS-MPH, or ATX, respectively. The annual person-days of IR-MPH use increased regularly from 2000 to 2009, dropped abruptly in 2010, and then increased again the next year. Furthermore, the person-days of OROS-MPH prescriptions did not reach their expected goal in 2010; however, the person-days of ATX prescriptions have increased constantly since entering the market in 2007. Compared with patients newly diagnosed with ADHD in 2009, those newly diagnosed in 2010 were less likely to be treated with medication.
Conclusion:
These findings suggest that negative publicity affected the writing of stimulant prescriptions for ADHD patients throughout Taiwan. Media reporting has a vital role in influencing children with ADHD, their parents, and their willingness to accept pharmacotherapy as treatment. Copyright © 2015 John Wiley & Sons, Ltd.
Attention deficit/hyperactivity disorder (ADHD) denotes childhood problems of hyperactivity,
inattention, and impulsivity, leading to impairments in daily functioning, scholastic performance, and relationships with peers. Although the rationale for stimulant medication is to reduce the morbidity associated with having ADHD, critics have argued that methylphenidate and other prescribed stimulant drugs (PSDs) are overly prescribed and inherently dangerous. Researchers have also raised concerns that PSDs might prime the central nervous system, thus rendering individuals more susceptible to substance use disorders
(SUDs) later in life. There is also a strong comorbidity between ADHD and SUDs
in adulthood. If many adults with SUDs were prescribed stimulants for ADHD as children or during adolescence, this could suggest that taking these drugs during these critical developmental periods increase the risks for SUDs later on. Research articles (i.e., both animal and human data) were reviewed to ascertain if any associations exist between PSDs and brain and behavioral changes. Review articles, meta-analyses, clinical trials, and clinical data were examined to assess associations between PSDs during childhood and
adolescence and the development of SUDs in adolescence and adulthood. Contentious evidence does suggest that PSDs are not likely responsible for substance use and SUDs in adolescence, although it remains equivocal if PSDs offer any protection against substance use and abuse in adolescence. Although PSDs do reduce symptoms of ADHD that may interfere with learning in childhood, the evidence raises the possibility that these drugs might be responsible for substance use and SUDS in some adults.
This article has two central purposes. The first is to suggest that Western, as well as non-Western, illness categories are culture-bound. The second is to elucidate the diagnostic and treatment implications associated with adopting a reductionist diagnostic approach, including for psychiatric as well as nonpsychiatric illnesses. A comparative approach is used to highlight the differences between American psychiatry's diagnostic system (i.e. DSM) and French child psychiatry's diagnostic system (CFTMEA). The analysis begins by identifying the overarching differences between the systems, then analyzes the differences between their respective versions of the Attention Deficit/Hyperactivity Disorder diagnostic category, and ends by tracing the diagnostic and treatment implications of those differences. This comparative analysis reveals three significant differences between the diagnostic systems: 1) theoretical orientation (biological vs. psychodynamic); 2) the view that symptoms should be counted as opposed to understood; and 3) the presence of symptoms checklists versus their absence. Additionally, I argue the American characteristics encourage American clinicians to administer the ADHD diagnosis to a greater number of symptomatic children to treat these children with psychiatric medications. This analysis makes three contributions: 1) it highlights the limitations of the DSM's ADHD definition; 2) it strengthens the case for seeing Western diagnostic categories in general, and the DSM categories in particular, as cultural artifacts; and 3) it elucidates the profound relationship between diagnostic systems and both diagnostic rates and treatment practices.
Large community-based, computerized administrative datasets comprised of enrollment data, socio-demographic characteristics, and diagnostic and treatment information on all individuals in populations or a health insurance plan constitute the major resource for pharmacoepidemiologic research. Investigators use such data to estimate prevalence or new-onset medication use in terms of trends, persistence of use, and the demographic and clinical correlates of treatment. Physician visit data provide diagnoses which can be linked to medication use. This review covers psychotropic medication treatment patterns of U.S. youth over the last 20 years and reveals information very different from the findings derived from clinical trials or case series reports. Pharmacoepidemiologic data are more generalizable to the population at large. Recent trends show that concomitant psychotropic medication regimens, commonly including antipsychotics, have profoundly increased in youth, reflecting substantial off-label usage. Such population-based research can be used to identify and expand the public health mission in pediatric pharmacotherapy.
Objectives. Several guidelines have been published for the care of children with attention-deficit/hyperactivity disorder (ADHD); however, few data describe adoption of practice guidelines. Our study sought 1) to describe primary care diagnosis and management of ADHD, 2) to determine whether the care is in accordance with American Academy of Pediatrics (AAP) practice guidelines, and 3) to describe factors associated with guideline adherence.
Methods. We conducted a mail survey of 1374 primary care physicians in Michigan. Main outcome measures were reported adherence to practices specified in the AAP guidelines; ADHD practice patterns; and other measures, including attitudes about parent, teacher, and community influences on ADHD diagnosis and treatment. Bivariate and multivariate analyses were performed to assess patient and physician factors associated with adherence to guideline components.
Results. The overall response rate was 60%. The majority (77.4%) of primary care physicians were familiar with AAP guidelines on ADHD, and many (61.1%) reported incorporating the guidelines into their practice. Differences were apparent by specialty: 91.5% of pediatricians were familiar with the guidelines in contrast to 59.8% of family physicians. The majority of clinicians reported practices consistent with individual components of the diagnostic and treatment guidelines. However, when adherence to multiple components was analyzed together, only 25.8% of clinicians reported routine use of all 4 diagnostic components in the survey. In addition, some physicians continue to use diagnostic modalities that are currently not recommended for routine evaluation of school-aged children with ADHD—continuous performance testing, neuroimaging, and laboratory tests (eg, thyroid, lead, or iron testing). With regard to ADHD treatment, the majority (66.6%) of respondents reported routine recommendation of pharmacotherapy and titration of medications in the first month when prescribed (81.3%). However, just over half (53.1%) reported routine follow-up visits (3–4 times per year) for children who have ADHD and are taking medications. Most (53.4%) clinicians also recommended behavioral therapy for children who had a diagnosis of ADHD. Patterns of specialty differences were less consistent for treatment components: pediatricians were more likely to recommend medications, but family physicians reported more frequent follow-up evaluations for children who receive medications. There were no specialty differences in recommendations for behavioral therapy. In addition to physician specialty variations, differences in management were apparent by practice type and other demographic characteristics. There were few significant associations between adherence to guideline components and physician attitudes about parent, teacher, or community influences. However, these factors were noted by many respondents. Only 32.5% agreed that their community had adequate, accessible mental health resources. Half (50.1%) of the physicians reported that insurers limit coverage for assessment and treatment of ADHD.
Conclusions. Primary care physicians generally report awareness of pediatric ADHD guidelines and follow these clinical practice recommendations. However, some physician variations are apparent, and areas for improvement are noted. Many primary care physicians report poor access to mental health services, limited insurance coverage, and other potential system barriers to the delivery of ADHD care. Additional study is needed to confirm provider-reported data; to determine what constitutes high-quality, long-term management of this chronic condition; and to confirm how reported practices associate with long-term outcomes for children with ADHD.
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