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Daniel J. Safer, MD; John M. Krager, MD, MPH

JAMA. 1992;268(8):1004-1007.

Abstract
Objective.
—To enumerate and evaluate changes in the rate of medication treatment for hyperactive/inattentive students subsequent to negative media publicity about methylphenidate (Ritalin) and related lawsuits threatened or initiated from late 1987 to early 1989.

Design.
—Biennial 1971 to 1991 school nurse surveys of medication treatment for hyperactive/inattentive students; a 1989 school nurse questionnaire on parent attitudes about medication; annual 1984 through 1991 hyperkinetic clinic treatment data; annual 1986 through 1990 Drug Enforcement Administration estimates of retail sales of methylphenidate, nationally and locally.

Primary Setting.
—All public and private elementary and secondary schools in Baltimore County, Maryland.

Patients.
—Students receiving medication for hyperactivity/inattentiveness.

Results.
—Whereas the medication rate for the treatment of hyperactive/ inattentive students in Baltimore County doubled every 4 to 7 years from 1971 through 1987, it declined 39% in the 1989 and 1991 surveys from its 1987 peak. This drop occurred after the 1987 through 1989 media blitz against methylphenidate and after a well-publicized threatened lawsuit locally. Parents became fearful of media-reported medication "side effects" and school staff hesitated to refer restless, impulsive, and inattentive students to physicians. Most inhibited from the prospect of medication treatment were less affluent parents and parents of hyperactive/inattentive elementary schoolchildren who had never received medication. Drug Enforcement Administration data revealed that the Baltimore metropolitan area had a far greater decline in methylphenidate use than that which occurred nationally.

Conclusion.
—Strong circumstantial evidence suggests that the prominent 1989 and 1991 declines in the initiation of stimulant medication for hyperactive/inattentive students were related to the apprehension of parents and involved professionals generated by the methylphenidate media blitz and the threatened lawsuit.

(JAMA. 1992;268:1004-1007)

Author Affiliations
From the Baltimore County Department of Health and The Johns Hopkins University School of Medicine, Baltimore, Md.

Footnotes
Reprint requests to Baltimore County Department of Health, 9100 Franklin Square Dr, Baltimore, MD 21237 (Dr Safer).

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