Study Finds Gaps in Treatment for Children with ADHD on Medicaid

ADHD or attention-deficit/hyperactivity disorder is the most common neurological disorder in children in the United States. According to the Centers for Disease Control and Prevention, doctors have diagnosed more than six million children with ADHD; about two million of these children were preschoolers. Children with ADHD are more likely to experience injury, emergency room visits, and drop out of high school than their peers without the disorder.

Although there’s no cure for ADHD, doctors and caregivers can manage the disorder and improve some symptoms over time. In 2007, the American Academy of Pediatrics (AAP), viewed as an expert voice on child health, recommended behavioral therapy as the first choice of care for the youngest ADHD patients—preschoolers ages two to five. AAP shared its recommendations more widely to doctors beginning in 2011.

A study from Georgia Tech and CDC shows that despite guidelines from AAP, most preschoolers on Medicaid in seven Southeastern states receive medication to treat ADHD instead of the recommended behavioral therapy.

H. Milton Stewart School of Industrial and Systems Engineering (ISyE) Professor Nicoleta Serban examined Medicaid claims data from 2005 through 2012 for 53,000 preschoolers in Alabama, Florida, Georgia, Louisiana, Mississippi, North Carolina, and South Carolina. She found that overall, doctors treat about 65% of these children with medication, while just 16% receive the recommended care.

Serban called the results surprising. “Children on Medicaid with ADHD don’t get the appropriate care, period,” she said. “Medication is prevalent, and at ages two to five, to only be exposed to ADHD medication, that’s worrying.”

Additional results show gaps in care for black preschoolers, those living in higher rates of poverty and in rural areas. Serban said children in these populations are less likely to have access to qualified behavioral therapists who accept Medicaid, and overburdened caregivers are unable to transport their children to multiple therapy sessions.

“Behavioral therapy requires weekly or bi-weekly visits; it requires a lot of investment from parents. They don’t have the time to take off of work, and they don’t have the resources. It’s a very complex situation where children are forced into medication.”

There’s also a limited number of therapists who treat children with ADHD, and that number shrinks even more when it comes to doctors who accept Medicaid.

Serban said an expanded network of home or school-based therapists would benefit children on Medicaid, and allow therapists to observe children with ADHD in their own environment. She’s currently studying access to mental health services for Medicaid recipients.

The Institute for People and Technology, ISyE, and Children’s Healthcare of Atlanta have previously provided funding for this research. IPaT also provides access to multiple years of Medicaid data to support a deeper understanding of the challenges and patterns surrounding healthcare access.