Children and adults in Maine are being diagnosed with attention deficit disorder at rates far exceeding the national average, fueling higher spending on treatment and medication, according to a national study by Express Scripts, one of the country’s largest pharmacy benefit management companies.
Maine saw a 35 percent growth rate in treatment for ADD from 2008 to 2010, ranking the state fifth in the nation, according to the Express Scripts Drug Trend Report, presented in May at an international pharmaceutical conference in New Orleans. Maine’s rate growth was twice the national average of 17 percent.
ADD, also known as attention deficit hyperactivity disorder, was once thought to affect only children, but can persist into adulthood. Symptoms include difficulty staying focused and paying attention, trouble controlling behavior, and physical restlessness. About 4 to 6 percent of the U.S. population, or 8 million to 9 million adults, are estimated to have the disorder, according to the Attention Deficit Disorder Association.
By the time many adults are diagnosed, they’ve spent years struggling with broken personal relationships and frustrations at work, said Patricia MacDonald, a South Portland psychotherapist who works with adults with ADD. For them, diagnosis is “like a gift,” she said.
Maine trailed New York, where the rate of treatment ballooned 95 percent, followed by Hawaii, South Dakota and Vermont. The state with the lowest growth rate in ADD treatment was Montana at 3 percent, compared with an average of 21 percent nationally.
The study, based on insurance claims, reflects a subset of the population with ADD, patients covered by a commercial health plan.
The South leads in the nation in the percentage of people diagnosed and treated for ADD, but the Northeast was the fastest growing region for ADD diagnosis, medication use and total costs associated with the disorder, the study found.
Over the three-year period, medical and pharmacy costs related to ADD in Maine jumped 58 percent, topping the national average of 35 percent and ranking Maine third in the country after Hawaii and New York, the study found.
The report did not provide any explanation for Maine’s high rates of ADD diagnosis and treatment. While the findings suggested an overall increase nationally in diagnosis, treatment with medication and costs associated with ADD, further research is needed to determine what’s driving the trend and why increases vary by geographic region, the study said.
Dr. Sharon Frazee, who is responsible for research on drug safety and affordability at Express Scripts, told the New Hampshire Union Leader that two factors contributed to a higher number of ADD diagnoses in the New England region. The region is fairly affluent, with many children in nursery school or preschool where professionals are trained to identify the condition, and is home to premiere medical research hospitals and universities, she said.
Jane McCarty, a licensed clinical social worker in Portland who treats children and adults with ADD, speculated that providers are better educated about the disorder. With shortages of mental health professionals in some areas of Maine, primary care doctors have had to step up to offer prescriptions for ADD, she said.
“There’s been a gaining in understanding about adults being diagnosed,” she said.
In a separate drug trend forecast published last month, Express Scripts projected that national spending on attention disorder therapies will jump 25 percent over the next three years, despite the availability of generic medications to treat the disorder. The increase will be partially driven by greater use of attention disorder drugs among middle-aged adults, the company said.
MacDonald questioned whether the Express Scripts study, which she had not reviewed, reflected more people actually having the disorder or improved detection.
Among children, overdiagnosis of ADD and overprescribing of ADD medications have caused concern nationally. Stimulant medications including Ritalin and Adderall are commonly used to treat the disorder.
In Maine, 9 percent of children have ADD or ADHD, ranking the state 17th nationally in youth diagnosis rates, according to the 2011-12 National Survey of Children’s Health. Among all children age 4 to 17 in Maine, 4.6 percent are taking medication for the disorder, according to the U.S. Centers for Disease Control and Prevention.