The extent of drug therapy for attention deficit-hyperactivity disorder among children in public schools

Am J Public Health. 1999 Sep;89(9):1359-64. doi: 10.2105/ajph.89.9.1359.


Objectives: The purpose of this study was to determine the extent of medication use for attention deficit-hyperactivity disorder (ADHD) in southeastern Virginia.

Methods: Students enrolled in grades 2 through 5 in school districts in city A (n = 5767 students) and city B (n = 23,967 students) were included. Nurses recorded students who received ADHD medication in school.

Results: The proportion of students receiving ADHD medication was similar in both cities (8% and 10%) and was 2 to 3 times as high as the expected rate of ADHD. Receipt of drug therapy was associated with social and educational characteristics. Medication was used by 3 times as many boys as girls and by twice as many Whites as Blacks. Medication use increased with years in school, and by fifth grade 18% to 20% of White boys were receiving ADHD medication. Being young for one's grade was positively associated with medication use (P < .01). The prevalence of ADHD was 12% in district A, 63% in district B.

Conclusions: These findings suggest that criteria for diagnosis of ADHD vary substantially across US populations, with potential overdiagnosis and overtreatment of ADHD in some groups of children.

MeSH terms

  • African Americans / statistics & numerical data
  • Attention Deficit Disorder with Hyperactivity / diagnosis
  • Attention Deficit Disorder with Hyperactivity / drug therapy*
  • Attention Deficit Disorder with Hyperactivity / epidemiology
  • Bias
  • Child
  • Child, Preschool
  • Drug Utilization
  • Educational Status
  • European Continental Ancestry Group / statistics & numerical data
  • Female
  • Humans
  • Logistic Models
  • Male
  • Prevalence
  • Risk Factors
  • School Health Services / statistics & numerical data*
  • Sex Factors
  • Socioeconomic Factors
  • Students / statistics & numerical data*
  • Virginia / epidemiology