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It is normal for children to occasionally forget things, not concentrate or be restless. But a persistent pattern of inattention, impulsivity and hyperactivity suggests attention deficit hyperactivity disorder (ADHD) — a behavioral condition that affects a child’s ability to learn and interact with others.[1] The diagnosis of ADHD should be made by a health care professional who asks about the child’s behavior in multiple settings, such as at home or school, and when interacting with...
It is normal for children to occasionally forget things, not concentrate or be restless. But a persistent pattern of inattention, impulsivity and hyperactivity suggests attention deficit hyperactivity disorder (ADHD) — a behavioral condition that affects a child’s ability to learn and interact with others.[1] The diagnosis of ADHD should be made by a health care professional who asks about the child’s behavior in multiple settings, such as at home or school, and when interacting with peers.[2]
Over 6 million American children under the age of 17 are reported by their parents to have been diagnosed with ADHD.[3] Nearly a third of the children were diagnosed with ADHD before the age of 6.[4] (For information on ADHD treatment in children age 6 and older, see “A Guide to Treatment for ADHD”)
The 2011 guidelines of the American Academy of Pediatrics (AAP) recommend that doctors prescribe behavior therapy administered by parents or teachers as the first-choice ADHD treatment for children under 6 before prescribing ADHD drugs.[5] However, a recent report by the Centers for Disease Control and Prevention (CDC)[6] published in the May 6, 2016, issue of the agency’s Morbidity and Mortality Weekly Report found that the majority of children with ADHD were not receiving this therapy. Instead, the report showed that just 42 percent of children ages 2 to 5 who have ADHD receive such therapy.
Behavior therapy
The ultimate goal of behavior therapy is to teach children with ADHD how to control their behavior to be able to succeed at home, in school and in relationships. This type of therapy focuses on training parents in the skills[7] (see box, below) that they can use to modify their child’s ADHD behavior.
| Skills That Parents Can Learn In Behavior Therapy[8] |
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Learning and practicing behavior training require time and effort from the parents to achieve the optimal impact on the child’s behavior. Parents typically attend eight or more sessions of behavior training and then meet with the therapist regularly to review their progress, receive support and adjust strategies as needed. According to a federal report by the Agency for Healthcare Research and Quality, behavior training provided to the parents is the most effective of any ADHD treatment for children younger than 6.[9] Additionally, the positive effects of this training last for up to two years[10] and do not have the side effects associated with ADHD drugs.
The CDC report
The report looked at national medical health insurance claims data from Medicaid and employer-sponsored health plans for children ages 2-5 who received treatment for ADHD.[11] The authors of the report found that no more than 53 percent of the children with Medicaid insurance received any form of behavior therapy from 2008 to 2011. Similarly, only about 45 percent of the children with employer-sponsored health insurance received behavior therapy in 2011.
Surprisingly, the report’s authors found a 5 percent decline in the use of behavior therapy in the employer-sponsored health insurance group following the publication of the AAP guidelines.
Finally, the authors found that about three-quarters of the children in both insurance groups received ADHD prescription drugs, which are the second line of treatment according to the AAP guidelines. They called for increasing the use of behavior therapy in order to improve the effectiveness of ADHD treatment among young children without the side effects of ADHD medications.
What You Can Do
If you have a child under 6 with ADHD, pursue behavior therapy as the first treatment option. You can find behavior therapy providers through the health care professionals’ directories available from your health plan or from the websites of professional associations (such as the American Psychological Association). Call any potential therapists beforehand to inquire about their approach to ADHD treatment. Avoid professionals whose training is limited to play or talk therapy; although these treatments may be helpful for children with certain mental and emotional disorders, they have not been shown to be effective in young children with ADHD.[12] Resort to ADHD medications only if behavior therapy fails and your child has moderate to severe ADHD.[13]
References
[1] American Psychiatric Association. Diagnostic and Statistical Manual of Mental Disorders. 4th ed. Arlington, VA: American Psychiatric Association; 2013.
[2] Centers for Disease Control and Prevention. Updated January 8, 2016. Attention-deficit/hyperactivity disorder (ADHD). Symptoms and diagnosis. Updated January 8, 2016. http://www.cdc.gov/ncbddd/adhd/diagnosis.html. Accessed July 20, 2016.
[3] Visser SN, Danielson ML, Bitsko RH, et al. Trends in the parent-report of health care provider-diagnosed and medicated attention-deficit/hyperactivity disorder: United States, 2003–2011. J Am Acad Child Adolesc Psychiatry. 2014;53:34–46.e2.
[4] Visser SN, Zablotsky B, Holbrook JR, Danielson ML, Bitsko RH. Diagnostic experiences of children with attention-deficit/hyperactivity disorder. Natl Health Stat Report. 2015;81:1–7.
[5] Subcommittee on Attention-Deficit/Hyperactivity Disorder; Steering Committee on Quality Improvement and Management, Wolraich M, Brown L, Brown RT, et al. ADHD: Clinical practice guideline for the diagnosis, evaluation, and treatment of attention-deficit/hyperactivity disorder in children and adolescents. Pediatrics. 2011;128(5):1007–1022.
[6] Visser SN, Danielson ML, Wolraich ML, et al. Vital signs: National and state-specific patterns of attention deficit/hyperactivity disorder treatment among insured children aged 2–5 years — United States, 2008-2014. Morb Mortal Wkly Rep. 2016;65:443-450.
[7] Centers for Disease Control and Prevention. Attention-deficit/hyperactivity disorder (ADHD). Behavior therapy for young children with ADHD. Updated July 20, 2016. http://www.cdc.gov/ncbddd/adhd/behavior-therapy.html. Accessed July 20, 2016.
[8] Centers for Disease Control and Prevention. Attention-deficit/hyperactivity disorder (ADHD). Behavior therapy for young children with ADHD. Updated July 20, 2016. http://www.cdc.gov/ncbddd/adhd/behavior-therapy.html. Accessed July 20, 2016.
[9] Charach A, Dashti B, Carson P, et al. Attention deficit hyperactivity disorder: Effectiveness of treatment in at-risk preschoolers; long-term effectiveness in all ages; and variability in prevalence, diagnosis, and treatment. Rockville, MD: Agency for Healthcare Research and Quality; 2011. Comparative Effectiveness Review No. 44.
[10] Ibid.
[11] Visser SN, Danielson ML, Wolraich ML, et al. Vital signs: National and state-specific patterns of attention deficit/hyperactivity disorder treatment among insured children aged 2-5 years — United States, 2008-2014. Morb Mortal Wkly Rep. 2016;65:443-450.
[12] Centers for Disease Control and Prevention. Attention-deficit/hyperactivity disorder (ADHD). Behavior therapy for young children with ADHD. Updated July 20, 2016. http://www.cdc.gov/ncbddd/adhd/behavior-therapy.html. Accessed July 20, 2016.
[13] Wolraich M, Brown L, Brown RT, et al. ADHD: Clinical practice guideline for the diagnosis, evaluation, and treatment of attention-deficit/hyperactivity disorder in children and adolescents. Pediatrics. 2011;128:1007–1022.
