A statewide school survey, supervised by school nurses, was performed to determine the prevalence of stimulant medication administered to Maryland public school students for the treatment of attention deficit hyperactivity disorder (ADHD), and reported by Johns Hopkins University Medical Institutions, and the Maryland State Department of Education, Baltimore, MD.

Of 816,465 students surveyed, 20,050 (2.46%) received methylphenidate and 3721 (0.46%) received other medications for ADHD. Methylphenidate was the most common stimulant prescribed, and represented 84% of all drug treatment for ADHD. Amphetamines were used in 11%, clonidine in 1.7%, pemoline in 0.4%, and tricyclic antidepressants in 0.4%. The male:female ratio was 3.5:1 for children receiving medication in elementary schools, and 4.3:1 in secondary schools. White children were medicated twice as often as black and Hispanic students.

Almost 50% of children receiving methylphenidate had special education accommodations, and 8.3% were eligible for Section 504 services, having an impairment that limited their major life activities. Children with Individual Education Programs (IEP), a marker for special education, received medication 5.6 times more often than students in regular education (8.7% of students compared to 1.55%, respectively). In high school, students with IEP were 10-fold more likely to be receiving methylphenidate in school than regular students. School-district rates of methylphenidate treatment varied 5-fold geographically, from a low of 1.18% to a high of 6.02%. Geographic variability was influenced by race/ethnicity demographics, and by large ADHD clinics in some localities.

By medical specialty, pediatricians were the prescribers of methylphenidate in 63% of students, family practitioners in 17%, psychiatrists, 11%, and nurse practitioners in 3%. When drugs other than methylphenidate were prescribed, the psychiatrist’s role was increased to 29%. [1]

COMMENT. In the authors’ summary of their findings, the rate of medication, mainly methylphenidate, administered to students during school hours for ADHD in Maryland public schools was found to vary with several factors: 4-fold by gender (male:female ratio); 2-fold by ethnicity/race (white vs minority); 3-fold by school level (elementary vs high school); 6-fold by educational category (special vs regular); and 5-fold by school district (highest vs lowest rate). Surveys of the prevalence of stimulant use in school age children must necessarily include all these variables. In addition, the specialty of the practitioner treating these patients must be considered, since the majority were supervised by pediatricians. The absence of the pediatric neurologist as a specialist for the treatment of ADHD in Maryland was disappointing.