A new national study from the US Centers for Disease Control and Prevention (CDC) has found large state-to-state differences in the use of medication, therapy, and combination treatment for children with ADHD. Overall, the study found that close to 87% of children in the US with diagnosed ADHD receive at least one of these treatments.
The study, “Treatment of Attention Deficit/Hyperactivity Disorder Among Children with Special Health Needs,” found that among children ages 4 to 17 diagnosed with ADHD, nationwide about 40% took medication alone, 10% received behavioral therapy alone, and 30% used a combination of medication and behavioral therapy. About 10% took nutritional supplements believed to help treat ADHD.
The CDC reports that among preschoolers specifically, about half received behavioral therapy either alone or in combination with medication, and about 25% took medication alone. In addition, 20% of children aged four to five with ADHD received no treatment.
Published in the April 1, 2015 issue of The Journal of Pediatrics, this study relies on the most recent data available, which were collected during 2009–2010. The data came from the National Survey of Children with Special Health Care Needs, a nationwide phone questionnaire that relies on parent reports of ADHD diagnosis and treatment.
In this study, the term “behavioral therapy” serves as a catchall for a wide range of behavior treatments. These include classroom management, peer interventions, social skills training, and cognitive behavioral therapy. The questions also didn’t distinguish the intensity of treatments.
Large Differences in Treatment Between US States
The state-by-state breakdown of treatment for ADHD showed some dramatic trends. In nearly the entire Northeast, at least 50% of children with ADHD had received some sort of behavioral therapy for ADHD in the past year. Compare that to southern states such as Georgia, Alabama, Virginia, and West Virginia where less than 40% of kids had done the same. The state with the highest use of behavioral therapy was Hawaii (60.6%) and the lowest was Tennessee (32.5%).
In several states in the Midwest, including South Dakota, Nebraska, and Iowa, more than 80% of kids with ADHD had been treated with medication within the previous week. However, many of these states also had high levels of behavioral therapy use.
The state with the highest percentage of kids with ADHD who took medication was Michigan (87.5%), while the lowest was California (56.6%).
Benchmarking Against Clinical Guidelines
In 2011, the American Academy of Pediatrics released a new set of clinical guidelines for treating ADHD in children. These recommendations came out after the data were collected for this survey.
Among the guidelines, the AAP says a combination of therapy and medication is the best treatment for children ages 6 to 11 with ADHD. The AAP says that children under age six should initially be treated only with behavioral therapy. When a preschooler doesn’t respond to therapy, the AAP says to try adding a methylphenidate medication, such as Ritalin.
The CDC researchers see these data as a benchmark on which they can compare how prescribing and therapy practices have changed since the AAP guidelines were released.
Demographic Differences in Treatments
Other noteworthy facts that came out of the study include the following:
- White children were more likely to be treated with medication alone than non-white children.
- Children who lived in the West, had mild ADHD, or who had a co-occurring condition were less likely to have taken medication for ADHD in the previous week.
- Children with ADHD who lived below the poverty line were more likely to have received behavioral therapy in the past year than children living 200% or more above the poverty line.
- There was an inverse correlation between state-based estimates of past year behavioral therapy use and past week medication use (in other words: more behavioral therapy = less medication and vice-versa).
- About 10% of kids with ADHD took a dietary supplement for it. This was most common among those with a co-occurring condition and those with college-educated and high-earning parents. Only about 1% of kids took only a dietary supplement with no other treatment; the majority of them took the supplement along with medication, therapy or both.
- A total of 88.6% kids with ADHD were being treated with medication, dietary supplements, behavioral therapy, or some combination of the three; about 11% of kids with ADHD were not being treated with any of these methods.
- About 85% of kids taking medication took a central nervous system stimulant, the standard medication of choice for ADHD. So what were the other kids taking? Almost 6% were taking an atypical antipsychotic, 3% an SSRI, and 4% each clonidine (Catapres, Kapvay) and guanfacine (Intuniv).
- Kids who had a “medical home”—a concept mainstreamed by the AAP that focuses on coordinated, accessible, patient-centered care—and private insurance were more likely to have taken medication than kids without a medical home (or a central hub of care) and with public insurance; those children were more likely to have received behavioral therapy.
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