ABSTRACT
The psychostimulants methylphenidate (Ritalin, Methylin, Metadate ER, Concerta), dextroamphetamine (Dexedrine), dextro (d) and levo (l) amphetamine (Adderall), and magnesium pemoline (Cylert) remain the most commonly prescribed medications in child and adolescent psychiatry, despite their having been approved by the U.S. Food and Drug Administration (FDA) only for attentiondeficit hyperactivity disorder (ADHD) in children and adolescents and for narcolepsy in adults (Barkley, 1990; Dulcan, 1990; Gillberg et al., 1997; Findling and Dogin, 1998; PDR, 1999; Greenhill et al., 1999; NIH Consensus Statement on ADHD, 2000). ADHD, the most common neuropsychiatric disorder of childhood, affects approximately 3-5% of the school-age population (NIH Consensus Statement on ADHD, 2000). In recent years there has been a marked increase (2.5fold) in school-age children, 5-14 years old, receiving psychostimulants, predominantly methylphenidate for ADHD symptoms (Safer et al., 1996). Part of this increase may be reflected by public health initiatives focused on identification and inclusion of more female patients, treatment of more high school-age students, and longer duration of treatment (Safer et al., 1996). Nearly 3% of children 5-18 years old in the United States received psychostimulant medication by 1995 (Goldman et al., 1998). An especially dramatic increase in psychostimulant pre-
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scriptions (2-to 3-fold), primarily methylphenidate (Ritalin), was also recently reported in preschool-age children 2-4 years old enrolled in Midwestern and mid-Atlantic Medicaid programs and a health maintenance organization in the Northwest (Zito et al., 2000). Nearly 60% of 223 Michigan Medicaid patients under 4 years of age received at least onemedication,most commonlymethylphenidate, to treat ADHD in 1995-1996 (Rappley et al., 1998).
