RESEARCH
Attention disorder care gets hard look
An unusual study is under way at the University of
California, Berkeley that could help parents, doctors, teachers and
lawmakers better grasp the economic and social reasons why some kids are
receiving drug therapy for attention deficit hyperactivity disorder, or
ADHD.
Dr. Richard Scheffler, a UC Berkeley professor of
health economics and public policy, and Dr. Stephen Hinshaw, a
psychology professor and leading expert on ADHD, last month received a
$900,000 grant from the National Institute of Mental Health for the
three-year project.
Unlike most studies that look at the effects of
psychostimulant drugs — such as Ritalin — on kids diagnosed with ADHD,
researchers aim to uncover the economic and policy issues behind
prescription trends. “There's enormous variation in the use of these
drugs across state lines and communities,” Scheffler said.
ADHD is the most commonly diagnosed behavioral
disorder in children. In the decade leading up to 2001, the number of
people — mostly children — diagnosed with ADHD grew fivefold, from
900,000 to 4.5 million, according to the National Centers for Disease
Control and Prevention. That rise coincided with national policy changes
that allowed children with ADHD to receive special accommodations at
school.
At the same time, the number of prescriptions for
Ritalin, Adderall and other psychostimulants to treat ADHD rose by about
50 percent over the past decade. Using data from the U.S. Drug
Enforcement Agency, researchers will track shipments of these drugs to
the pharmacies dispensing them to see which communities are heavy
prescribers. In addition, they will drill down into those communities
and examine underlying policy decisions, teacher influence and health
care issues, such as access to child psychiatrists.
Clinical research isn't telling the whole story,
Hinshaw said. “All this research is taking place against a backdrop of
quickly changing market forces and treatment practices,” he said.
Some states have enacted legislation that limits
school influence in drug treatment. To get a better picture of treatment
and diagnosis, UC Berkeley researchers will have access to the medical
records of 14,000 children enrolled with Kaiser Permanente Northern
California.
This piece of the puzzle is key, the researchers said,
because the patient records will include information about race,
ethnicity, family history, area of residence and compliance in drug
therapy. “Are poorer kids being underdiagnosed and rich kids being
overmedicated? We hope to get a sense of that,” Scheffler said.
The study is the first of its kind — and atypical of
what the National Institutes of Mental Health usually funds, a spokesman
for the federal grant-making and research institute said, because of the
focus on sociology and economics of drug therapy.
Skepticism about drug treatment for ADHD relates to
the ambiguous nature of diagnosis and stigma surrounding mental illness,
Hinshaw said.
There is no test for ADHD. Rather, diagnosis is based
on observed behavior and family and medical history. When left
untreated, ADHD can have a significant effect on a child's growth and
development. Studies have shown that untreated children with ADHD have
higher rates of school failure, underemployment, illicit drug and
alcohol use and accidental injuries.
“The problem is many practitioners don't follow
well-established guidelines for diagnosis and treatment,” Hinshaw said.
“There's a brief pediatric visit and sporadic follow-up and monitoring.
Some kids are diagnosed too quickly and some, such as girls or inner
city children, may get ignored and underdiagnosed. You need an accurate
diagnosis first.”
By Rebecca Vesely
8 April 2004
http://www.oaklandtribune.com/Stories/0,1413,82~1865~2063849,00.html
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