Barely half of US pre-schoolers (4-5 years) with special health care needs (CSHCN) and an ADHD diagnosis used behavioural therapy in 2009-10, say researchers, despite it being their recommended first-line treatment.
The finding emerged from a study looking at the prevalence of medication, behavioural therapy, and dietary supplement use for ADHD among a national sample CSHCN aged 4-17 with the condition. The study also assessed the extent to which their treatment patterns aligned with the age group-specific guidelines for treatment issued by the American Academy of Pediatrics (AAP).
These were expanded in 2011 to include all children aged 4-18 years, with special considerations for pre-schoolers and adolescents. The AAP now recommends behavioural therapy first for preschoolers, with short-acting methylphenidate prescribed if therapy does not sufficiently improve symptoms. For older children, a Food and Drug Administration-approved ADHD medication with or without behavioural therapy is recommended. Combination therapy (medication and behavioural therapy) is preferred, particularly for elementary-aged children.
The study, published in The Journal of Pediatrics, analysed parent-reported data from the 2009-2010 National Survey of CSHCN – a nationally representative, population-based telephone survey conducted by the Centers for Disease Control and Prevention. In 2011, 6.4 million children aged 4-17 years (11%) had a parent report of an ADHD diagnosis by a health care provider. Prevalence estimates of parent-reported ADHD increased by 33% from 1997 to 2008.
Approximately 87% of children with parent-repor ted current ADHD were receiving either medication treatment or behavioural therapy, with an additional 1.2% receiving dietary supplements alone as an alternative treatment. Among pre-schoolers with ADHD, 25.4% received medication treatment alone, 31.9% received behavioural therapy alone, 21.2% received both treatments, and 21.4% received neither treatment.
The researchers note that while a recent comparative effectiveness study had identified four behavioural interventions for preschoolers with ADHD, ‘these and other high-quality interventions might not be available to children in medically underserved settings in which there is limited access.’ They suggest, ‘Ongoing surveillance and future research on ADHD practice patterns for pre-schoolers will improve our understanding of the barriers to providing behavioral services that may be limiting our ability to more closely align clinical practice with best practices.’