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

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