title: Ten-Year Trends In Treatment Services For Children With Attention Deficit Hyperactivity Disorder Enrolled In Medicaid.
abstract: Closing the gap between evidence-based clinical practice standards and their inclusion in routine practice continues to be a major goal of health policy reforms. This gap is especially large for the care of children with psychiatric disorders-especially those from low-income families, many of whom are insured through Medicaid. To address this gap, we analyzed trends over ten years (2001-10) from Medicaid claims data describing changes over time in medication, psychotherapy, and combined treatment services for children diagnosed with attention deficit hyperactivity disorder (ADHD). Over this time, more children received treatments that conformed to practice standards, including the use of combination treatments of medication and psychotherapy. Rates of combined treatment increased by 74 percent, rates of psychotherapy alone more than doubled, and rates of medication alone decreased by 18 percent. Rates of diagnoses without any reimbursed treatment decreased by 39 percent. These trends suggest increasing adherence to clinical practice standards by providers serving children with ADHD in the Medicaid population, although the quality of those services is unknown.
authors.affiliation: Kimberly E. Hoagwood (kimberly.hoagwood@nyumc.org) is the Cathy and Stephen Graham Professor of Child and Adolescent Psychiatry in the Department of Child and Adolescent Psychiatry, New York University School of Medicine, in New York City.
authors.forename: Kimberly E
authors.initials: KE
authors.lastname: Hoagwood
authors.affiliation: Kelly Kelleher is the vice president of community health and community health services research at Nationwide Children's Hospital, in Columbus, Ohio.
authors.forename: Kelly
authors.initials: K
authors.lastname: Kelleher
authors.affiliation: Bonnie T. Zima is the associate director of the Center for Health Services and Society, David Geffen School of Medicine, University of California, Los Angeles.
authors.forename: Bonnie T
authors.initials: BT
authors.lastname: Zima
authors.affiliation: James M. Perrin is a professor of pediatrics and director of Harvard Medical School, as well as associate chair for research in the Division of General Pediatrics at Mass General Hospital for Children, in Boston, Massachusetts.
authors.forename: James M
authors.initials: JM
authors.lastname: Perrin
authors.affiliation: Scott Bilder is an associate research scientist at the Institute for Health, Health Care Policy and Aging Research at Rutgers, The State University of New Jersey, in New Brunswick.
authors.forename: Scott
authors.initials: S
authors.lastname: Bilder
authors.affiliation: Stephen Crystal is the associate director for health services research at the Institute for Health, Health Care Policy and Aging Research at Rutgers, The State University of New Jersey.
authors.forename: Stephen
authors.initials: S
authors.lastname: Crystal
mesh_terms: D001289:Attention Deficit Disorder with Hyperactivity / Q000175:diagnosis / Q000191:economics* / Q000453:epidemiology / Q000628:therapy*; D000697:Central Nervous System Stimulants / Q000627:therapeutic use; D002648:Child; D002662:Child Health Services / Q000191:economics* / Q000639:trends; D002675:Child, Preschool; D015928:Cognitive Behavioral Therapy / Q000639:trends; D015331:Cohort Studies; D003131:Combined Modality Therapy; D003362:Cost-Benefit Analysis; D016208:Databases, Factual; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008297:Male; D008484:Medicaid / Q000191:economics* / Q000706:statistics & numerical data*; D012189:Retrospective Studies; D018570:Risk Assessment; D012720:Severity of Illness Index; D013997:Time Factors; D016896:Treatment Outcome; D014481:United States
chemical_list: D000697:Central Nervous System Stimulants
keywords: ADHD; Low Income; Medicaid; Treatment; Youth