Ritalin Use in Virginia is "Astronomical"
By Elizabeth Simpson
Originally published in The Virginian-Pilot, November 15, 2001
Portsmouth ranks in the top 1 percent of communities nationwide for use of Ritalin, the drug prescribed to treat attention deficit disorders, a new study by a local researcher has found.
Other Hampton Roads communities are not far behind. Virginia Beach ranked in the top 3 percent; Chesapeake in the top 5 percent; Hampton, Norfolk and Newport News in the top 10 percent; and Suffolk in the top 12 percent.
The researcher, Gretchen LeFever, said the state as a whole has the nation's fourth highest rate of Ritalin use.
"Fifteen to 18 percent of elementary students in Virginia are taking Ritalin," said LeFever, a psychologist and assistant professor of pediatrics at Norfolk's Center for Pediatric Research. "That's astronomically high."
The growing use of medications to treat attention disorders in schoolchildren has sparked enormous national debate. Some experts believe that Ritalin is overprescribed and that children with normal behavior problems are being drugged rather than taught how to control their behavior.
Pediatricians also have raised concerns that prescribing medication to children who don't have an attention deficit could mask problems they do have, such as learning disability or depression. Researchers also do not yet know the long-term effects of Ritalin on children.
LeFever said that she is not "anti-Ritalin." But the data suggests the drug may be prescribed too often in some communities and not often enough in others, she said.
She also urged more study of how Ritalin affects schoolchildren. "Are children doing better in counties where there's a high Ritalin use, or worse? Or is there no association?"
Several years ago, LeFever documented the use of Ritalin for attention deficit/hyperactivity disorders among students in Virginia Beach and Portsmouth schools. She found that 8 percent to 10 percent of second- through fifth-graders—two to three times the national rate—were taking the drug.
Now she has compiled a national database using Drug Enforcement Agency records. She has not released all the data, which she and other CPR researchers are still analyzing, but today she will present preliminary findings at a legislative forum at Children's Hospital of The King's Daughters in Norfolk. The data is based on 1997-99 records from 2,994 communities.
The National Institutes of Health estimates that attention deficit disorders—characterized by impulsiveness or difficulty concentrating or sitting still—affect 3 percent to 5 percent of school-age children nationwide. The American Academy of Pediatrics sets its estimates higher, at 4 percent to 12 percent.
Still, LeFever has found communities with much higher Ritalin rates in pockets throughout the nation. She said that at this point in her study, she can't speculate about the reasons. She believes, however, that the wide range in rates shows the need for more systematic diagnosis of ADHD and more coordinated treatments.
Although her study looked at Ritalin usage among all age groups, LeFever said the drug is most commonly prescribed to children.
Other areas of the state with high Ritalin use are Northern Virginia, Richmond, Charlottesville and Roanoke. Other high-use states include Montana, Iowa and Michigan.
In Virginia, a legislative joint committee is studying Ritalin use among students.
"The numbers are cause for concern, but there are so many unknowns to the issue," state Sen. Yvonne Miller, a Norfolk Democrat who serves on the committee, said Wednesday. "There are a lot of unanswered questions."
Miller said the committee will look at demographic factors, such as whether a large military community could contribute to Hampton Roads' high rates; whether children on Ritalin perform better or worse than their peers; and what forms of behavior management work best in classrooms.
"There's no denying there are pockets of high rates around the country," said Jeffrey Katz, a Virginia Beach clinical psychologist who treats children with attention deficit disorders. "I'm not sure what that means, or if it's necessarily bad."
He said having a large military population means people are better insured and more likely to seek treatment. He also thinks the region's population is well-educated about attention deficit/hyperactivity disorders.
Frances Gray, medical services supervisor for Portsmouth schools, said that because LeFever's previous study showed a high use among Portsmouth students, the new figures did not surprise her much.
Nurses in the city have seen the number of children taking Ritalin while in school decline during the past few years, she said. But that's not necessarily because fewer children are on medication. Rather, she said, more children are using alternatives to Ritalin, such as Adderall, that can be taken before and after school.
LeFever said she hopes the statistics will help the community to devise better, more coordinated treatment for children with attention deficits, and to offer more education for parents and health-care providers.
The Center for Pediatric Research, a joint program of CHKD and Eastern Virginia Medical School, is working closely with a local coalition—the School Health Initiative For Education—on several projects to improve the treatment of children with attention deficit disorders.
In a project at one Virginia Beach school, for instance, teachers are learning classroom techniques to manage student behavior. Another project called SHARE—Schools, Health and Academic Resilience Everywhere—is scheduled to start in January. Virginia Beach and Portsmouth schools will use standardized forms to keep parents and physicians informed about children with attention deficits.
"I think our community is unique in its willingness to look at the problem and engage in solutions," LeFever said.
