ADHD treatment: many children can fall through the cracks

According to a cross-sectional study, many children with attention deficit hyperactivity disorder (ADHD) may not be getting the treatment they need.

Of 1,206 children with parent-reported ADHD, only 26.2% ever received some form of outpatient mental health care, reported Mark Olfson, MD, MPH, of Columbia University and New York State. Psychiatric Institute in New York, and colleagues.

Additionally, only 12.9% of children were currently receiving ADHD medication; 8% were receiving stimulants and 5.1% were receiving atomoxetine (Strattera), guanfacine or clonidine, the group noted in Open JAMA Network.

“These ADHD treatment rates contrast with CDC reports that most children with ADHD receive treatment,” Olfson and his team wrote. However, the difference is that the CDC numbers are based on children who were clinically diagnosed with ADHD, while Olfson’s group only looked at parent-reported ADHD.

“It would be naive to assume that all children with parent-reported ADHD need or would benefit from treatment,” they added, acknowledging that parent reports are no substitute for formal clinical evaluation. However, they explained that these figures suggest that a significant number of children suspected of ADHD could fall through the cracks.

“Because most American children receive an annual health visit, there are opportunities to improve detection of ADHD in primary care,” they wrote. “However, because no screening tool has sufficient accuracy for stand-alone use, primary care clinicians should consider multiple informants when assessing children for ADHD. Local shortages of children’s mental health clinicians hamper also access to care in many communities.”

To better identify children with ADHD who might be overlooked for treatment, Olfson’s group identified certain groups that were lagging behind in medication use and mental health care.

For example, significantly more boys than girls were prescribed medication for ADHD (15.7% versus 7%). “A common explanation for this gender-based difference is that because boys tend to have more disruptive clinical presentations than girls, they have a greater likelihood of being referred for evaluation,” the group noted. .

Additionally, white children were more likely than black children to have written a script (14.8% versus 9.4%). Olfson and his team pointed out that black children were specifically less likely to receive stimulants, and that the discrepancy in drug rates was less evident for non-stimulants.

“Contrary to our expectations,” the researchers wrote, children whose parents had only a high school diploma were more likely to be prescribed ADHD medications than parents with a bachelor’s degree or a bachelor’s degree. a higher diploma (32.2% against 11.5%). . In addition, the proportion of children with ADHD who received mental health care was higher among families with low annual income:

• Less than $25,000: 36.5%
• $25,000 to $49,999: 27.7%
• $75,000 or more: 20.1%

Regarding the ADHD subtype, more children with the combined subtype received medication or mental health care compared to those with the inattentive subtype or the hyperactive-impulsive subtype.

“The results provide insight into the magnitude and distribution of children with ADHD reported by parents who do not receive treatment,” Olfson and colleagues wrote. “As such, they underscore the importance of developing strategies to increase clinical recognition of children with ADHD, especially girls, and to increase access to acceptable treatments.”

The group used cross-sectional survey data from the Adolescent Brain and Cognitive Development Study and identified 1,206 children aged 9 and 10 who met the criteria DSM-5 Criteria for ADHD based on parental reports. Of this group, 68.2% were boys and 62.2% were white.

Many more children with parent-reported ADHD also had a disruptive behavior disorder, an anxiety or obsessive-compulsive disorder, or a mood disorder.

Olfson and his team noted that drug reviews were based on parent reports without confirmatory administrative or prescription data. Additionally, no information on the dose, duration, or prescriber of the drug was available.