The American Medical System Fails Patients With ADHD: A Call to Action

Charles P. Vega, MD


April 09, 2014

In This Article

A Disturbing Snapshot

This study provides a disturbing snapshot of ADHD treatment in the United States. Although the researchers could not account for all of the variables present in comparing geographic areas, they recorded the main demographic and medical service variables. Moreover, their research is corroborated by other studies that demonstrate wide differences in the management of ADHD in different parts of the United States.[12] There is also clear evidence of racial disparities in the diagnosis of ADHD. A study of more than 17,000 children found that African American, Hispanic, and other nonwhite children experienced prevalence rates of ADHD that were 31%, 50%, and 54% lower, respectively, than rates among white children.[13]

A more uniform and robust effort to diagnose ADHD effectively is critical because the treatment of ADHD can improve patients' lives and even lead to better societal outcomes. A systematic review from the US Agency for Healthcare Research and Quality found that parent behavioral training had the most significant effect on children's behavior. However, school-aged children, particularly boys, exhibited better behavior when treated with stimulants or atomoxetine.[14]

A meta-analysis of 43 studies with a total of 2110 children demonstrated that drug treatment of ADHD increased the amount of school work completed by up to 15%.[15] Medications were associated with a similar significant increase in the amount of time that children were "on task" during class time. Although several stimulants were effective in these outcomes, atomoxetine was not. Moreover, both stimulant therapy and psychosocial interventions can reduce the risk for serious conduct problems among children with ADHD, with the combination of these 2 treatment modalities probably most effective in this respect.[16]

A study of 414 adults with ADHD demonstrated that only 24% were employed, compared with 79% of controls.[17] Combined subtype of ADHD, the presence of comorbid depression and anxiety, and substance abuse were associated with a higher risk for unemployment among individuals with ADHD, but stimulant therapy was positively and significantly associated with employment. In fact, stimulant therapy during childhood was the most significant predictor of employment.

In a study of more than 25,000 individuals with ADHD in Sweden, the risk for commission of a crime was cut by 32% among men and 41% among women when comparing periods of treatment for ADHD with untreated periods.[18] This difference was significant regardless of the type of ADHD treatment or the type of crime.

An important concern is the risk for substance use disorders among patients treated for ADHD with stimulants. It has been demonstrated that 14% of stimulant prescriptions are misused or diverted by adolescents.[19] However, a recent meta-analysis failed to establish a higher risk for substance abuse associated with previous treatment with stimulants.[20]


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