Listen to thisThree-quarters of young children with ADHD are receiving medication, but only half are getting therapy.
Government health officials are urging medical providers to refer parents of preschoolers who have attention deficit hyperactivity disorder, or ADHD, to therapy sessions rather than turning first to medication.
The recommendation, issued Tuesday by the Centers for Disease Control and Prevention, comes alongside a dispatch in the agency's monthly report, called Vital Signs, that shows 75 percent of children who have ADHD receive medication. Among the concerns is that drugs that treat the condition can cause side effects like irritability and difficuty sleeping and can curb hunger, stunting growth. Further, researchers don't know what the long-term effects of these medicines are for children in this group.
The American Academy of Pediatrics offered similar guidance in 2011, saying medical providers should refer parents to training in behavior therapy before turning to medication. About a third of the 6.4 million children who have the condition, which causes children to be overly active and impulsive and to have difficulty concentrating, are diagnosed before age 6. At that point, symptoms can be very severe, and only half of the children who are diagnosed are receiving recommended behavioral therapy.
But Dr. Anne Schuchat, principal deputy director for the CDC, said in a call with reporters Tuesday that this type of therapy could be as effective as medication. “We recognize that these are not easy treatment decisions for parents to make,” she said, alluding to the fact that this type of treatment takes more time that medication.
Behavior therapy programs can occur over the course of eight or more sessions, and therapists teach parents how to give their children their full attention and reflect words back to them so their children know they are listening and care about what they have to say. They learn how to praise their children when they do something right and how to set up and follow routines. "It's like having your own personal coach for dealing with challenging conditions," Dr. Georgina Peacock, director of the CDC’s division of human development and disability, said during Tuesday's call.
The Vital Signs report analyzed health care claims data from at least 5 million young children between the ages of 2 and 5 who are insured by Medicaid, which is funded by the government, from 2008 to 2011. It also looks at an additional 1 million who were coverd by health insurance that employers pay for, from 2008 to 2014. Though it found the same rates of medication prescriptions among both groups, it found that 54 percent of children on Medicaid recevied psychological services each year, while 45 percent of children with private plans did.
These numbers did not increase over time, and the different rates between the two groups likely occurs because not all private health insurance companies will cover behavioral therapy as Medicaid typically does.
The CDC stopped short of saying that young children should never be
medicated for ADHD, adding that decision was for parents and doctors and
that medication may sometimes be appropriate. With behavioral therapy,
however, it's possible that some children may never need medication for
ADHD, Peacock said.
By Kimberly Leonard
3 May 2016
