Dissertation Title:  "Treatment for Children with Attention-Deficit/Hyperactivity Disorder"

Treatment for attention-deficit hyperactivity disorder (ADHD) among children commands our attention because the disorder is the most commonly diagnosed and because its treatment continues to stir controversy. This study examines treatment patterns for children with attention-deficit hyperactivity disorder using cross-sectional and trend analyses. It explores the policy dilemmas decision makers face when they craft mental health policy for children with ADHD.

Chapter 1 examines treatment patterns for children and adolescents with a diagnosis of ADHD enrolled in the Florida Medicaid program during FY 1996-1997. The study establishes the relationship between provider and personal attributes and treatment modality. It also focuses on appropriate treatment. Findings show that most children received sub-optimal care. Results of this analysis show disproportionate rates of access, based on race, to evidence-based care: stimulant only therapy and combination therapy. Provider type determined treatment option selection and whether care was appropriate as measured by whether a child received an assessment or family treatment.

Chapter 2 describes a case study of the Ritalin Relief Act, a law designed to reduce the use of stimulants to treat attention deficit-hyperactivity disorder. It provides insight into the legislative process in Minnesota; analyzes the socio-cultural context of anti-Ritalin legislation that fostered its political legitimacy and appeal; and, tests normative assumptions on political deliberation. It assesses whether the legislative process in this case adhered to the tenets of deliberative democracy.

Chapter 3 explores treatment patterns of children with ADHD enrolled in the Florida Medicaid program in FY 1996-2000. Findings show that most children received sub-optimal care. Nonetheless, small but significant improvements in concordance with treatment guidelines occurred over the period examined. Similar improvements in the rates of assessment and family treatment were not found except for small sub-groups. Racial disparities in receipt of appropriate treatment diminished over time in some cases. Finally, long-acting stimulants, which were introduced to the market in the last year of the study diffused rapidly among the study population. White children were most likely to receive the long-acting stimulants compared to African-Americans, while Latinos were least likely to get these newer drugs.