Association for Public Policy Analysis & Management

In 2011, nearly 9% of U.S. children had at one point received a diagnosis of Attention Deficit/Hyperactivity Disorder (ADHD). More than half of these children – 55.7% – were undergoing pharmacological interventions (NSCH 2011). ADHD is a common neurodevelopment disorder characterized by difficulty in staying focused, paying attention, controlling behavior, and, in some individuals, hyperactivity (APA 2014). In this paper, we consider the pharmacological trends for children’s ADHD between 1997 and 2011 using the Medical Expenditures Panel Survey (MEPS), a nationally representative survey of households, medical providers, and employers. In particular, we focus on on-label versus off-label prescribing. On-label prescribing refers to those drugs explicitly approved for both ADHD and pediatric use by the Food and Drug Administration (FDA). Off-label prescribing refers to using a drug in a way not covered by the label. This could include different doses, different clinical indications, other age groups, or administration by an alternative route (Conroy et al. 2000). Off-label prescribing in children is a concern to medical care professionals and policymakers because one’s response to a drug depends on a variety of factors, including weight, surface area (for topical agents) metabolism, and excretion. Preliminary results indicate substantial demographic and institutional variation in the decision to utilize pharmacological intervention: black and Hispanic children were less likely to use any prescription drug; children of parents who work longer hours are more likely to receive on-label prescription drugs; and children with public insurance are more likely to receive off-label prescription drugs.