Attention-Deficit–Hyperactivity Disorder

Open Access
Publisher Website
Google Scholar
Abstract
In their review of attention-deficit–hyperactivity disorder (ADHD), Zametkin and Ernst (Jan. 7 issue)1 acknowledged the eightfold rise in the use of stimulants in the United States over the past decade. They did not mention that the use of methylphenidate (Ritalin) in the United States accounts for 90 percent of the use worldwide.2 In the United States, per capita use of methylphenidate varies sixfold among states.3 Within individual states, analyses based on ZIP Codes show 20-fold variations from one community to the next.3 Such large variations in the use of stimulants point to factors other than neurologic ones in the diagnosis of ADHD and treatment with stimulants. The wide variation may be accounted for by social, cultural, and economic influences, which include the readiness to accept a biologic explanation and medical intervention for behavioral problems, fears of educational failure, access to medical systems, and parenting styles.4 Cultural factors specific to the United States should be explored further to help in determining whether the unique approach to children's performance and behavioral problems in the United States represents progress or is a sign that we are either expecting too much or not meeting the needs of our children, their families, and schools.