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Behavior therapy underused in 2- to 5-year-olds with ADHD: CDC :

May 3, 2016

More than 75% of young children with attention-deficit/hyperactivity disorder (ADHD) are prescribed medication, but only about half receive psychological services, according to a new study.

The findings from the Centers for Disease Control and Prevention (CDC) come despite AAP guidelines that recommend using behavior therapy first.

“This treatment can work as well as medicine and without the risk of side effects in young children,” said CDC Principal Deputy Director Anne Schuchat, M.D. “And research shows the benefits of behavior therapy can last for years.”

The findings are published in the study “Vital Signs: National and State-Specific Patterns of Attention-Deficit/Hyperactivity Disorder Treatment Among Insured Children Age 2-5 Years – United States, 2008-2014” released Tuesday in the CDC’s Morbidity and Mortality Weekly Report.

Roughly 6.4 million U.S. children ages 4-17 years had a diagnosis of ADHD in 2011-’12, a 42% increase compared to 2003, according to the study. These children are more likely to be held back in school and to visit the emergency department.

In 2011, the Academy released guidelines calling for 4- and 5-year-olds to receive behavior therapy before stimulants. However, when studying treatment of 2- to 5-year-olds with ADHD for the CDC report, researchers found about 45% of children with employer-sponsored insurance and 54% of children with Medicaid received psychological services. In both insurance groups, about three-quarters of the children received medication.


The study did not distinguish between types of psychological services so the number of children receiving appropriate therapy likely is even lower, according to co-author Mark L. Wolraich, M.D., FAAP, chair of the AAP Subcommittee on ADHD, Steering Committee on Quality Improvement and Management, which developed the Academy’s 2011 guidelines.

“When we’re talking about evidence-based therapy, it’s a behavior modification approach where you’re training parents or teachers to provide a structured program with appropriate rewards and positive attention as well as clear rules and appropriate consequences if children aren’t following the rules,” said Dr. Wolraich, director of the University of Oklahoma Child Study Center.

He and Dr. Schuchat acknowledged there are barriers to choosing behavior therapy, including lack of provider availability and parental awareness, time and resources. They called for pediatricians to educate parents and work with government bodies and insurers to advocate for more services in their communities.

Dr. Schuchat said children with ADHD can thrive if they receive the proper support from parents and health care providers.

“We know medicine will be the appropriate choice for some young children, but we strongly encourage pediatricians, therapists and others to work with families to make sure kids with ADHD are receiving the most appropriate treatment,” she said. “For young children, this should include a discussion of behavioral therapy as the first step.”

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