Vital Signs report from the Centers for Disease Control and Prevention (CDC) found that among insured children 2–5 years old receiving care for attention deficit hyperactivity disorder (ADHD), medication treatment was more common than the recommended first-line treatment of psychological services. 

In 2011, the American Academy of Pediatrics (AAP)’s guidelines recommended behavior therapy as first-line treatment over medication therapy for children 4–5 years old with ADHD. These recommendations are in line with the current guidelines from the American Academy of Child and Adolescent Psychiatry for younger children.

CDC researchers reviewed claims data to analyze state- and national-level ADHD treatment patterns among ~6 million young children. Using the MarketScan commercial database (2008–2014) and Medicaid (2008–2011) data, Susanna N. Visser, DrPH, and colleagues compared Medicaid and employer-sponsored insurance (ESI) claims for “psychological services” and ADHD drugs among children 2–5 years old. ADHD indicators were then compared among children with ESI for the periods before and after the 2011 AAP guidelines. 

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The analysis showed an increase in the percentage of children aged 2–5 years receiving clinical care for ADHD in both Medicaid and ESI populations. However, the percentage of Medicaid beneficiaries receiving ADHD care doubled that of ESI beneficiaries during 2008–2011. Nationally, no more than 55% of children with ADHD received psychological services yearly (regardless of insurance type), compared to the 75% that received medication. 

Among children with ESI, a significant 5% decrease in psychological services was seen after the release of the guidelines (from 44% in 2011 to 42% in 2014). The 1% decrease in the percentage of medication treatment was not significant (from 77% in 2011 to 76% in 2014). 

Increasing evidence-based behavior therapy may lead to more effective management of ADHD without the adverse effects of ADHD drugs, researchers added. 

Healthcare providers are recommended to follow clinical guidelines for ADHD diagnosis and treatment in young children, to discuss with parents the benefits of behavior therapy and why they should get training, and to identify parent training providers in the area and refer parents of young children with ADHD for training in behavior therapy before prescribing medication. 

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