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CDC: ADHD treatment rates for young children do not reflect AAP-recommended guidelines

Recent findings from the CDC indicated medication was more common than psychological services for treatment of attention-deficit/hyperactivity disorder in children aged 2 to 5 years, despite guidelines that recommend psychological services as first-line treatment for attention-deficit/hyperactivity disorder in young children.

In 2011, the American Academy of Pediatrics published guidelines recommending behavior therapy over medication as the first-line treatment for ADHD in children aged 4 to 5 years, consistent with current guidelines for young children from the American Academy of Child and Adolescent Psychiatry.

Anne Schuchat

“Behavior therapy has been shown to help improve symptoms in young children with ADHD and can be as effective as medicine but without the side effects,” Anne Schuchat, MD, principal deputy director of the CDC, said in a telebriefing. “We know that medicine will be appropriate for some young children, but we encourage pediatricians, therapists and other health care providers to work with families to ensure children with ADHD are receiving the most appropriate treatment. This should include a discussion about behavior therapy as the first step.” 

To assess national and state-level ADHD treatment patterns among young children, Susanna N. Visser, DrPH, of the CDC’s Division of Human Development and Disability, National Center on Birth Defects and Developmental Disabilities, and colleagues analyzed claims data using the MarketScan commercial database for 2008 to 2014 and Medicaid data for 2008 to 2011. Analysis included Medicaid and employer-sponsored insurance claims for psychological services and ADHD medication among children aged 2 to 5 years receiving clinical care for ADHD.

Susanna N. Visser

From 2008 to 2011, the percentage of children aged 2 to 5 years in Medicaid receiving clinical care for ADHD was 2.6 to 2.9 times greater than that of those with employer-sponsored insurance.

Among states with available data, the percentage of children with ADHD medication claims was similar regardless of insurance type. However, the percentage of children receiving Medicaid and psychological services was 13% to 22% higher than the percentage of children receiving psychological services with employer-sponsored insurance.

From 2008 to 2011, approximately 78% to 79% of children receiving Medicaid and clinical care for ADHD received at least one prescription for ADHD medication and approximately 51% to 53% had at least one claim for psychological services.

Each year during 2008 to 2011, approximately 40% of Medicaid children with ADHD received medication only, approximately 15% received psychological services only, approximately 40% received both and approximately 5% received neither.

From 2011 to 2014, the percentage of children with employer-sponsored insurance and ADHD medication claims did not significantly change (76.6% vs. 75.7%), while the percentage with psychological services claims decreased 5% from 44.5% to 42.4% (P = .009).

Joinpoint analysis did not indicate a significant change in trend throughout 2008 to 2014 for medication or psychological services.

From 2008 to 2014, approximately half of children with employer-sponsored insurance and ADHD received medication only, approximately 15% received psychological services only, 30% received both and approximately 10% received neither.

“These data suggest we are missing opportunities for young children with ADHD to receive behavior therapy,” Schuchat said. “Increasing referrals and the availability of appropriate services could help many families with young children who have ADHD ... We all can play a role in helping parents get the information and services they need.” – by Amanda Oldt

Disclosure: The researchers report no relevant financial disclosures.