Adherence to treatment guidelines and barriers to access of health care services in children and adolescents with ADHD

Background: Attention-Deficit/Hyperactivity Disorder(ADHD) is the most common neurobehavioral disorder in youth. Due to increasing prevalence, the American Academy of Pediatrics(AAP) released clinical recommendations for the diagnosis and treatment of ADHD in patients under the age of eighteen in 2000-2001. These recommendations were updated in 2011. The purpose of this study was to determine whether children and adolescents with ADHD are being treated in accordance with AAP recommendations, and explore the barriers to treatment. Methods: The study utilized the Centers for Disease Control's(CDC) 2009/10 National Survey of Children with Special Health Care Needs data. A retrospective analysis was conducted using SAS 9.3. Results: Reported treatments were consistent with AAP recommendations for youth aged 6-18 years old. For children ages 4-5, AAP recommends behavioral therapy as first line treatment. Approximately 53% of children ages 4-5 were receiving behavioral therapy. In the absence of significant improvement, AAP recommends the addition of methylphenidate. Of the 44% who reported taking a medication, 18,549 were taking methylphenidate, but nearly as many (15,921) were taking a different medication. Additionally, 59,773 youth ages 4-18 were taking medication not approved by the FDA to treat ADHD. The most commonly reported barriers to services included cost, lack of resources in communities and schools, and health plan problems. Conclusions: Reported treatment for ADHD was consistent with AAP recommendations for children aged 6-18, but not for children aged 4-5. There is substantial off-label drug use in the treatment of this disorder. Furthermore, barriers exist when treating children and adolescents with ADHD.