title: Multimodal treatment for ADHD among youths in three Medicaid subgroups: disabled, foster care, and low income.
abstract: OBJECTIVE
  This study compared the use of treatments for attention-deficit hyperactivity disorder (ADHD) among three distinct subpopulations of Medicaid-insured youths who have very different mental health needs and patterns of service use: those with federally documented disability, those in foster care, and those in families with low income.
  
  
  METHODS
  This one-year, cross-sectional study of community mental health services used administrative data. Individuals who were younger than 20 years, who were continuously enrolled in one Mid-Atlantic state Medicaid program, and who had two or more medical encounters associated with an ADHD diagnosis in 1998 were identified (N=1,296). Measures of the use of mental health services were the number of different classes of psychopharmacologic medications, the psychopharmacologic regimen, and the combined use of pharmacotherapy and psychotherapy treatments (multimodal treatment).
  
  
  RESULTS
  Use of multiple psychopharmacologic agents was greater in the disabled and foster care groups compared with the low-income group. Significantly fewer mental health provider visits, but greater use of stimulant treatment only, were observed in the low-income group compared with the other groups. Youths in the disabled group were significantly more likely than youths in the low-income group, but not more likely than youths in the foster care group, to receive multimodal treatments. Children in foster care were significantly more likely than those in the other groups to use a substance abuse service.
  
  
  CONCLUSIONS
  Among a cohort of Medicaid-enrolled youths with ADHD, co-existing psychiatric disorders and complex psychopharmacologic treatments were more common in the disabled and foster care groups than in the low-income group. Youths with disabilities were significantly more likely than youths in the low-income group to receive multimodal treatment.
authors.affiliation: Division of Child and Adolescent Psychiatry, Johns Hopkins Medicine, Johns Hopkins Hospital, Baltimore, Maryland 21287, USA. sdosrei1@jhmi.edu
authors.forename: Susan
authors.initials: S
authors.lastname: dosReis
authors.forename: Pamela L
authors.initials: PL
authors.lastname: Owens
authors.forename: Karen B
authors.initials: KB
authors.lastname: Puccia
authors.forename: Philip J
authors.initials: PJ
authors.lastname: Leaf
mesh_terms: D000293:Adolescent; D000328:Adult; D001289:Attention Deficit Disorder with Hyperactivity / Q000453:epidemiology* / Q000628:therapy*; D002648:Child; D002675:Child, Preschool; D015331:Cohort Studies; D003131:Combined Modality Therapy; D003710:Demography; D019988:Children with Disabilities / Q000706:statistics & numerical data*; D005260:Female; D005581:Foster Home Care; D006801:Humans; D008297:Male; D008484:Medicaid / Q000706:statistics & numerical data; D001523:Mental Disorders / Q000453:epidemiology / Q000628:therapy; D008605:Mental Health Services / Q000458:organization & administration* / Q000706:statistics & numerical data; D008873:Mid-Atlantic Region / Q000453:epidemiology; D012959:Socioeconomic Factors