Nationally it appears most children are being treated for ADHD by medication alone, according to a recent study by the Centers for Disease Control and Prevention.
“Medication treatment was the single most common treatment with about 43 percent of children receiving medication alone,” said Susanna Visser, DrPH, lead epidemiologist of child development studies at the CDC and lead author on the study. “That was followed with combination therapies at 31 percent.”
The study was the first national study by the CDC examining the use of behavioral therapy and supplements alongside medication to treat ADHD during 2009 and 2010 in children aged 4-17.
The idea was to capture a snapshot of national practices before the American Academy of Pediatrics (AAP) published its treatment guidelines in 2011.
“We were hoping these data collected just before the release of those guidelines would be able to benchmark where we were in terms of data practice for the care of ADHD compared to where we needed to go in terms of those best practice guidelines,” said Visser.
The AAP recommends behavioral therapy alone for preschoolers and a combination of behavioral therapy and medication for children aged 6-17.
“We found that less than one in three children who were six years of age and older were receiving the recommended treatment,” Visser said. “We also found that only half of preschoolers were receiving behavioral therapy, which is now considered the recommended first line of treatment for this age group.”
According to the study, published in April in The Journal of Pediatrics: nine in 10 children were receiving treatment that included medication, behavioral therapy or a combination of both, one in 10 children did not receive any kind of treatment; one in 10 received behavioral therapy alone and one in 10 received supplements; one in two preschoolers aged 4-5 received behavioral therapy, one in two preschoolers took medication, one in four was treated with medication alone.
The study also looked at treatment rates for each state and D.C.
Medication treatment rates ranged from a low of 55 percent in California to a high of 88 percent in Michigan. Behavioral therapy rates ranged from a low of 33 percent in Tennessee to a high of 61 percent in Hawaii.
“States that had higher medication rates had lower behavioral therapy rates and vice versa,” Visser said.
New England states medication rates ranged from of a low of 69 percent in Maine and a high of 77 percent in Connecticut when parents were asked if their child used medication for treating ADD or ADHD within the past week.
Nationally, the average was 74 percent. Midwest states like Nebraska, Iowa, and Kansas were closer to 80 percent, Visser said.
The study showed higher rates of behavioral therapy for the New England area compared to the southern quadrant of the U.S., Visser said. That ranged from a low of 47 percent in Mass. to a high of 55 percent in Maine. The national rate was 44 percent.
“Those rates are really similar to the West which has some of the highest rates of behavioral therapy nationally,” she said.
Combination therapy rates ranged from a low of 31 percent in N.H. to a high of 40 percent in Conn. The national rate was 31 percent.
Visser said the study shows there is work to be done to get treatment to align with guidelines.
John Fanton, M.D., a child psychiatrist and medical director of the Child Partial Hospitalization Program at Baystate Medical Center in Springfield, Mass., said the study is an important one that shows there are still barriers to communities implementing parent behavioral management therapies.
“A number of them have to do with evidence based interventions,” he said. “They are well-studied and well-disseminated, but they are also not well-funded from a public health perspective.”
Medication helps reduce symptoms, but the best course of treatment is a mix of medication and intervention that involves parents, Fanton said. Parent behavioral therapy has been shown to work and give them tools to help them and the child move forward.
“People need to be reminded that pills don’t teach skills,” he said. “Medications are well studied and definitely help reduce symptoms, but symptom reduction does not cure ADHD.”
To check out state specific information, visit: http://www.cdc.gov/ncbddd/adhd/stateprofiles-behavioral/index.html