Nearly three percent of Maryland public school students receive medication, most commonly the methylphenidate trademarked Ritalin, during school hours for treatment of attention deficit hyperactivity disorder (ADHD), according to a Maryland State Department of Education-supervised survey of school nurses. Published in the September issue of Pediatrics, the findings note significant disparities in the treatment rate for minority children and a concentrated use of ADHD medications among children receiving special education services.
The Maryland General Assembly's Legislative Task Force for the Study of the Use of Methylphenidate and Other Drugs in School Children mandated the survey over concerns for ADHD prescription practices. The study findings, "Stimulant Treatment in Maryland Public Schools," represent the largest survey of its kind and the only published school assessment of medication treatment for ADHD to cover an entire state.
Lead author Daniel Safer, M.D., adjunct associate professor of pediatrics and psychiatry at the Johns Hopkins Children's Center, draws particular attention to the finding that grade school African-American, Hispanic, and Asian students receive medication for ADHD at approximately half the rate of Caucasian students. The racial disparity increases with age so that by high school, the medication rate for African-American students is only one-fifth that for Caucasians.
"This correlates with long standing observations that African-American and Hispanic children receive less medical care than their white counterparts," says Safer. "We found that race has a stronger influence on medication rates for ADHD than average household income."
In a second major finding, students receiving special education services - representing approximately 13 percent of the total student population - are almost six times more likely to receive medication for ADHD than their regular education counterparts. In all, 45 percent of the nearly 24,000 students receiving medication for ADHD are receiving special education services, with another eight percent identified by school officials as requiring additional classroom assistance for an impairment in major life activities.
In related findings, Ritalin accounts for 84 percent of the medication prescribed for ADHD; there is a five-fold variation in medication rates across the 24 school jurisdictions in Maryland; prescription rates for girls substantially out-paced those for boys; and three percent of the medication is prescribed by nurse practitioners, 63 percent by pediatricians, and 11 percent by psychiatrists.
The survey was conducted as a result of Maryland General Assembly House Bill 981, and is a modification of summary findings presented by the task force in November 14, 1998, at the Maryland Interdisciplinary Conference on Attention Deficit Hyperactivity Disorder in College Park, Maryland. Safer's co-author was Michael Malever, Ph.D., Maryland State Department of Education.
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PEDIATRICS