The 130th Annual Meeting of APHA

3356.0: Monday, November 11, 2002 - 8:50 PM

Abstract #46109

Rise of ADHD Prevalence and Psychostimulant Use: A Historical Perspective

Rick Mayes, PhD, Department of Political Science, University of Richmond, 28 Westhampton Way, University of Richmond, Richmond, VA 23173, 804-289-8529, and Farasat Bokhari, PhD, School of Public Health, University of California, Berkeley, 140 Earl Warren Hall, MC 7360, University of California, Berkeley, Berkeley, CA 94720-7360.

Background: Our work focuses on the significant increase in ADHD diagnoses and psychostimulant use that began in the early 1990s. In 1985 there were between 650,000 and 750,000 individuals diagnosed with ADHD, in 1990, there were between 850,000 and 950,000 individuals. By 2000, there were 4 to 5 million individuals—mostly school-age children—diagnosed with ADHD, 75-85% of whom were treated with psychostimulants. In 1991, doctors wrote approximately 2.5 million prescriptions for Ritalin and related drugs; in 2000, the number had increased to approximately 20 million prescriptions. We seek to identify the primary institutional factors (medical, political, economic and educational)—as well as the links between them—that had previously served to restrain this phenomenon from occurring during the 1970s and 1980s, but which fundamentally changed over the course of the 1980s. The two main psychostimulants for treating ADHD, methylphenidate (Ritalin) and amphetamine, have been in use since at least the 1960s. Likewise, ADHD as an official diagnosis has been in existence since 1980, and under other names (minimal brain dysfunction and hyperkinetic reaction) since the 1960s. Several scholars point to Congress’s passage of the Individuals with Disabilities Education Act (IDEA) in 1990, along with the Department of Education’s Policy Clarification Memorandum in 1991 directing schools to include ADHD as a covered disability, as the catalyst for increasing the legitimacy—among clinicians, parents, and teachers—of both the diagnosis and the use of psychostimulants. Thus, we explain how changes in the 1980s in the mental health community (the publication of the DSM-III in 1980), the insurance industry (the growth of managed care), and in the public’s attitude to psychopharmacology (the popularity of Prozac) contributed to the political momentum for Congress’s inclusion of ADHD as a covered disability under the IDEA. We also explain how the feedback from this new policy interacted with relevant institutional actors—clinicians, educators, the courts, and pharmaceutical companies—to bring about a marked increase in ADHD diagnoses and psychostimulant use.

Methodology: Analytical narrative emphasizing historical research and interviews – We do this by collecting specific reports and hearings on ADHD and psychostimulants from the: Dept. of Education, Drug Enforcement Administration, public survey data, and the Food & Drug Administration. We collect data from Lexis-Nexis, Infotrac, and ProQuest searches of newspaper, magazine, and academic journal articles on ADHD and psychostimulants. Finally, we tally the number of ADHD-related psychostimulant advertisements in pediatric and other relevant clinical journals over time.

Learning Objectives:

Keywords: Child/Adolescent Mental Health, Drug Use

Presenting author's disclosure statement:
I do not have any significant financial interest/arrangement or affiliation with any organization/institution whose products or services are being discussed in this session.

Health Services Research Contributed Papers #3: Mental Health

The 130th Annual Meeting of APHA