Treatment of attention-deficit hyperactivity disorder: patterns of evolving care during the first treatment episode.
OBJECTIVE
This study sought to better understand factors associated with different patterns of treatment among children starting treatment for attention-deficit hyperactivity disorder (ADHD).


METHODS
Factors associated with service utilization and pharmacy claims data for 2,077 Medicaid-enrolled children aged six to 12 who started treatment for ADHD between October 2006 and December 2007 in a large mid-Atlantic state were investigated by using logistic regressions and Cox proportional hazard models.


RESULTS
A total of 45% of children started ADHD treatment with a psychosocial intervention alone, 41% of children started treatment with medication alone, and 14% of children started treatment with a combination of both treatments. By the end of the treatment episode, 42% of children who initiated treatment with psychosocial interventions alone had added medication. Within six months of starting treatment, approximately 40% of children had discontinued treatment. Among those who continued receiving treatment, a majority received medication, either alone or with a psychosocial intervention. Treatment with a psychosocial intervention was significantly more likely to be initiated among nonwhite versus white children and among younger versus older children. Younger versus older children and African-American versus Caucasian children were significantly more likely to drop out of treatment sooner.


CONCLUSIONS
During the first episode of treatment for ADHD, the interventions children received frequently changed, suggesting dissatisfaction with initial treatment. Further research is needed to better understand what underlies the patterns of evolving care so that all families seeking care for children with ADHD may receive preferred and effective treatment.
RAND Corporation, 4570 Fifth Ave., Suite 600, Pittsburgh, PA 15213, USA. stein@rand.org
Bradley D
BD
Stein
Gary R
GR
Klein
Joel B
JB
Greenhouse
Jane N
JN
Kogan
D001741:Black or African American / Q000706:statistics & numerical data; D001289:Attention Deficit Disorder with Hyperactivity / Q000188:drug therapy / Q000453:epidemiology / Q000628:therapy*; D001521:Behavior Therapy; D002648:Child; D003131:Combined Modality Therapy; D004812:Epidemiologic Methods; D005260:Female; D006801:Humans; D019458:Insurance Coverage; D008297:Male; D008484:Medicaid / Q000706:statistics & numerical data*; D001523:Mental Disorders / Q000453:epidemiology*; D008605:Mental Health Services / Q000706:statistics & numerical data*; D010342:Patient Acceptance of Health Care / Q000706:statistics & numerical data; D013997:Time Factors; D014481:United States / Q000453:epidemiology; D044465:White People / Q000706:statistics & numerical data