Use of Stimulants to Treat ADHD:

Interdisciplinary Research at the HDC

Bill Frankenberger

These studies represent collaborations with students and faculty at UW-Eau Claire

Significance of the TopicGrowth of ADHD in the 90’s

• 700% increase in Ritalin production 1990 -1997

• 3754% increase in Amphetamine production 1993 - 1999 (Dexedrine and Adderall), 65% increase 1998 - 1999

• One half million children, aged 3 to 6, were treated (1995)

• Increasing use of multiple medications

• Increasing abuse in schools

Amphetamine Production Quotes

238787

1226

2280

3137

5554

9174

230730

1230173022302730323037304230473052305730623067307230773082308730

1993 1994 1995 1996 1997 1998 1999

Production

Changes in types of stimulants produced from 1990 to 1999

DEA Quotas

Ritalin

1990 1999

81% 62%

Dexedrine & Adderall

1990 1999

19% 38%

Target effects of stimulant medication

• Better attention in class

• Better behavior in class

• Better seat work

• Better grades

• Better relationship with teachers

• Better relationship with parents

Side effects of stimulants

• Insomnia ( REM sleep)

• State dependent effects

• Decreased appetite

• Slowed rate of growth

• Tic development

• Increased heart rate & blood pressure

• Rebound effect

Fourteen years of research on ADHD

at the Human Development Center

• Changes in types of stimulants being used

• Incidence for general and special education

• Long-term effects on achievement

• Student’s self-reports of effects

• Professionals’ knowledge and attitudes

Incidence of stimulant useElementary level (Frankenberger et al., 1990;

Runnheim et al., 1996; Snider et al., 2000)

Before 1990 Mid to late 1990s

General ed 1.5%

ED 8%

LD 5%

General ed 5%

ED 40%

LD 16%

Interaction Plot for ITBS Complete Composite Scores

(Frankenberger & Cannon, 1999)

43

48

53

58

63

Grade 1 Grade 2 Grade 5

contrast Ritalin

Student Self-Reported Effects of Stimulant Medication

• Doherty, Frankenberger, Fuhrer & Snider (2000)

• 925 students, WI, MN

• 86 receiving Meds for ADHD

• Moline & Frankenberger (in press)

• 651 students, WI, MN

• 50 receiving Meds for ADHD

Mean Cluster Ratings (Moline &

Frankenberger, in press)

0

1

2

3

4

Achiev. Behav. Friends Parent-Teacher

Student reported side effects (Moline & Frankenberger, in press)

• 64% of students reported side effects at least sometimes (2 or higher)

• 30% reported side effects almost always or always• 55% felt sleepy after taking medication• 53% reported some difficulty sleeping• 43% reported headaches• 54% reported not feeling like eating lunch• 40% reported tics not present before meds

Student reported side effects (Doherty et al., 2000)

• 58% did not feel like themselves• 43% did not feel like eating lunch• 35% had difficulty sleeping• 36% reported tics

• Not feeling like themselves was related to wanting to discontinue use of medication

Non-ADHD Student reports of Medication Abuse (Moline & Frankenberger, in press)

• 53% of students reported seeing some students give away or sell their medication at least some of the time

• 28% of students reported that students give away or sell their medication almost always or always

ADHD Student reports of Medication Abuse

(Moline & Frankenberger, in press)

• 34% of students reported being approached to give away or sell their medication at least some of the time

• 11% of students reported being approached to give away or sell their medication almost always or always

Other Findings: Positive Correlations (Moline & Frankenberger, in press)

• Doctor visits related to increased dosage

• Dosage related to increased side effects

• Dosage related to giving away or selling

If it were up to you, would you continue taking your medication? (Doherty et al.,

2000; Moline & Frankenberger, in press)

37

10

22

13

41

0

5

10

15

20

25

30

35

40

1 2 3 4 5

N = 123

Stop Now Continue

Do you need meds to pay attention to activities that you find interesting? (Moline &

Frankenberger, in press)

18

75 4 3

02

468

101214

1618

1 2 3 4 5

n = 37

Never Always

Type of Medication used to Treat Children with ADHD (Frankenberger et al., 1990)

94

1.7 1.7 2.50

102030405060708090

100

Ritalin Dexedrine Cylert Others

% of total

Type of Medication used to Treat Children with ADHD

(Moline & Frankenberger, in press)

44

13 8 2

13

21

0

10

20

30

40

50

Ritalin Dexedrine Wellbutrin Cylert other Multiple

% of total

Comparison of Professionals’ Knowledge, Attitudes, & Experience

(Frankenberger et al., submitted)

School Psychologist• Return Rate (n=414)

– national 47%, state 53%

• Majority female 61%

Comparison of Professionals

In your experience, who most frequently recommends students for AD/HD assessment?

Teachers 77%Parents 15%School Psychologists 3%Physicians 1%