Many Young Children With ADHD Are Missing Behavior Therapy
For toddlers and young children with attention deficit hyperactivity disorder, the first order of treatment isn't for the child—it's for the parents.
That means teaching caregivers several concrete strategies for guiding their child's behavior. This therapy is the preferred first option for children ages 2-5 with ADHD.
But about three-quarters of children in this age group are getting medication, says a new report on ADHD treatment in young children from the Centers for Disease Control and Prevention. Only about 50 percent of children are receiving any type of psychological services, which could include therapy aimed at addressing ADHD behaviors.
The findings, taken from a study of children insured by Medicaid and by employer-sponsored insurance programs, suggests that many children are being overmedicated for attention deficit disorder. And the medication comes with some damaging side effects for young children, including irritability, stomach pain, reduced appetite and slowed growth.
"We are missing opportunities for young children with ADHD to receive appropriate therapy," Dr. Anne Schuchat, the CDC's principal deputy director, said Tuesday.
What Does ADHD Therapy Look Like?
ADHD is a common childhood behavioral disorder that often lasts into adulthood. Children with ADHD may be overly active, have trouble paying attention, or be prone to impulsive behaviors. Children diagnosed as having ADHD when they are toddlers and preschool-age tend to have more severe symptoms, the CDC said.
Behavior therapy for ADHD focuses on positive reinforcement, setting up routines and daily schedules, and positive communication. This type of therapy is generally administered over eight or more sessions with a trained therapist. Both the American Academy of Pediatrics and the American Academy of Child and Adolescent Psychiatry have recommended this as a first step for young children, because the effects of long-term medication use for children in this age group is not fully known.
(For children ages 6-11, the recommendation is to use both behavior therapy as well as medication. For adolescents, medication is a first-line recommendation, and doctors may also recommend behavioral treatments.
But, the CDC acknowledges that therapy takes time, effort and resources. That may be the reason why more doctors are tilted towards medication.
To determine the percentages, the CDC looked at healthcare claims data from at least 5 million young children insured by Medicaid between 2008 and 2011, and about 1 million young children insured through employer-sponsored insurance between 2008 and 2014.
For both sets of children, the findings were the same: about 75 percent were receiving medication, and approximately half were getting psychological assistance. Those percentages have not changed over time.
The CDC said that in some cases, medication may be appropriate, even for young children. But families need to understand both the risks as well as the benefits of various treatment options.
The CDC called on health professionals to follow the recommendation of medical groups by identifying behavior therapists in the area, and by referring families to that option rather than prescribing drugs.
"We recognize that these are not easy treatment decisions for parents to make," Dr. Schuchat said. "We know that behavior therapy is effective, and the skills parents learn can help the whole family be successful."
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