Before 1970, the diagnosis of ADHD was relatively rare for schoolchildren and almost nonexistent for adolescents and adults. Between 1980 and 2007, there was an almost 8-fold increase of ADHD prevalence in the United States compared with rates of 40 years ago. Considering the prevalence of school-administered stimulants as synonymous with the prevalence of ADHD, Safer and colleagues, estimated the prevalence of ADHD in American schoolchildren as 1% in the 1970s, 3% to 5% in the 1980s, and 4% to 5% in the mid to late 1990s. In 2007, using data from the National Survey of Children’s Health, Visser and colleagues reported that 7.8% of youths aged 4 to 17 years had a diagnosis of ADHD and 4.3% reported current use of a medication for the disorder.
The rise in prevalence stemmed from a complex confluence of forces and events that came together in the first half of the 1990s and permitted a dramatic expansion of ADHD diagnosis and treatment. The growing political strength of children’s welfare advocates and the mental health consumer’s movement associated with decreasing stigma resulted in changes to federally funded special education programs. The Individuals with Disabilities Education Act recognized ADHD as a disability, and children with ADHD became eligible for school accommodations. |
Beginning in the 1990s, Congress expanded eligibility criteria for Medicaid, especially for children. This fueled a rapid increase in coverage for psychotropic medications, including stimulants. At the same time, scientific knowledge about the longitudinal course of ADHD and its lifetime morbidity, heritability, and neurobiology was rapidly increasing, This provided empiric evidence as well as a scientific and neurobiological rationale for medication intervention.
In 1997, Congress passed the FDA Modernization Act, which encouraged the pharmaceutical industry to develop and test drugs for children by extending patent exclusivity. This resulted in a dramatic increase in randomized controlled trials in children that involved stimulant compounds for ADHD and further supported an evidence-based rationale for medication intervention in ADHD. As a result, the prescribing of stimulants for children with ADHD increased between 1987 and 1996, with a further increase of 9.5% between 2000 and 2005. The rise in stimulant prescribing for youths must be taken in context. Between 1990 and 2005 there was a rapid rise in pediatric prescriptions for many psychiatric medications. Public perception of stimulant overprescribing is driven by concerns over the rapid rise in the amount of available stimulants produced in the United States over the past 3 decades. For sale stimulant production quotas are published yearly by the Drug Enforcement Administration. With the production of more stimulants every year, worries about the increased availability of stimulants for abuse and diversion rise as well. |