Type of Therapy Kids Receive for ADHD Depends on Where They Live


September 22, 2014

About one quarter of commercially-insured children who are treated with medication for attention-deficit/hyperactivity disorder also receive psychotherapy, and the percentage is far lower in many parts of the country, according to a new RAND Corporation study.

Published as a research letter in the Sept. 22 edition of JAMA Pediatrics, the study is the first to document the substantial variation in receipt of talk therapy among U.S. children treated with ADHD medication, varying more than six-fold across counties in the United States.

For many children with attention-deficit/hyperactivity disorder, medication alone can manage symptoms. But evidence shows that some affected children do better and can take lower doses of stimulant medications when they receive behavioral therapy along with ADHD drugs.

“Treatment of ADHD in children generates lots of controversy, primarily because of potential for overuse and abuse of stimulant medications,” said Dr. Walid F. Gellad, the study's lead author and an adjunct scientist at RAND, a nonprofit research organization. “We wanted to find out among those who receive ADHD medications, how many also receive billed psychotherapy services? The answer is few, but it actually depends on where you live.”

Using a large commercial claims database, researchers examined records of more than 300,000 children aged 17 and younger from 1,516 counties across the United States who had received a prescription for medication for ADHD. Sparsely populated counties were not included in the study.

The researchers looked at how many children receive some amount of talk therapy along with medication, and also examined the supply of licensed psychologists in the counties studied.

Less than a quarter of those prescribed ADHD drugs received any talk therapy in the same year they received medication, 13 percent had at least four therapy visits and 7 percent had eight or more therapy visits. And in 200 U.S. counties, fewer than one in 10 children getting ADHD medication received any talk therapy.

“In areas of the country where rates of use are so low, it indicates that many kids with private insurance who could benefit from therapy are not receiving it,” said Gellad, who also is affiliated with the VA Pittsburgh Healthcare System and the University of Pittsburgh School of Medicine.

The percentage of children who received therapy along with medication was lower in those counties with fewer licensed psychologists, but didn't always reflect the number of available psychologists.

For example, Sacramento County in California and Miami-Dade County in Florida have the same number of licensed psychologists per capita. Yet almost half the children with ADHD in the California county received therapy along with drugs, compared to only about 20 percent of those in the Florida country.

Other authors of the study are Dr. Bradley D. Stein of RAND and the University of Pittsburgh, Teague Ruder of RAND, Rochelle Henderson and Sharon G. Frazee of Express Scripts, Dr. Ateev Mehrotra of RAND and the Harvard Medical School, and Julie M. Donohue of the University of Pittsburgh Graduate School of Public Health.

Funding for the study was provided by Express Scripts, a pharmacy benefit management company that works to make the use of prescription drugs safer and more affordable.

RAND Health is the nation's largest independent health policy research program, with a broad research portfolio that focuses on health care costs, quality and public health preparedness, among other topics.

About the RAND Corporation

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