Most children with ADHD do not receive treatment

Key takeaways:

• About one-quarter of children with parent-reported ADHD had ever received mental health care, and about 13% were currently using medication.
• There were differences in treatment based on sociodemographics.

Rates of current ADHD medication use and ever accessing mental health care were low among children with parent-reported ADHD, according to findings published in JAMA Network Open.

Mark Olfson, MD, MPH, the Elizabeth K. Dollard Professor of Psychiatry, Medicine and Law and a professor of epidemiology at the Columbia University Medical Center in New York City, and colleagues analyzed data from the first wave of the Adolescent Brain and Cognitive Development (ABCD) Study, which surveyed students aged 9 and 10 years from June 1, 2016, to Oct 15, 2018. They evaluated reported sociodemographics, current ADHD medication treatment and lifetime outpatient mental health care.

Among 11,723 children in the ABCD cohort, 1,206 had parent-reported ADHD. Of these, only 149 (12.9%) were using ADHD medications and 301 (26.2%) had ever received mental health care, the researchers wrote.

A higher proportion of boys compared with girls (15.7% vs. 7%) were using ADHD medication, as were a higher proportion of white children compared with Black children (14.8% vs. 9.4%), children of parents without a high school education compared with those who had parents with a bachelor’s degree or higher (32.2% vs. 11.5%) and children with a combined ADHD subtype compared with an inattentive ADHD subtype (17% vs. 9.5%).

Analyses of medication type revealed that stimulant use was twice as likely among boys compared with girls (OR = 2; 95% CI, 1.14-3.5) and less likely among Black compared with white children (OR = 0.44; 95% CI, 024-0.82). Nonstimulant use was more common among children whose parents had a high school education compared with a bachelor’s degree or higher (OR = 2.79; 95% CI, 1.09-7.13), among children with combined compared with inattentive ADHD (OR = 2.74; 95% CI, 1.51-4.95) and among children with comorbid disruptive behavior disorders compared with no comorbid disruptive behavior disorders (OR = 2.8; 95% CI, 1.43-5.47).

A greater percentage of children whose parents had a high school education (36.2%) or some college education (31%) had ever received mental health care compared with those whose parents had a bachelor’s degree or higher (21.3%). Lifetime mental health care was also more common in children with a family income of less than $25,000 (36.5%) and $25,000 to $49,999 (27.7%) compared with those whose families made $75,000 or more (20.1%), as well as among children with the combined ADHD subtype (33.6%) compared with the inattentive (20%) or hyperactive-impulsive subtype (22.4%).

“Low treatment rates among children with parent-reported ADHD suggest a need to increase mental health service availability; enhance knowledge of ADHD symptoms among parents, teachers, and primary care clinicians; and develop accessible care pathways,” Olfson and colleagues wrote. “Because most U.S. children receive an annual well-child visit, opportunities exist to improve ADHD detection in primary care. However, because no screening tool has sufficient accuracy for stand-alone use, primary care clinicians should consider multiple informants when evaluating children for ADHD. Local shortages of child mental health clinicians also hinder care access in many communities.”