September 9, 1999

Community Ritalin Use Rates Reach Twenty Per Cent in the U.S. and Canada

"The Extent of Drug Therapy for Attention Deficit-Hyperactivity Disorder Among Children in Public Schools," GB LeFever, KV Dawson and AL Morrow. American Journal of Public Health, September 1999, vol. 89, pages 1359-1364.

"'Boys Will Be Boys' -- That's Why We've Got Them Popping Pills," Anne Rees. The Province, Vancouver, BC, August 9, 1999, pp. A14-16.

These two articles just out convincingly demonstrate there are communities where the rates of stimulants prescribed to children is twenty per cent (Ritalin).

This data has been circulating for three years but the Extent of Drug Therapy article appears in a prestigious peer review journal and the documentation for the 'Boys Will Be Boys' piece is pristine and clear. LeFever and colleagues had school nurses survey all the students of two medium size school districts (6,000 and 24,000 students respectively) in southeast Virginia in 1996. They found among fifth grade white boys, 18 % in the first district and 20 % in the second were taking stimulants at school. Overall use rates were 8 and 10 %. African American children were prescribed Ritalin at half the rate of the white children. The figures were for children taking the medication at school. Previous studies have shown that perhaps another 20% of children are taking Ritalin only at home. That could mean nearly one on four boys taking Ritalin.

Up until now most large surveys have concluded that Ritalin is under prescribed, if anything. I've been saying that Ritalin is both under prescribed and over prescribed depending upon the community you survey, their standards (compared to yours) for the ADHD diagnosis and their threshold for medication use. Rees has been studying the Vancouver area for years and succeeded under the Canadian Freedom of Information Act and the detailed information available through a national health service like HealthCanada to come up with the exact number of children prescribed Ritalin in each community in her area. She then compared them to census data for the various age group and sexes. She found 20 % of the 170 boys between age 8 and 13 in one small community to be on Ritalin. Victoria with nearly 4000 boys had a 10.5% rate. Vancouver by comparison with 14265 boys had on a 2.3 % rate. Girls' comparable rates were 1/3 to 1/4 lower.

A colleague who has been a staunch proponent of the biological view of ADHD but sensitive to the larger issues, upon reading the American Journal of Public Health article, reacted, "If this data is accurate, and I have no reason to believe that it isn't, it is truly shocking and we must wonder what the heck is going on."

2099 Mt. Diablo Blvd., Suite 208
Walnut Creek, CA 94596