Are 10,000+ U.S. Toddlers Really on ADHD Medications?
Under the headline, “Thousands of Toddlers Are Medicated for A.D.H.D., Report Finds, Raising Worries,” the New York Times on May 16 published an article about a CDC expert’s report on attention deficit/hyperactivity disorder medication patterns, which had been presented that day at a relatively small symposium in Georgia.
The Times article describes the findings of ADHD expert Susanna Visser, MS, DrPh, who is acting associate director of science for the CDC’s National Center on Birth Defects and Developmental Disabilities. Visser presented her research at the 19th Annual Rosalynn Carter Georgia Mental Health Forum in Atlanta, a 1-day symposium held each May to address a timely mental health policy issue facing the state of Georgia. “Service providers, policymakers, advocates, and consumers from across Georgia are invited to participate in open discussions on diverse topics,” the forum’s Web site notes.
The Times article notes that Visser’s report is based on data 2 sources: “Medicaid claims in Georgia and claims by privately insured families nationwide kept by MarketScan, a research firm.” The article points out that Visser did not directly present the total number of U.S. toddlers aged 2 to 3 years who are being medicated for ADHD, but that “her data suggested a number of at least 10,000 and perhaps many more.”
According to Visser’s analysis of Georgia Medicaid claims, about 1 in 225 toddlers—about 760 statewide—are being medicated for ADHD. The Times notes that nationwide Medicaid data are not yet available, but that Visser says Georgia’s ADHD rates are typical of the United States as a whole.
“If we applied Georgia’s rate to the number of toddlers on Medicaid nationwide, we would expect at least 10,000 of those to be on ADHD medication,” Visser told the Times reporter, adding that MarketScan data suggest that another 4,000 privately insured toddlers were receiving ADHD drug therapy.
The conclusions Visser draws assuredly are a matter for concern, given the dearth of valid scientific studies about the use of stimulants in young children and the ubiquity of the ADHD diagnosis among the U.S. pediatric population. The CDC estimated last year that 11% of American children between the ages of 4 and 17—or 6.4 million—had been diagnosed with ADHD as of 2011, and about half were taking medications to treat the disorder.
Still, the Times article about Visser’s report quickly transformed into the journalistic equivalent of “whisper down the lane” as media outlets reported on the Times article (but not on Visser’s report per se) and sensationalized the story with inaccurate or misleading information. A sampling of headlines from the more than two dozen stories aggregated at Google News:
• “CDC Finds Shocking Number Of Toddlers Medicated For ADHD,” from Inquisitr.com. The CDC did not "find" the numbers, but rather an employee (albeit an expert one) did. Calling out the use of “the CDC” as a synecdoche isn’t semantic hair-splitting, either: Not a single mention of the results of Visser’s research could be found anywhere on the agency’s sprawling Web site, www.cdc.gov, a full 4 days after the Georgia Mental Health Forum. Note also that the data on which Visser bases her conclusions have not been collected by the CDC but rather by the Georgia Medicaid program and by a marketing research firm.
• “‘That’s nuts’: 10000 toddlers get drugs for ADHD,” from Today.com, the site of the popular NBC News morning show. The “nuts” quote is from Dr. Lawrence H. Diller, a behavioral pediatrician in Walnut Creek, Calif., who appears to have no connection whatsoever to Visser’s report and was interviewed via telephone as part of the New York Times’ reporting of the story. His full quote in the TODAY article: “We’re giving Adderall to 2-year-olds? I mean, that’s nuts. … There's no evidence that it works. There's no evidence that it's safe. These are desperate measures.” Given that amphetamine-plus-dextroamphetamine has been deemed safe and effective enough to be FDA-approved for use in children as young as 3 years of age, and that recent American Academy of Pediatrics guidelines offer guidance for its use in preschool-aged children (4 to 5 years old) under certain circumstances, is it “desperate” and “nuts” to rule out Adderall completely for every single 2-year-old?
• “10000 Young Toddlers Are on Stimulant Drugs for ADHD,” from the extremely popular Huffington Post. To reiterate the New York Times’ (accurate) reporting of Visser’s study, in Visser’s own words: “If we applied Georgia’s rate to the number of toddlers on Medicaid nationwide, we would expect at least 10,000 of those to be on ADHD medication.” To conclude that 10,000 toddlers across the United States have been prescribed ADHD drugs based on a single researcher’s hedged statement about a subset of toddlers in one state is, generously speaking, a stretch. The true number has not been studied—nor, for that matter, has the prevalence apparently been estimated by anyone other than Visser. And the lead paragraph of the Huffington Post article takes hyperbole to thermonuclear levels: “How crazy is it to drug babies?”
As with March’s overstated media coverage on the CDC’s report on the rates of autism, parents will have questions about the appropriate use of ADHD medications for their child, and their information and perceptions are likely to come from media reports that don’t accurately characterize the data and don’t put the speculative nature of such findings in context. Be prepared to address their concerns with facts and a rational explanation for your ADHD treatment plan.
—Michael Gerchufsky
(CDC photo)