A new study of Maryland school children shows that whites are up to five times more likely to be using Ritalin, the drug prescribed to control attention deficit disorder, than minorities.
Findings also showed that nearly half of Ritalin users are enrolled in special education classes, which include many students with multiple learning problems.
The study, published in the September issue of the journal Pediatrics, suggests that Ritalin is being prescribed in a more conservative fashion than has been popularly believed, said Michael Malever, co-author and a researcher at the State Department of Education.
Ritalin has often been criticized as being over-prescribed for children who have no real medical problem but are merely unruly.
"The public perception is that relatively healthy kids are going into the doctor's office and get hit with Ritalin," said Mark Riddle, director of child and adolescent psychiatry at the Johns Hopkins School of Medicine. "This makes the point that kids who use Ritalin are having special problems and often attention deficit is just one part of it."
The study came from data collected by a task force called by the General Assembly in 1997 to look into prescription practices for Ritalin, which is commonly used to treat a condition known as Attention Deficit Hyperactivity Disorder (ADHD).
Some earlier results from the study, which had been presented to the legislature in 1998, showed that only 3 percent of Maryland students - almost 24,000 children - were getting Ritalin and other drugs to treat ADHD. Even that usage appears to decline as students age.
Based on a survey of more than 816,000 students, the study revealed that 45 percent of the Ritalin users were in special education and 8 percent had a separate school-documented impairment.
"The majority of kids were identified as having some kind of handicapped condition," said Daniel Safer, lead author of the study and an adjunct associate professor at the Johns Hopkins Children's Center. "That's especially interesting because there are some critics who claim that we're just giving Ritalin to kids to keep them quiet."
The finding about Ritalin use among minorities was more difficult for the authors and experts to comprehend.
The survey showed that white children are two times more likely to use Ritalin in grade school than African-American children, a ratio that escalates through high school, when whites are five times more likely to use the drug. The authors found that a similar pattern emerged among Hispanics and Asians.
Interestingly, Safer said, the two school districts with the lowest rate of Ritalin usage, Prince George's County and Baltimore City, also had the highest percentages of black students. Noting that the median income in Prince George's County is much higher than in Baltimore, he said, suggests that income is probably less an influence than race alone.
"I believe there has been a feeling in the black community that there's been a tendency to over-medicate black kids, when actually the opposite is the case - relatively speaking, they may be under-medicating," Safer said.
Julie Zito, a professor at the University of Maryland School of Pharmacy who has published numerous studies about Ritalin use, said it is difficult to know whether the racial differences point out a cultural phenomenon or represent a problem of medical access.
In a study she published two years ago, Zito observed that among Medicaid recipients, white children were two to two-and-a-half times more likely to receive psychotropic drugs than African-Americans.
Without proper studies, she said, "we are in the realm of hypothesizing." Zito said she had heard an African-American psychiatrist note at the American Psychological Association in 1998 that African-Americans have reservations about the use of psychotropics to treat behavioral problems. Also, biases among health care providers or teachers who help identify emotional and behavioral disorders could interfere with proper treatment, Zito said.
"The problem is we have to speculate too much because we have inadequate information," Riddle said. "But the numbers do send up a red flag, and that's worrisome because it suggests here are a group of kids who may not be getting the medication they deserve."