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CDC: One-third of children with ADHD received both medication, behavioral therapy

Researchers found that, while a majority of children with attention-deficit/hyperactivity disorder received behavioral therapy or medication treatment, less than one-third of children received combined behavioral and medication therapy, according to a national study.

“The 2011 American Academy of Pediatrics guidelines were expanded to include all children aged 4-18 years, with special considerations for preschoolers and adolescents,” Susanna Visser, DrPH, MS, epidemiologist at the CDC National Center on Birth Defects and Developmental Disabilities, and colleagues wrote. “The AAP now recommends behavioral therapy first for preschool aged children, with short-acting methylphenidate prescribed if therapy does not sufficiently improve symptoms. Combination therapy (medication and behavioral therapy) is preferred, particularly for elementary aged children.”

Susanna Visser

Visser and colleagues used the National Survey of Children with Special Health Care Needs to identify 9,459 children with ADHD aged 4 years to 17 years who met study criteria. In a telephone interview, the researchers asked a parent or guardian to report the severity of ADHD as well as whether the child was taking medication, dietary supplements or receiving behavioral therapy.

Researchers found that 82.6% (95% CI, 81.1% - 84.1%) of children had taken medication for ADHD within the past year, while 74% (95% CI, 72.3% - 75.7%) had taken ADHD medication within the past week. The most common medications taken were central nervous system stimulants (84.8%) and atomoxetine (8.4%).

Among children aged 4 years to 17 years, children between 4 years and 5 years were the least likely to take their medication (46.6%). Further, treatment with medication varied by state, and children who lived in the west (62.7%) were less likely to receive medication treatment. Children without insurance (50%), with mild ADHD (64.8%), without a medical home (70.3%), and with a co-occurring condition (71.2%) were the least likely to take their medication.

Visser and colleagues also noted that 44% of children had received behavior therapy within the past year (95% CI, 42.2% - 45.8%). Children 12 years of age or older were less likely to receive behavioral therapy within the last year than children aged 4 years to 5 years (40.4%; 95% CI, 38.0% -42.8%). Behavioral therapy was more likely for children living below the federal poverty level (47.6%); it was less likely for children without a medical home (34.3%), with moderate (45.6%) or severe ADHD (60.5%), or for those children with public insurance (49.9%). The researchers found an inverse correlation between behavioral therapy use within the past year and the past week at the state level (P = < .01).

Regarding dietary supplements, researchers observed that 10.2% of children took dietary supplements within the past year and 6.2% within the past week. Children who lived in the Midwest (14.0%) who were 12 years or older (8.8%) were less likely to take dietary supplements, while children with a co-occurring condition (12.4%) and without a medical home (12.0%) were more likely to have received dietary supplements.

The researchers noted that, overall, 30.7% of children with ADHD were receiving either medication treatment or behavioral therapy, with 87.3% of children receiving either medication or behavioral therapy. Children aged between 4 years and 5 years received medication in 25.4% of cases, behavioral therapy in 31.9% of cases, and both treatments in 21.2% of cases.

“Treatment decisions for [attention-deficit/hyperactivity disorder] ADHD in children can be complex. Parents, health professionals, psychologists, and educators can work together to ensure that children receive the best treatment available,” Susanna Visser, DrPH, MS, epidemiologist at the CDC National Center on Birth Defects and Developmental Disabilities, stated in a press release. “The good news is that we now have strong clinical guidelines to support the more than 5 million children living with ADHD.”

Disclosure: Cuffe receives research support from Nexstim Oy.