Stimulant Use for ADHD Varies Widely and Is Tied to Socioeconomics, Physician Supply

There appear to be wide variations across states, regions, and counties in use of stimulants to treat attention-deficit/hyperactivity disorder (ADHD)—especially in primary care, where most patients prescribed stimulants are managed—according to the report "Geographic Variation and Disparity in Stimulant Treatment of Adults and Children in the United States in 2008" in the November Psychiatric Services.

Researchers from Abt Associates, a public-policy and business consulting firm, obtained records of 24.1 million stimulant prescriptions dispensed to insured and uninsured patients from approximately 76% of U.S. retail pharmacies. They found that stimulant treatment prevalence among states varied widely, and the variation among counties was even wider. Two-thirds of the variation among counties in stimulant treatment prevalence was associated with supply of physicians, socioeconomic composition of the population, and, among children, funding for special education.

“One plausible interpretation of our findings is that physicians, schools, and parents in locales where pediatric treatment rates were closer to the estimated national ADHD prevalence rates are more effective in identifying, diagnosing, and treating ADHD and, perhaps to a lesser extent, other conditions for which stimulants are indicated,” the researchers said. “The strongest predictor of treatment was the availability of physicians in the area—a common finding in studies of geographic variations among other types of medical treatment.”

For more information about the use of medications to treat ADHD, see the Psychiatric News articles, "Blood Pressure Doesn't Spike With Long-term Stimulant Use" and "Teens Not Overmedicated, NIMH Study Finds."

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