Hawaii's doctors prescribe considerably less Ritalin, the popular drug for children with attention deficit disorder, than doctors do elsewhere in the nation, according to a nationwide analysis by The Plain Dealer in Cleveland. Ritalin use ranks lowest
in the nation among Hawaii’s
kids, analysis saysStar-Bulletin staff and wire
The newspaper, using analysis from federal Drug Enforcement Administration records and U.S. census data, ranked the prescription rate by dividing the amount of Ritalin sold in each of the nation's 3,141 counties by the county population of children ages 5-19. Hawaii's counties collectively gave the state the lowest per-capita rate of Ritalin use in the country, the newspaper said.
The newspaper ranked Maui as having the 1,590th highest per capita rate of Ritalin prescriptions, while Kauai ranked 2,307, Honolulu ranked 2,344 and the Big Island ranked 2,508.
The analysis shows whether or not Ritalin -- or its generic equivalent, methylphenidate -- is prescribed varies greatly from county to county.
"Children are getting it who shouldn't be getting it, and children who should be getting it aren't," said Gretchen LeFever, a psychiatry professor at Eastern Virginia Medical School who reviewed the analysis.
LeFever, who is studying Ritalin use in the Virginia Beach area, said many children in high-use locales are being misdiagnosed and put at risk of side effects, including Tourette's Syndrome and stunted growth. In low-use areas, she said, children might not be getting treatment they need.
Ritalin has helped many children lead normal lives. A nationwide 1999 National Institutes of Mental Health study found the medication worked better than counseling in treating attention deficit disorder, or ADD, and attention deficit hyperactivity disorder, ADHD. Combining the two treatments worked best.
ADD is a behavioral condition marked by symptoms including inattention, forgetfulness and inability to focus. ADHD is a related syndrome with symptoms that include impulsivity and excess activity.
Theories on why Hawaii per capita rate of prescriptions is low varied.
Dr. Alfred Arensdorf, medical director for the Child and Adolescent Mental Health Division, said the low rankings are due to the lack of child psychiatrists in Hawaii.
"We don't have enough practitioners to make the diagnosis," said Arensdorf, who is also a professor of psychiatry at the John A. Burns School of Medicine. .
Children in some areas of the Northeast and upper Midwest were three times more likely to get Ritalin than children in the Southwest. With 90 percent of specialists living in Honolulu, the neighbor islands are not provided with much care to treat ADD, he said.
Arensdorf said there are about 60 to 70 specialists statewide. About 10 to 12 specialists serve the neighbor islands.
Parts of the islands such as Honokaa and Kau in the Big Island have no availability to physicians who specialize in behavioral problems, he said.
But Honolulu child psychiatrist Dr. William Sheehan said ADHD behavior does not bother Hawaii's South Pacific islanders as much as it does whites, and many of the state's Japanese-Americans avoid any mental health diagnosis so they do not feel stigmatized.
Still, Hawaii's fine climate also could be a factor, Sheehan said. In warm weather, children can burn off energy outdoors.
Arensdorf also said children suffering from anxiety or trauma can be misdiagnosed with ADD.
"ADD is a persistent disorder," he said.
Another possible reason for the low rate of Ritalin in Hawaii is that children are not exposed to environmental lead that is associated with ADD, he said.
Dr. Jeff Okamoto, developmental and behavioral pediatrician for Kapiolani Medical Center, offered another possible reason for the low rate or Ritalin prescriptions in Hawaii.
"Families are very often worried about putting their child on medication," he said. "It's not a pro-medication for behavioral problems kind of culture."
bout evaluating the situation."
Newhouse News Service and Star-Bulletin reporter
Rosemarie Bernardo contributed to this report.