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For little children with ADHD, more than a pill is best

ADHD and psychological services

Only about half of kids ages 2 to 5 diagnosed with ADHD get the kinds of psychological services that would help them cope long-term with their symptoms, says a new study.

(Cavu Pictures)

Among the littlest people diagnosed with attention deficit and hyperactivity disorder--ADHD--nearly half get no more help dealing with their distractedness, impulsiveness and hyperactivity than that provided by prescription medication, says a new government report.

That’s despite the fact that for these patients--children ages 2 to 5 diagnosed with ADHD--behavior therapy can help children develop self-control, organizational skills and coping mechanisms, tools that would help them over the long run.

More than 6 million American kids--about 11%--have been diagnosed with ADHD, and a third of those kids, generally those most severely affected by the disorder, got a diagnosis before they even entered first grade. For kids this young, the American Academy of Pediatrics recommends that psychological services be tried first before medications are prescribed.

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But 3 in 4 such children receive prescription medication, generally stimulant medication that can disrupt sleep patterns, cause irritability and stomachaches and blunt appetites. And about half do not, in any given year, see a psychologist.

That pattern of over-reliance on medication alone has changed little over recent decades, even as rates of pediatric ADHD diagnoses have soared. A 2015 study in the Journal of Clinical Psychiatry reported a 43% jump in ADHD diagnoses among American schoolchildren in a recent eight-year stretch alone. Among girls, the hike in diagnoses was even steeper.

Dr. Anne Schuchat, principal deputy director of the U.S. Centers for Disease Control and Prevention, told reporters Tuesday that the benefits of behavior therapy “can last for years.”

At the same time, Schuchat said the effects of long-term ADHD medication use by young children is unknown. The CDC is therefore “encouraging pediatricians and other healthcare providers to work with families to make sure children with ADHD are receiving the most appropriate treatment,” she said.

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And that should include a discussion about behavior therapy as a first step, Schuchat added. In addition to psychological services aimed directly at helping the child, services that help train parents to deal with and mold a child’s behavior can be highly effective in managing a child’s ADHD symptoms.

Schuchat’s comments came against the backdrop of a CDC report that tracked the healthcare claims data of at least 5 million children from the age of 2 to 5. It found that children on Medicaid, the federal healthcare program for low-income families and the disabled, are more likely than children who are privately insured to receive psychological services if they are diagnosed with ADHD. Among young kids on Medicaid with ADHD, 54% received such services. Among those who are privately insured, just 45% did.

Schuchat acknowledged that behavioral training is not available everywhere and is not covered by all insurance plans. Some centers base their fees on income or offer group sessions, which are less costly than individual sessions, she said. While states oversee the expansion of services available to children with ADHD, Schuchat added, physicians should  stress to parents the desirability of getting such help for their children with ADHD.

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