Requested DocAlert: CDC Vital Signs: ADHD in Young Children – First-line Behavior Therapy Is Underused

Information sourced from CDC:

Morbidity and Mortality Weekly Report (MMWR)

Early Release
May 3, 2016 / 65
[Free full-text MMWR article PDF]

Vital Signs: National and State-Specific Patterns of Attention Deficit/Hyperactivity Disorder Treatment Among Insured Children Aged 2–5 Years — United States, 2008–2014



Background: Attention deficit/hyperactivity disorder (ADHD) is associated with adverse outcomes and elevated societal costs. The American Academy of Pediatrics (AAP) 2011 guidelines recommend “behavior therapy” over medication as first-line treatment for children aged 4–5 years with ADHD; these recommendations are consistent with current guidelines from the American Academy of Child and Adolescent Psychiatry for younger children. CDC analyzed claims data to assess national and state-level ADHD treatment patterns among young children.

Methods: CDC compared Medicaid and employer-sponsored insurance (ESI) claims for “psychological services” (the procedure code category that includes behavior therapy) and ADHD medication among children aged 2–5 years receiving clinical care for ADHD, using the MarketScan commercial database (2008–2014) and Medicaid (2008–2011) data. Among children with ESI, ADHD indicators were compared during periods preceding and following the 2011 AAP guidelines.

Results: In both Medicaid and ESI populations, the percentage of children aged 2–5 years receiving clinical care for ADHD increased over time; however, during 2008–2011, the percentage of Medicaid beneficiaries receiving clinical care was double that of ESI beneficiaries. Although state percentages varied, overall nationally no more than 55% of children with ADHD received psychological services annually, regardless of insurance type, whereas approximately three fourths received medication. Among children with ESI, the percentage receiving psychological services following release of the guidelines decreased significantly by 5%, from 44% in 2011 to 42% in 2014; the change in medication treatment rates (77% in 2011 compared with 76% in 2014) was not significant.

Conclusions and Comments: Among insured children aged 2–5 years receiving clinical care for ADHD, medication treatment was more common than receipt of recommended first-line treatment with psychological services. Among children with ADHD who had ESI, receipt of psychological services did not increase after release of the 2011 guidelines. Scaling up evidence-based behavior therapy might lead to increased delivery of effective ADHD management without the side effects of ADHD medications.

Key Points

    • Children diagnosed with attention deficit/hyperactivity disorder (ADHD) can be overly active, have trouble paying attention, and/or have difficulty controlling behavior. They have higher rates of grade retention, high school dropout, unintentional injuries, and emergency department visits.
    • About 2 million of the more than 6 million children with ADHD were diagnosed as young children aged 2–5 years. Children with more severe ADHD are more likely to be diagnosed early.
    • Behavior therapy in the form of “parent training in behavior therapy” is the recommended first-line treatment for young children with ADHD. It works as well as medication without the risk of side effects. The American Academy of Pediatrics recommends health care providers advise parents of young children with ADHD to obtain training in behavior therapy and practice that before trying medication.
    • Among young children with either Medicaid or employer-sponsored insurance, just over 75% of young children in clinical care for ADHD received ADHD medication for treatment. Yet only about 54% of the young children in Medicaid and 45% of the children with employer-sponsored insurance (2011) annually received psychological services (including parent training in behavior therapy). The percentage of young children with ADHD receiving psychological services also has not increased over time.
    • Increasing delivery of parent training in behavioral therapy could lead to improved management of ADHD in young children without the side effects of ADHD medication.

[CDC Press Release]

[Vital Signs Article]

[Link to free full-text MMWR report PDF]

Centers for Disease Control and Prevention

The above message comes from CDC, who is solely responsible for its content.

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