The American Academy of Pediatrics (AAP) recommends children between the ages of 6 and 18 diagnosed with attention deficit hyperactivity disorder (ADHD) be treated with both FDA-approved medication and behavioral therapy.
Yet, a new study analyzing 2011 data shows that only one-third of kids with ADHD are getting the suggested AAP treatment — both medication and therapy — up just slightly from 2009.
In 2011, the latest year data is available, 9 out of 10 youngsters diagnosed with ADHD were receiving some form of treatment. Of those nine, four were getting medication alone, one was receiving behavioral therapy alone, one was taking dietary supplements (not currently a recommended ADHD treatment), and the remaining three were taking medication and getting behavioral therapy at the same time.
This begs the question, if the combination treatment is the medical gold standard, why are so few kids getting this ideal treatment?
“While I have definitely seen the merits of combined ADHD treatment, it is also important to remember that an individualized approach is key,” Dr. Mandi Silverman, a clinical psychologist at the ADHD and Disruptive Behavior Disorders Center at the Child Mind Institute, told Healthline. “This means that parents may opt to try one or the other first, due to whatever their specific preferences for treatment may be.”
Besides parental decisions, there are also several potential access barriers that may be affecting ADHD treatment in the United States.
“Sometimes practitioners are wed to one approach over another, and thus, they recommend that approach to families,” explained Silverman. “Other times, parents or families may have certain preferences for treatment, even when a combined approach is touted as the most effective option to take. A family may choose to participate in one option and decline other options if that is what they feel is best for their child.”
Silverman added, “Medication is sometimes easier and less time consuming than therapy, so for families with limited time, resources, and access to therapy providers, medication is the option chosen, especially if it is dispensed by a pediatrician.”
Not all doctors are ADHD specialists, especially in general practice. They don’t necessarily know the recommended guidelines for treating ADHD.
“Initially we were not advised that both [medication and therapy] were recommended,” said Jamie Freedman, a Massachusetts mom of an 8-year-old son with ADHD. “We tried behavioral therapy with a social worker before trying medication but chose not to continue therapy after starting medication. We weren’t seeing enough results and it was a power struggle just to get [our son] to attend.”
Many families also don’t have health insurance or cannot afford the cost of behavioral therapy. And, of those who have health insurance, many face steep mental health deductibles and copays, if they can get mental health coverage at all. The Affordable Care Act stipulates that mental health must now be covered by all insurance policies, easing this barrier somewhat.
Access to mental health care is also a struggle for many families due to a shortage of therapists that leads to long waiting lists, especially in small towns and rural areas.
“We would prefer our son have behavioral therapy too,” said Freedman, “but our pediatrician said there isn’t anyone to recommend in our area.”
There is a large discrepancy in ADHD treatment standards across states, too. For example, Michigan has the highest use of medication, with 88 percent of kids diagnosed with ADHD taking drugs. In contrast, 57 percent of California kids with ADHD take medication, the lowest of all states. About 33 percent of kids with ADHD in Tennessee receive behavioral therapy, yet 61 percent in Hawaii do. Why such a large gap in the way ADHD is treated among the 50 states?
“That’s difficult to answer,” said Silverman, “but it may come down to the resources available in each state or within each community in the particular state.”
Experts say it’s important that parents and doctors are familiar with the medical practice guidelines, so children with ADHD receive optimal care and have the chance to achieve the best possible outcomes.
A self-described “veteran” parent of a son with ADHD, Penny Williams is an award-winning blogger and author of the Amazon best-seller, "Boy Without Instructions: Surviving the Learning Curve of Parenting a Child with ADHD." Her second book, "What to Expect When You’re Not Expecting ADHD," is now available.