Stimulant treatment for children: a community perspective.
OBJECTIVE
To examine the use of prescribed stimulants in relation to research diagnoses of attention-deficit hyperactivity disorder (ADHD) in a community sample of children.


METHODS
Data from 4 annual waves of interviews with 9- to 16-year-olds from the Great Smoky Mountains Study were analyzed.


RESULTS
Over a 4-year period, almost three quarters of children with an unequivocal diagnosis of ADHD received stimulant medications. However, girls and older children with ADHD were less likely to receive such treatment. Most children with impairing ADHD symptoms not meeting full criteria for DSM-III-R ADHD did not receive stimulant treatment. Stimulant treatment in this group was significantly related to the level of symptoms reported by parents and teachers and was much more common in individuals who met criteria for oppositional defiant disorder. The majority of individuals who received stimulants were never reported by their parents to have any impairing ADHD symptoms. They did have higher levels of nonimpairing parent-reported ADHD symptoms, higher levels of teacher-reported ADHD symptoms, and interviewer-observed ADHD behaviors, but these typically fell far below the threshold for a DSM-III-R diagnosis of ADHD.


CONCLUSIONS
In this area of the Great Smoky Mountains, stimulant treatment was being used in ways substantially inconsistent with current diagnostic guidelines.
Department of Psychiatry and Behavioral Sciences, Duke University Medical Center, Durham, NC 27710, USA.
A
A
Angold
A
A
Erkanli
H L
HL
Egger
E J
EJ
Costello
D000293:Adolescent; D000367:Age Factors; D001289:Attention Deficit Disorder with Hyperactivity / Q000150:complications / Q000175:diagnosis* / Q000188:drug therapy* / Q000453:epidemiology; D000697:Central Nervous System Stimulants / Q000627:therapeutic use*; D002648:Child; D003937:Diagnosis, Differential; D005260:Female; D019983:Guideline Adherence; D006801:Humans; D007406:Interview, Psychological; D008137:Longitudinal Studies; D008297:Male; D009657:North Carolina / Q000453:epidemiology; D011159:Population Surveillance; D011569:Psychiatric Status Rating Scales; D012307:Risk Factors; D012737:Sex Factors
D000697:Central Nervous System Stimulants