I don't know a percentage, and I don't think anyone else has looked at it systematically, (except to observe higher medication rates in HMOs). Sometimes the ADHD diagnosis has been specifically excluded as an insured diagnosis, but recently, under pressure from self-help groups and professionals in the field, this is happening less. Some of the best standardized evaluations have come from Northern California Kaiser, where the doctors are better regulated and scrutinized for standards of care than in private practice or IPAs (independent practice associations which are formed for contract purposes with managed care). However, the pressure to compete for the lower and lower premiums with low-ball HMOs has decimated Kaiser's enlightened approaches.

I heard one story second hand from a parent who attended a self-help group. He related that a mother, who wanted her son assessed for ADHD, was told to call an 800 number of a Mental Health Carve-out (that's the business term for an organization that supplies mental health services separately from the main HMO because it's supposedly cheaper doing it that way). The mother was sent several forms for the parents and teachers to fill out. When they were completed, she mailed them back, and a few weeks later she received a Ritalin prescription in the mail for her child. The boy was never seen. She was asking at this meeting if this was common practice. Another urban legend?

The "lifers," those researchers in child psychopharmacology who suggest that lifetime medication may be appropriate (particularly a group at Harvard led by Joe Biederman), point out that ADHD continues into adolescence and adulthood, so that there is a group of people who might do better if they were treated continuously.

In fact, the few long-term studies of childhood ADHD medication indicate that children who received only medication as treatment for ADHD, and were then evaluated in late adolescence, at which point they had discontinued medication, did not have improved outcomes compared to ADHD kids who did not receive medication. So we're not sure what the results would be for a population which stays on the medication long term.

The problem is that no one knows the effects of continuous treatment through adolescence. We have 60 years of experience with school age kids taking Ritalin for a few years. We have far fewer people taking it for decades, so there are unknown risks that must be weighed (see my www.salon.com article, Dying on Ritalin.)

I'm not saying medication shouldn't be used, but in late high school and after high school, there are many opportunities for kids who aren't fitting into a rigid educational niche. In my book, Running on Ritalin, I discuss where, and in what fields, ADHD type people wind up being successful without medication.