From the Council on Scientific Affairs, American Medical Association, Chicago, Ill.
Objective.— To deal with public and professional concern regarding possible overprescription
of attention-deficit/hyperactivity disorder (ADHD) medications, particularly
methylphenidate, by reviewing issues related to the diagnosis, optimal treatment,
and actual care of ADHD patients and of evidence of patient misuse of ADHD
Data Sources.— Literature review using a National Library of Medicine database search
for 1975 through March 1997 on the terms attention deficit
disorder with hyperactivity,methylphenidate, stimulants, and stimulant abuse and dependence. Relevant documents from the Drug Enforcement Administration were
Study Selection.— All English-language studies dealing with children of elementary school
through high school age were included.
Data Extraction.— All searched articles were selected and were made available to coauthors
for review. Additional articles known to coauthors were added to the initial
list, and a consensus was developed among the coauthors regarding the articles
most pertinent to the issues requested in the resolution calling for this
report. Relevant information from these articles was included in the report.
Data Synthesis.— Diagnostic criteria for ADHD are based on extensive empirical research
and, if applied appropriately, lead to the diagnosis of a syndrome with high
interrater reliability, good face validity, and high predictability of course
and medication responsiveness. The criteria of what constitutes ADHD in children
have broadened, and there is a growing appreciation of the persistence of
ADHD into adolescence and adulthood. As a result, more children (especially
girls), adolescents, and adults are being diagnosed and treated with stimulant
medication, and children are being treated for longer periods of time. Epidemiologic
studies using standardized diagnostic criteria suggest that 3% to 6% of the
school-aged population (elementary through high school) may suffer from ADHD,
although the percentage of US youth being treated for ADHD is at most at the
lower end of this prevalence range. Pharmacotherapy, particularly use of stimulants,
has been extensively studied and generally provides significant short-term
symptomatic and academic improvement. There is little evidence that stimulant
abuse or diversion is currently a major problem, particularly among those
with ADHD, although recent trends suggest that this could increase with the
expanding production and use of stimulants.
Conclusions.— Although some children are being diagnosed as having ADHD with insufficient
evaluation and in some cases stimulant medication is prescribed when treatment
alternatives exist, there is little evidence of widespread overdiagnosis or
misdiagnosis of ADHD or of widespread overprescription of methylphenidate
Goldman LS, Genel M, Bezman RJ, Slanetz PJ, for the Council on Scientific Affairs, American Medical Association. Diagnosis and Treatment of Attention-Deficit/Hyperactivity Disorder in Children and Adolescents. JAMA. 1998;279(14):1100–1107. doi:10.1001/jama.279.14.1100
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