CDC: Preschoolers Receiving ADHD Meds Despite Recommendations

The Centers for Disease Control and Prevention (CDC) announced the results of the first national study on the use of behavioral therapy, pharmacologic treatment, and dietary supplements to treat attention-deficit/hyperactivity disorder (ADHD) in children ages 4–17 with special health care needs (CSHCN), which appears in The Journal of Pediatrics.

Parent-reported data from the 2009–2010 National Survey of Children with Special Health Care Needs were reviewed for information on family demographics, health care services, and presence of selected health conditions that included ADHD. In the survey, parents were asked if their child had ever received an ADHD diagnosis from a physician or other health care provider and if the child currently suffered from ADHD. Follow-up questions for those with current ADHD focused on parent-reported severity levels (mild, moderate, or severe), ADHD medication use during the past week and past year, dietary supplement use to treat ADHD in the past week or year, and behavioral therapy including classroom management or cognitive-behavioral therapy in the past year.

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Among all survey respondents, approximately 32.3% of parents reported that their child currently suffered from ADHD; of these, 82.6% reported that their child had taken an ADHD drug in the past year and 74.0% had taken one in the past week. For CSHCN with current ADHD aged 4–5, 25.4% were taking medication alone despite guidelines recommending behavioral therapy alone for children under 6 years of age. Forty-four percent of CSHCN with current ADHD had received behavioral therapy in the past year, with children ≥12 years less likely to have received behavioral therapy in the past year vs. children aged 4–5 years. Parents reported that 10.2% of CSHCN with current ADHD had taken dietary supplements for ADHD in the past year and 6.4% in the past week.

About 30% of CSHCN with current ADHD were receiving both pharmacologic treatment and behavioral therapy for ADHD. Children taking dietary supplements alone for ADHD treatment comprised only 1.2% of the CSHCN with current ADHD. CSHCN with current ADHD receiving either or both pharmacologic treatment or behavioral therapy to treat ADHD was 87.3%. For those who took medication for ADHD in the past week, 84.8% took a CNSS medication, with just over half as methylphenidate formulations.

Use of the serotonin-norepinephrine reuptake inhibitor (SNRI) atomoxetine was reported in 8.4% of CSHCN who were taking medication for ADHD along with atypical antipsychotics (5.7%), selective serotonin reuptake inhibitors (SSRIs) (3.1%), centrally-acting alpha-agonist hypotensive agents (clonidine) (4.1%), and centrally-acting alpha-adrenergic receptor agonists (guanfacine) (4.3%).

A CDC spokesperson stated that because the long-term effects of psychotropic medications in young children are unknown, behavioral therapy is considered to be the safest ADHD treatment for children under 6 years of age and should be prior to pharmacotherapy.

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Image courtesy of the CDC