National trends in the treatment of attention deficit hyperactivity disorder.
OBJECTIVE
Nationally representative descriptive data were presented regarding recent trends in the outpatient treatment of attention deficit hyperactivity disorder (ADHD) in children.


METHODS
Service use data were analyzed in children ages 3 to 18 years from two nationally representative surveys of the U.S. general population, the 1987 National Medical Expenditure Survey, and the 1997 Medical Expenditure Panel Survey. Trends in the rates of treatment for ADHD were presented by age, gender, race, family income, and health insurance status. Trends in ADHD treatment were also determined by annual numbers of visits, use of pharmacotherapies, and types of health care professionals.


RESULTS
The rate of outpatient treatment for ADHD increased from 0.9 per 100 children in 1987 to 3.4 per 100 children in 1997. Significant increases in the rates of treatment for ADHD were evident across nearly all sociodemographic groups, with the largest increases among children from poor, near-poor, and low-income families and children ages 12 to 18. Among children who received treatment for ADHD, there was a significant decrease in the number of treatment visits but an increase in the number of stimulant prescriptions between 1987 and 1997.


CONCLUSIONS
During the decade, there was a marked and broad expansion in access to treatment of children with ADHD but a decline in intensity of treatment, as measured by number of visits. These changes occurred during a period of expanding access to special education services, growth of managed behavioral healthcare, and increased public acceptance of effective psychotropic medications.
Olfson
Mark
M
New york State Psychiatric Institute, New York, NY 10032, USA. mo49@columbia.edu
Gameroff
Marc J
MJ
Marcus
Steven C
SC
Jensen
Peter S
PS
D000293:Adolescent; D000553:Ambulatory Care / Q000639:trends; D001289:Attention Deficit Disorder with Hyperactivity / Q000628:therapy*; D000697:Central Nervous System Stimulants / Q000627:therapeutic use; D002648:Child; D002675:Child, Preschool; D003131:Combined Modality Therapy / Q000639:trends; D003695:Delivery of Health Care / Q000639:trends*; D004363:Drug Utilization; D005260:Female; D019538:Health Care Surveys / Q000706:statistics & numerical data*; D005102:Health Expenditures / Q000639:trends; D006279:Health Maintenance Organizations / Q000639:trends; D006801:Humans; D008297:Male; D008605:Mental Health Services / Q000706:statistics & numerical data; D009819:Office Visits / Q000706:statistics & numerical data; D011613:Psychotherapy / Q000639:trends; D011619:Psychotropic Drugs / Q000627:therapeutic use; D014481:United States
D000697:Central Nervous System Stimulants; D011619:Psychotropic Drugs