Treatment of Attention Deficit/Hyperactivity Disorder among Children with Special Health Care Needs

doi:10.1016/j.jpeds.2015.02.018

The Journal of Pediatrics

Volume 166, Issue 6, June 2015, Pages 1423-1430.e2

https://doi.org/10.1016/j.jpeds.2015.02.018 Get rights and content

Objectives

To describe the parent-reported prevalence of treatments for attention deficit/hyperactivity disorder (ADHD) among a national sample of children with special health care needs (CSHCN), and assess the alignment of ADHD treatment with current American Academy of Pediatrics guidelines.

Study design

Parent-reported data from the 2009-2010 National Survey of Children with Special Health Care Needs allowed for weighted national and state-based prevalence estimates of medication, behavioral therapy, and dietary supplement use for ADHD treatment among CSHCN aged 4-17 years with current ADHD. National estimates were compared across demographic groups, ADHD severity, and comorbidities. Medication treatment by drug class was described.

Results

Of CSHCN with current ADHD, 74.0% had received medication treatment in the past week, 44.0% had received behavioral therapy in the past year, and 10.2% used dietary supplements for ADHD in the past year. Overall, 87.3% had received past week medication treatment or past year behavioral therapy (both, 30.7%; neither, 12.7%). Among preschool-aged CSHCN with ADHD, 25.4% received medication treatment alone, 31.9% received behavioral therapy alone, 21.2% received both treatments, and 21.4% received neither treatment. Central nervous system stimulants were the most common medication class (84.8%) among CSHCN with ADHD, followed by the selective norepinephrine reuptake inhibitor atomoxetine (8.4%).

Conclusion

These estimates provide a benchmark of clinical practice for the period directly preceding issuance of the American Academy of Pediatrics' 2011 ADHD guidelines. Most children with ADHD received medication treatment or behavioral therapy; just under one-third received both. Multimodal treatment was most common for CSHCN with severe ADHD and those with comorbidities. Approximately one-half of preschoolers received behavioral therapy, the recommended first-line treatment for this age group.

Section snippets

Methods

The 2009-2010 National Survey of Children with Special Health Care Needs (NS-CSHCN) is a nationally representative, population-based telephone survey conducted by the Centers for Disease Control and Prevention with funding and direction from the Health Resources Services Administration. Data were collected between July 2009 and March 2011.¹² Secondary analyses of these de-identified, existing survey data was considered exempt from Centers for Disease Control and Prevention institutional review

Results

Among all completed NS-CSHCN interviews (n = 40 242), 9459 CSHCN aged 4-17 years had current ADHD, valid responses to the ADHD treatment questions, and complete data on sex. The demographic profile of the sample and this population is presented in Table I (available at www.jpeds.com). Among all CSHCN, the weighted estimate of parent-reported current ADHD was 32.3% (95% CI, 31.5%-33.2%).

Discussion

This US study establishes the relative national prevalence of reported ADHD treatments, specifically medication treatment and behavioral therapy, as well as the use of dietary supplements for the treatment of ADHD, among CSHCN in 2009-2010. In this national sample of CSHCN, approximately 87% of children with parent-reported current ADHD were receiving either medication treatment or behavioral therapy, with an additional 1.2% receiving dietary supplements alone as an alternative treatment.

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Cited by (62)

Adverse Effects of α-2 Adrenergic Agonists and Stimulants in Preschool-age Attention-deficit/Hyperactivity Disorder: A Developmental–Behavioral Pediatrics Research Network Study
2023, Journal of Pediatrics
To characterize and compare the type and frequency of a range of common and uncommon adverse effects (AEs) associated with α-2 adrenergic agonist (A2A) and stimulant treatment of attention-deficit/hyperactivity disorder at preschool-age as well as to evaluate the impact of age on common AEs.
This was a retrospective electronic medical record review of children <72 months of age (n = 497) evaluated at outpatient developmental–behavioral pediatric practices at 7 US academic medical centers within the Developmental-Behavioral Pediatrics Research Network. Data on AEs were abstracted for children who had treatment initiated by a developmental–behavioral pediatrician with an A2A or stimulant medication between January 2013 and July 2017; follow-up was complete by February 2019.
A2A and stimulants had distinctive AE profiles. A2A compared with stimulants had a greater proportion with daytime sleepiness and headaches; stimulants had significantly greater proportions for most other AE, including moodiness/irritability, difficulty with sleep, appetite suppression, stomachaches, skin picking/repetitive behaviors, withdrawn behavior, and weight loss. Younger age was associated with disruptive behavior and difficulty with sleep.
Stimulants had a greater rate of most AEs compared with A2A. AE profiles, together with efficacy, should inform clinical decision-making. Prospective randomized clinical trials are needed to fully compare efficacy and AE profiles of A2A and stimulants.
Early response to SPN-812 (viloxazine extended-release) can predict efficacy outcome in pediatric subjects with ADHD: a machine learning post-hoc analysis of four randomized clinical trials
2021, Psychiatry Research
Citation Excerpt :
Although the concept of personalized medicine has been discussed for decades (Gibson, 1971), it has not yet been implemented in ADHD, and current guidelines are based on the efficacy/tolerability tradeoff of these medications as reported in randomized controlled trials (Cortese et al., 2018; Faraone et al., 2015). Historically and currently, psychostimulants are first-line pharmacological treatments for ADHD (Faraone et al., 2015; Visser et al., 2015) with nonstimulants being considered only if both classes of stimulants fail, there is a contraindication to stimulants (e.g., a family history or currently active substance use disorder or a serious cardiovascular condition), or there are intolerable adverse effects (CONCERTA®, 2017; Faraone et al., 2020; VYVANSE®, 2018). This approach, however, does not consider inter-patient variability in the treatment response.
Machine learning (ML) was used to determine whether early response can predict efficacy outcome in pediatric subjects with ADHD treated with SPN-812. We used data from four Phase 3 placebo-controlled trials of 100- to 600-mg/day SPN-812 (N=1397; 6–17 years of age). The treatment response was defined as having a ≥50% reduction in change from baseline (CFB) in ADHD Rating Scale-5 (ADHD-RS-5) Total score at Week 6. The variables used were: ADHD-RS-5 Total score, age, body weight, and body mass index at baseline; CFB ADHD-RS-5 Total score at Week 1, cumulative change in ADHD-RS-5 Total score at Week 2, and cumulative change in ADHD-RS-5 Total score at Week 3; Clinical Global Impressions-Improvement (CGI-I) score at Week 1, 2, and 3; and target dose. Using the best selected model, lasso regression, to generate importance scores, we found that change in ADHD-RS-5 Total score and CGI-I score were the best predictors of efficacy outcome. Change in ADHD-RS-5 Total score at Week 2 could predict treatment response at Week 6 (75% positive predictive power, 75% sensitivity, 74% specificity). Therefore, early response after two weeks of treatment with once-daily SPN-812 in pediatric patients with ADHD can predict efficacy outcome at Week 6.
Rapid quantitative analysis of methylphenidate and ritalinic acid in oral fluid by liquid chromatography triple quadrupole mass spectrometry (LC-QqQ-MS)
2018, Journal of Chromatography B: Analytical Technologies in the Biomedical and Life Sciences
Citation Excerpt :
According to the Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition (DSM-IV), Attention-Deficit/Hyperactivity Disorder (ADHD) is a disorder generally diagnosed in childhood (around seven years old) that meets five criteria (A–D); traditionally a “persistent pattern of inattention and/or hyperactivity-impulsivity that is more frequent and severe than is typically observed in individuals at a comparable level of development” [1]. The 2011 National Survey of Children with Special Health Care Needs reported that 11% of children aged 4–17 were diagnosed with ADHD by a health care provider in the United States, with 6.1% of children in that age group having been prescribed medication for treatment of ADHD [2]. In 1937, psychiatrist Charles Bradley first reported the effects of Benzedrine sulfate, an amphetamine marketed by Smith, Kline & French, on “problem” children while treating them for severe headaches, when he noted that the children showed an improved performance in school, social interactions, and emotional feedback [3].
Methylphenidate (MPH), which is metabolized into ritalinic acid (RA), is an amphetamine derivative largely used in the treatment of attention-deficit hyperactivity disorder, a neurological condition commonly diagnosed in early childhood. Ensuring that patients comply with clinical treatment is crucial and compliance is generally monitored in blood or urine specimens which, especially in the case of children, can be challenging to obtain on a repetitive basis. Here we report validation of a specific, non-invasive, and rapid dilute-and-shoot analytical method for the detection and quantitation of MPH and RA in oral fluid (OF). The method is based on liquid chromatography coupled to triple quadrupole MS with electrospray ionization utilizing dynamic MRM mode. Subject OF specimens were collected using a Quantisal™ device, processed, and diluted for analysis with seven-point quadratic calibration curves (weighting of 1/x) using MPH-d₉ and (±)-threo-RA-d₁₀ as internal standards. QC samples and diluted specimens showed intra- and inter-day bias and imprecision values no greater than ±12%. The LOD and LOQ for MPH were 0.1 and 0.5 ng/mL, respectively, and 0.2 ng/mL and 0.5 ng/mL for RA, respectively, indicating the validity of the method for identification and confirmation at low concentrations. Selectivity was specific for the analytes of interest and matrix effects were minimized through the use of internal standard based quantitation.
The epidemiology of pharmacologically treated attention deficit hyperactivity disorder (ADHD) in the Region of Murcia, Spain: Differences by gender, age and location of residence
2018, Anales de Pediatria
El trastorno por déficit de atención e hiperactividad (TDAH) es la alteración del comportamiento más frecuente en la infancia y la adolescencia, representando un problema de salud pública. El tratamiento recomendado incluye tratamiento farmacológico y psicosocial. El objetivo de este estudio es analizar la evolución del consumo de los fármacos utilizados para el TDAH en la Región de Murcia y su variabilidad sociodemográfica.
Estudio observacional retrospectivo referido a la dispensación de medicamentos para el tratamiento del TDAH mediante receta en la Región de Murcia entre los años 2010 y 2014. Se calcularon las tasas de consumo expresadas en dosis diarias definidas (DDD) por 1.000 habitantes/día (DHD), estratificadas por sexo y edad y las razones de prevalencia de tratamiento por sexo comparando las tasas de consumo de hombres y de mujeres.
Durante el periodo estudiado prácticamente se ha duplicado el consumo de medicamentos para el tratamiento del TDAH, pasando de tasas de 5,58 DHD y 3,39 DHD en 2010 a 9,34 DHD y 6,71 DHD en 2014, para las franjas de edad de 10 a 14 años y de 15 a 19 años, respectivamente. Los varones de entre 10 y 14 años presentan las tasas de consumo más elevadas, observándose variabilidad geográfica con menores consumos relativos en las zonas rurales.
Se ha producido un importante aumento del uso de los medicamentos para el TDAH en la Región de Murcia, si bien las tasas de consumo siguen siendo inferiores a los datos de otras comunidades autónomas o países de nuestro entorno. Se observa una gran variabilidad geográfica con un mayor consumo en adolescentes de zonas urbanas.
Attention deficit hyperactivity disorder (ADHD) is the most frequent disorder in childhood and adolescence, and is seen as a public health problem. The recommended treatment includes pharmacological and psychosocial treatment. The aim of this work was to study the changes in the prescribing of the medicines used in ADHD treatment in the Region of Murcia, as well as their socio-demographic variability.
A retrospective observational study was conducted using the dispensing of medicines for ADHD treatment by means of prescription in the Region of Murcia from 2010 to 2014. The consumption rates were determined as defined daily doses (DDD) per thousand inhabitants/day (DHD), stratified by gender and age. The reasons for prevalence of treatment by gender were also determined by comparing male and female consumption rates.
The consumption of medicines for ADHD treatment had almost doubled in the period studied, from 5.58 DHD and 3.39 DHD in 2010 to 9.34 DHD and 6.71 DHD in 2014, for the age range of 10-14 and 15-19, respectively. Boys from 10-14 showed the highest consumption rates, showing a high geographical variability with less consumption in rural areas.
The results showed a large increase in the use of medicines for ADHD treatment in the Region of Murcia, although the consumption rates are still lower than in other Autonomous Communities or neighbouring countries. A wide geographical variability was found, with a higher consumption in adolescents from urban areas.
Measuring quality-of-care in treatment of young children with attention-deficit/hyperactivity disorder using pre-trained language models
2024, Journal of the American Medical Informatics Association
ADHD Diagnosis in Children of Non-US-Born Parents: A Cross-Sectional Analysis
2024, Journal of Attention Disorders

View all citing articles on Scopus

: S.C. receives support for research on navigated transcranial magnetic stimulation from Nextstim Oy. The other authors declare no conflicts of interest. The findings and conclusions in this report are those of the authors and do not necessarily represent the official position of the Centers for Disease Control and Prevention or the Health Resources and Services Administration.

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Original ArticleTreatment of Attention Deficit/Hyperactivity Disorder among Children with Special Health Care Needs

Objectives

Study design

Results

Conclusion

Section snippets

Methods

Results

Discussion

J Am Acad Child Adolesc Psychiatry

Ambul Pediatr

Biol Psychiatry

Diagnostic and statistical manual of mental disorders

Geographic variation and disparity in stimulant treatment of adults and children in the United States in 2008

Psychiatr Serv

ADHD: clinical practice guideline for the diagnosis, evaluation, and treatment of attention-deficit/hyperactivity disorder in children and adolescents

Pediatrics

Practice parameter for the assessment and treatment of children and adolescents with attention-deficit/hyperactivity disorder

J Am Acad Child Adolesc Psychiatry

Trends in the prevalence of developmental disabilities in US children, 1997-2008

Pediatrics

Increasing prevalence of parent-reported attention-deficit/hyperactivity disorder among children—United States, 2003 and 2007

MMWR Morb Mortal Wkly Rep

Stimulant medication use in children: a 12-year perspective

Am J Psychiatry

Trends in the prescribing of psychotropic medications to preschoolers

JAMA

Original Article
Treatment of Attention Deficit/Hyperactivity Disorder among Children with Special Health Care Needs