A recent study by the U.S. Centers for Disease Control (CDC) found that in 2015, 75 percent of children aged two to five years with a diagnosis of Attention Deficit-Hyperactivity Disorder (ADHD) were receiving medication-based treatment, and only 50 percent received some form of behavioral therapy. This was true regardless of insurance type; that is, it was equally true for children covered by Medicaid as it was for children on private insurance.
The study raises concerns on many levels.
The data on treating older children are fairly clear regarding the benefits and risks of medication treatment for ADHD. The landmark trial showed better outcomes in those treated with medication and behavioral therapy as opposed to behavioral therapy alone, and side effects were infrequent and readily manageable or reversible. Similar high-quality, multi-center, blinded scientific studies in younger children have not been done.
Collectively, the trials involved more than 12,000 children or adolescents with an ADHD diagnosis. Most compared methylphenidate to placebo, with treatment durations ranging from 1 to 425 days (average, 75). Of the 185 trials, 72 (40 percent) were industry-funded.
While the collective data indicate that the drug reduced hyperactivity and impulsivity and increased children’s ability to concentrate, most trials were small and judged to be low quality. For example, methylphenidate’s side effects may have compromised blinding in many studies. While short-term data indicated no life-threatening harms, the drug was associated with an increased risk of side effects such as sleeping problems and decreased appetite.
Of the 1,500 children, about 20 percent were initially diagnosed with ADHD. On average, they received their ASD diagnosis about three years later than those who were first diagnosed with ASD or with both ASD and ADHD simultaneously. This made them 30 times more likely to be over the age of 6 when diagnosed with ASD, missing a vital intervention window.
Notes talked to the paper’s first author, Amir Miodovnik, MD, MPH, of Boston Children’s Hospital’s Division of Developmental Medicine. (Miodovnik currently practices at The Maimonides Infants & Children’s Hospital in Brooklyn, NY.) …Read More
More than 50 years of epidemiologic research indicates that attention-deficit hyperactivity disorder (ADHD) affects 5 to 7 percent of the population. While there are “islands” of over-diagnosis—among boys, nonwhite children and children at the highest and lowest ends of the socioeconomic spectrum—most other ADHD is under-diagnosed, including in girls.
With time and care, ADHD can certainly be diagnosed and managed in a primary care setting. Pediatricians can be patients’ best advocates, helping children receive support services and appropriate testing and interventions at school. …Read More