Only about one quarter of commercially insured children who are treated with drugs for attention-deficit/hyperactivity disorder (ADHD) also receive psychotherapy, according to a new RAND Corporation study. Published as a research letter in the Sept. 22 online JAMA Pediatrics, the study also found that the percentage of kids receiving psychotherapy was far lower in many parts of the country.
Researchers from RAND Corporation, a non-profit research organization, noted the study was the first to document the substantial variation in the amount of talk therapy given to children in the U.S. who were being treated with ADHD medications. Led by Walid F. Gellad, MD, an adjunct scientist at RAND, the research team found a six-fold difference across counties in the United States.
At issue are concerns about the use of stimulant medications. While ADHD medications alone may help to manage the disorder’s symptoms, evidence shows that some affected children can take lower doses of the drugs when they also receive behavioral therapy.
“Treatment of ADHD in children generates lots of controversy, primarily because of potential for overuse and abuse of stimulant medications,” said Gellad in a news release. “We wanted to find out among those who received ADHD medications, how many also receive billed psychotherapy services. The answer is few, but it actually depends on where you live,” he added.
The RAND researchers used a large commercial database to examine the records of more than 300,000 children aged 17 and younger from 1,516 counties across the U.S., excluding sparsely populated areas. All the children in the study had been prescribed ADHD medications. The investigative team looked at how many kids got some amount of talk therapy and at the number of licensed psychologists in the studied counties.
Their findings showed that less than a quarter of the children who were prescribed ADHD drugs received psychotherapy in the same year they took the medication. Of those that received therapy, 13 percent had at least four therapy sessions and 7 percent had eight or more visits. In 200 of the studied counties, fewer than 10 percent of kids with ADHD received behavioral therapy.
In counties with fewer licensed psychologists, the percentage of children who received psychotherapy along with ADHD medications was lower. However, the lower percentage was not always a reflection of the number of available psychologists. For example, the researchers noted that both Sacramento County in California and Miami-Dade County in Florida have the same number of licensed psychologists per capita. Yet almost half the kids with ADHD in the California county received therapy along with medication, compared with 20 percent of those in the Florida county.
The bottom line, according to Gellad, who is also affiliated with the VA Pittsburgh Healthcare System and the University of Pittsburgh School of Medicine, is that 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.”