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Project Team

Richard Scheffler, PhD
Timothy T. Brown, PhD
Stephen Hinshaw, PhD
Peter Levine, MD
Teh-Wei Hu, PhD
Farasat Bokhari, PhD
Lisa Croen, PhD
Laurie Habel, PhD
Tom Ray, MBA
Susan Stone, PhD
Brent Fulton, PhD
Mistique Felton, MPH
Sepideh Modrek, BA

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Abstract

Our research provides an economic and policy analysis of Attention Deficit Hyperactivity Disorder (ADHD) and psychostimulant use. ADHD is the most commonly diagnosed behavioral disorder in children. Roughly 3.5 percent of school-age children in the U.S. have an ADHD diagnosis, and over half of those diagnosed with ADHD take psychostimulant medication regularly, according to a 2002 CDC report. Use of these drugs varies considerably, up to three-fold across states and ten-fold within states.

The main goal of this project is to understand the sources of these dramatic variations. We attempt to understand these sources on several different levels - state, county, and individual - with the aim of developing as complete a picture as possible. Since utilization levels of psychostimulants within a given area are likely to be related to the larger medical market characteristics of that area, we first perform a market analysis. Using aggregated data, we perform both a national-level market analysis and a state-level (California) market analysis to determine the factors influencing overall demand and supply for psychostimulants. We then perform individual-level cost and utilization analyses for Northern California using both birth cohort and other cohort data from Kaiser- Permanente. The market models are used to test hypotheses regarding the effects of economic, demographic (age, sex, race, ethnicity), state regulatory, school policy, health system, and other educational variables on the supply and demand for psychostimulants.

Examples of policy variables of interest include restrictions on refilling controlled substance prescription and school accountability laws. The cost and utilization models are used to test hypotheses regarding the effect of economic, demographic (age, sex, race, ethnicity, birth characteristics, co-morbidities), health system, school district policies and other educational variables on total and per capita cost of treating children with ADHD diagnoses. Additionally we examine the effects of these variables on "spells" of psychostimulant use including effects on the initiation, discontinuation, and restarting of psychostimulant drugs.

Using this approach we hope to able to sort through the many layers of factors influencing the large variation in psychostimulant use across the U.S. The results have the potential to help policymakers, health professionals, educators, and other interested parties evaluate whether the current disparities are acceptable, and if not, how they might be changed.