Few children with parent-reported ADHD received mental health care, medication

 Many kids with attention deficit-hyperactivity disorder (ADHD) may not be getting the treatment they need, a cross-sectional study suggested.

Of 1,206 children with parent-reported ADHD, only 26.2% ever received any form of outpatient mental health care, reported Mark Olfson, MD, MPH, of Columbia University and the New York State Psychiatric Institute in New York City, and colleagues.

Furthermore, only 12.9% of kids were currently receiving ADHD medications; 8% were receiving stimulants and 5.1% were receiving atomoxetine (Strattera), guanfacine, or clonidine, the group noted in JAMA Network Openopens in a new tab or window.

"These ADHD treatment rates contrast with CDC reports

opens in a new tab or window that most children with ADHD receive treatment," Olfson and team wrote. However, the difference is that the CDC numbers are based on kids who received a clinical ADHD diagnosis, while Olfson's group just looked at parent-reported ADHD.

"It would be naive to assume that all children with parent-reported ADHD need or would benefit from treatment," they added, acknowledging that parent reports are no substitute for a formal clinical evaluation. However, they explained that these numbers suggest a substantial amount of kids with suspected ADHD may be falling through the cracks.

"Because most U.S. children receive an annual well-child visit, opportunities exist to improve ADHD detection in primary care," they wrote. "However, because no screening tool has sufficient accuracy for stand-alone use, primary care clinicians should consider multiple informants when evaluating children for ADHD. Local shortages of child mental health clinicians also hinder care access in many communities."

In order to better identify children with ADHD who may be overlooked for treatment, Olfson's group pinpointed certain groups that were lagging behind in medication use and mental health care.

For example, significantly more boys than girls were being prescribed ADHD medications (15.7% vs 7%). "A common explanation for this sex-based difference is that, because boys tend to have more disruptive clinical presentations than girls, they have a higher likelihood of referral for evaluation," the group noted.

Additionally, white children were more likely than Black children to be written a script (14.8% vs 9.4%). Olfson and team pointed out that Black children were specifically less likely to receive stimulants, and the discrepancy between medication rates was less obvious for non-stimulants.

"Contrary to our expectations," the researchers wrote, kids whose parents only had a high school education were more likely to be written a prescription for ADHD medications compared with parents who had a bachelor's degree or a higher degree (32.2% vs 11.5%). In addition, the proportion of kids with ADHD who received mental health care was higher among families with lower annual incomes:

• Less than $25,000: 36.5%
• $25,000 to $49,999: 27.7%
• $75,000 or more: 20.1%

When it came to ADHD subtype, more kids with the combined subtype received medication or mental health care compared with those with the inattentive subtype or the hyperactive-impulsive subtype.

"The findings provide a sense of the scale and distribution of children with parent-reported ADHD not receiving treatment," Olfson and colleagues wrote. "As such, they highlight the importance of developing strategies to increase clinical recognition of children with ADHD, especially girls, and increasing access to acceptable treatments."

The group used cross-sectional survey data from the Adolescent Brain and Cognitive Development Study, and identified 1,206 kids ages 9 and 10 years who met the DSM-5 criteria for ADHDopens in a new tab or window based on parental reports. Of this group, 68.2% were boys and 62.2% were white.

Far more children with parent-reported ADHD also had disruptive behavior disorder, anxiety disorder or obsessive-compulsive disorder, or a mood disorder.

Olfson and team noted that medication assessments were based on parent reports without confirmatory administrative or prescription data. In addition, no information on medication dose, duration, or prescriber was available.

Disclosures

Olfson and co-authors reported no disclosures.

Primary Source

JAMA Network Open

Source Reference: opens in a new tab or windowOlfson M, et al "Treatment of US children with attention-deficit/hyperactivity disorder in the Adolescent Brain Cognitive Development Study" JAMA Netw Open 2023; DOI: 10.1001/jamanetworkopen.2023.10999.

https://www.medpagetoday.com/pediatrics/adhd-add/104260