PharmacoEconomics & Outcomes News 282 - 30 Sep 2000

Psychostimulant use: the goodnews and the bad news

The good news is that most children and adolescentswho meet full DSM-III-R* criteria for attention-deficithyperactivity disorder (ADHD) receive methylphenidateor other prescription psychostimulant medications. Butthe bad news is that these agents are usedinappropriately in paediatric patients without definiteADHD.

These are the findings of a study conducted byresearchers at Duke University, North Carolina, US,among paediatric patients (aged 9, 11 and 13 years) in11 counties in western North Carolina.**

Psychostimulant use among these patients was assessedduring 4 annually assessed 3-month periods over theyears 1992 to 1996.

Most ADHD treated appropriately . . .Among paediatric patients meeting full DSM-III-R

criteria for ADHD, an estimated 72% were receivingpsychostimulants. For paediatric patients not meetingthe full DSM-III-R criteria for ADHD, but having parentreports of ADHD symptoms associated with functionalimpairment [ADHD-not otherwise specified (ADHD-NOS)], the proportion receiving psychostimulants was23%. Just under 5% of children and adolescents who didnot fall into either the ADHD or the ADHD-NOScategories were receiving psychostimulants.

. . . but most psychostimulant useinappropriate

However, because of the absolute numbers involved,around two-thirds of all children and adolescents whowere receiving psychostimulants did not fall into eitherthe ADHD or the ADHD-NOS categories. Moreover, thegroup of treated individuals in the non-ADHD/ADHD-NOS group had a mean ADHD symptom count of only 1parent-reported symptom across the four 3-monthperiods. ‘It cannot be assumed that stimulants areefficacious in the treatment of such low levels of ADHDsymptoms’, comment the researchers.

The researchers also found the long-term use ofpsychostimulants by children and adolescents (a meanduration of > 3 years) ‘cause for concern’.* Diagnostic and Statistical Manual of Mental Disorders (revised thirdedition)** see Current Issues section, this issue, p5; 800763782

Angold A, et al. Stimulant treatment for children: a community perspective.Journal of the American Academy of Child and Adolescent Psychiatry 39:975-984, Aug 2000 800843779

» Editorial comment: These findings reveal a distinctlydifferent pattern of psychostimulant use than was found in a1992 survey. The 1992 survey found that only 12% of paediatricpatients (aged 9–17 years) meeting DSM-III-R criteria for ADHDwere receiving psychostimulant medications [seePharmacoEconomics & Outcomes News 231: 3, 25 Sep 1999;800786888]. .

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PharmacoEconomics & Outcomes News 30 Sep 2000 No. 2821173-5503/10/0282-0001/$14.95 Adis © 2010 Springer International Publishing AG. All rights reserved