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ARTICLE |

A Survey of Medication Treatment for Hyperactive/Inattentive Students FREE

Daniel J. Safer, MD; John M. Krager, MD, MPH
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Reprint requests to the Eastern Community Mental Health Center, 9100 Franklin Square Dr, Baltimore, MD 21237 (Dr Safer).


JAMA. 1988;260(15):2256-2258. doi:10.1001/jama.1988.03410150104040
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Since 1971, the Baltimore County Health Department has conducted nine biannual surveys of school nurses in all of the county's public and private schools to determine the prevalence of medication treatment for hyperactivity/inattentiveness among students. The results reveal a consistent doubling of the rate of medication treatment for hyperactive/inattentive students every four to seven years such that in 1987,5.96% of all public elementary school students were receiving such treatment. Related trends from 1971 to 1987 have been that stimulants increased from 76% to 99% of the medication prescribed; methylphenidate hydrochloride rose from 40% to 93% of the total; the male-female ratio dropped from an average of 8:1 to 5:1; the rate of medication treatment for hyperactive/inattentive students rose faster in secondary than in elementary schools; and 25% of students receiving stimulant medication in 1987 were in special education classes or schools.

(JAMA 1988;260:2256-2258)

REFERENCES

Krager JM, Safer DJ:  Type and prevalence of medication used in the treatment of hyperactive children . N Engl J Med 1974;;291:1118-1121.
Krager JM, Safer DJ, Earhart J:  Follow-up survey results of medication used to treat hyperactive school children . J Sch Health 1979;;49:317-321.
Safer DJ, Krager JM:  Trends in medication therapy for hyperactivity , in Gadow KD (ed): Advances in Learning and Behavioral Disabilities .
Greenwich, Conn, JAI Press Inc, 1984;, vol 3, pp 125-149.
Safer DJ, Krager JM:  Trends in medication treatment of hyperactive school children . Clin Pediatr 1983;;22:500-504.
Safer DJ, Allen RP: Hyperactive Children: Diagnosis and Treatment . Baltimore, University Park Press, 1976;,  chap 2 and 3 .
Quarterly Per Capita Consumption of Drugs by State: Fourth Quarter 1986 . Drug Enforcement Administration, 1987;.
DEA -controlled substances: Establishment of the 1987 aggregate production quota for methylphenidate . Federal Register 1987;;52( (June 2) ):20650-20651.
Drug Enforcement Administration, In the Matter of Methylphenidate Production Quotas—1986, decision of the Administrative Law Judge, Docket No. 86-52, Oct 28,1987, p29.
Gadow KD: Children on Medication . San Diego, College-Hill Press Inc, 1986;, vol 1, pp 97-141.
Current Population Report, Series P , publication 409. US Dept of the Census, 1986;.
Offord DR, Boyle MH, Szatmari P, et al:  Ontario child health study: II. Six-month prevalence of disorder and rates of service utilization . Arch Gen Psychiatry 1987;;44:832-836.
Bennett FC, Sherman R:  Management of childhood 'hyperactivity' by primary care physicians . J Dev Behav Pediatr 1983;;4:88-93.
Cullinan D, Gadow KD, Epstein MH:  Psychotropic drug treatment among learning disabled, educable mentally retarded, and seriously emotionally disturbed students . J Abnorm Child Psychol 1987;;15:469-477.
Safer DJ, Allen RP:  Stimulant treatment of hyperactive adolescents . Dis Nerv Syst 1975;;36: 454-457.
Varley CK:  Effects of methylphenidate in adolescents with attention deficit disorder . J Am Acad Child Psychiatry 1983;;22:351-354.
Klorman R, Coons HW, Borgstedt AD:  Effects of methylphenidate on adolescents with a childhood history of attention deficit disorder: I. Clinical findings . J Am Acad Child Adolesc Psychiatry 1987;;26:363-367.
Diagnostic and Statistical Manual of Mental Disorders , ed 2. Washington, DC, American Psychiatric Association, 1968;.
Diagnostic and Statistical Manual of Mental Disorders , ed 3. Washington, DC, American Psychiatric Association, 1980;.
Diagnostic and Statistical Manual of Mental Disorders , ed 3 (revised). Washington, DC, American Psychiatric Association, 1987;.
Douglas VI, Barr RG, O'Neill ME, et al:  Short term effects of methylphenidate on the cognitive, learning and academic performance of children with attention deficit disorder in the laboratory and the classroom . J Child Psychol Psychiatry 1986;;27: 191-211.
Gadow KD:  Effects of stimulant drugs on academic performance in hyperactive and learning disabled children . J Learning Disabil 1983;;16:290-299.
Barkley RA, Cunningham CE:  Do stimulant drugs improve the academic performance of hyperkinetic children? Clin Pediatr 1978;;17:85-92.
Rapport MD, Stoner G, DuPaul GJ, et al:  Methylphenidate in hyperactive children: Differential effects of dose on academic, learning, and social behavior . J Abnorm Child Psychol 1985;;13:227-244.
Pelham WE, Bender ME, Caddell J, et al:  Methylphenidate and children with attention deficit disorder: Dose effects on classroom academic and social behavior . Arch Gen Psychiatry 1985;; 42:948-952.
Famularo R, Fenton T:  Effect of methylphenidate on school grades in children with attention deficit disorder without hyperactivity: A preliminary report . J Clin Psychiatry 1987;;48:112-114.
Cowart VS:  The ritalin controversy: What's made this drug's opponents hyperactive? JAMA 1988;;259:2521-2523.

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Krager JM, Safer DJ:  Type and prevalence of medication used in the treatment of hyperactive children . N Engl J Med 1974;;291:1118-1121.
Krager JM, Safer DJ, Earhart J:  Follow-up survey results of medication used to treat hyperactive school children . J Sch Health 1979;;49:317-321.
Safer DJ, Krager JM:  Trends in medication therapy for hyperactivity , in Gadow KD (ed): Advances in Learning and Behavioral Disabilities .
Greenwich, Conn, JAI Press Inc, 1984;, vol 3, pp 125-149.
Safer DJ, Krager JM:  Trends in medication treatment of hyperactive school children . Clin Pediatr 1983;;22:500-504.
Safer DJ, Allen RP: Hyperactive Children: Diagnosis and Treatment . Baltimore, University Park Press, 1976;,  chap 2 and 3 .
Quarterly Per Capita Consumption of Drugs by State: Fourth Quarter 1986 . Drug Enforcement Administration, 1987;.
DEA -controlled substances: Establishment of the 1987 aggregate production quota for methylphenidate . Federal Register 1987;;52( (June 2) ):20650-20651.
Drug Enforcement Administration, In the Matter of Methylphenidate Production Quotas—1986, decision of the Administrative Law Judge, Docket No. 86-52, Oct 28,1987, p29.
Gadow KD: Children on Medication . San Diego, College-Hill Press Inc, 1986;, vol 1, pp 97-141.
Current Population Report, Series P , publication 409. US Dept of the Census, 1986;.
Offord DR, Boyle MH, Szatmari P, et al:  Ontario child health study: II. Six-month prevalence of disorder and rates of service utilization . Arch Gen Psychiatry 1987;;44:832-836.
Bennett FC, Sherman R:  Management of childhood 'hyperactivity' by primary care physicians . J Dev Behav Pediatr 1983;;4:88-93.
Cullinan D, Gadow KD, Epstein MH:  Psychotropic drug treatment among learning disabled, educable mentally retarded, and seriously emotionally disturbed students . J Abnorm Child Psychol 1987;;15:469-477.
Safer DJ, Allen RP:  Stimulant treatment of hyperactive adolescents . Dis Nerv Syst 1975;;36: 454-457.
Varley CK:  Effects of methylphenidate in adolescents with attention deficit disorder . J Am Acad Child Psychiatry 1983;;22:351-354.
Klorman R, Coons HW, Borgstedt AD:  Effects of methylphenidate on adolescents with a childhood history of attention deficit disorder: I. Clinical findings . J Am Acad Child Adolesc Psychiatry 1987;;26:363-367.
Diagnostic and Statistical Manual of Mental Disorders , ed 2. Washington, DC, American Psychiatric Association, 1968;.
Diagnostic and Statistical Manual of Mental Disorders , ed 3. Washington, DC, American Psychiatric Association, 1980;.
Diagnostic and Statistical Manual of Mental Disorders , ed 3 (revised). Washington, DC, American Psychiatric Association, 1987;.
Douglas VI, Barr RG, O'Neill ME, et al:  Short term effects of methylphenidate on the cognitive, learning and academic performance of children with attention deficit disorder in the laboratory and the classroom . J Child Psychol Psychiatry 1986;;27: 191-211.
Gadow KD:  Effects of stimulant drugs on academic performance in hyperactive and learning disabled children . J Learning Disabil 1983;;16:290-299.
Barkley RA, Cunningham CE:  Do stimulant drugs improve the academic performance of hyperkinetic children? Clin Pediatr 1978;;17:85-92.
Rapport MD, Stoner G, DuPaul GJ, et al:  Methylphenidate in hyperactive children: Differential effects of dose on academic, learning, and social behavior . J Abnorm Child Psychol 1985;;13:227-244.
Pelham WE, Bender ME, Caddell J, et al:  Methylphenidate and children with attention deficit disorder: Dose effects on classroom academic and social behavior . Arch Gen Psychiatry 1985;; 42:948-952.
Famularo R, Fenton T:  Effect of methylphenidate on school grades in children with attention deficit disorder without hyperactivity: A preliminary report . J Clin Psychiatry 1987;;48:112-114.
Cowart VS:  The ritalin controversy: What's made this drug's opponents hyperactive? JAMA 1988;;259:2521-2523.
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