Most US children and youth diagnosed with ADHD are taking stimulant medications, but less than one-quarter are receiving any amount of concurrent psychotherapy of any kind, according to a “Research Letter” published in JAMA Pediatrics.
University of Pittsburg researchers used a large commercial claims database covering 1,516 US counties to identify children who filled a prescription for an ADHD medication, were continuously enrolled in an insurance plan in 2010, and had been involved in psychotherapy.
The researchers identified 301,530 children receiving ADHD medication, of which 24.5% had at least some therapy visits in 2010. Rates of therapy varied widely across counties, from 6.3% to 38.1%, and the frequency of psychotherapeutic visits was often very low.
“We found that only one-quarter of commercially insured children in our sample receiving ADHD medication received any concurrent therapy services,” wrote the researchers. “In almost 200 US counties, fewer than 1 in 10 children receiving ADHD medication received therapy.”
“While medication-only treatment is consistent with guidelines for school-aged children, it may not represent the optimal treatment for many patients,” the researchers suggested. “The geographic variation in receipt of therapy, despite adjustment for clinical characteristics, may be explained not only by psychologist supply but also by parent, child, or pediatrician preferences for or comfort with nonpharmacologic care.”
Coincidentally, an article this month in The Lancet Psychiatry discussed ongoing questions and concerns about the high rates of ADHD diagnosing and medicating in the US, and referenced the findings of a Center for Disease Control study. “The CDC officials reported that in 2012, about 1660 children younger than 4 years received a diagnosis of ADHD, 760 of whom had a claim filed for an ADHD drug. This report was released only months after the CDC reported in November, 2013, that about 2 million more Americans aged 4—17 years received an ADHD diagnosis in 2011 than in 2003, and that more than two-thirds of these patients received drugs for the disorder.”
Geographic Variation in Receipt of Psychotherapy in Children Receiving Attention-Deficit/Hyperactivity Disorder Medications (Gellad, Walid F. et al. JAMA Pediatrics. Published online September 22, 2014. doi:10.1001/jamapediatrics.2014.1647)
US authorities attempt to quantify ADHD prevalence in toddlers as treatment debate continues (Granovetter, Michael. The Lancet Psychiatry, Volume 1, Issue 4, Page 262. September 2014.