ADHD’s Failing Formula = Ignore Behavioral Guidelines + Meds = Frustration [Circular Reference]

IGNORING ADHD’S BEHAVIORAL TREATMENT RECOMMENDATIONS [SHOCKER!]

In 2011, the American Academy of Pediatrics (AAP) released clinical practice guidelines for the diagnosis, evaluation, AND treatment of ADHD in Children and Adolescents. Those guidelines advise clinicians to consider these youths as having special health care needs and specifically emphasize psychological services including behavioral therapy be used as first-line therapy.

A new report from the Centers for Disease Control and Prevention (CDC), in Atlanta, Georgia, states that only 55% of Children and Adolescents with the disorder receive some sort of psychological service that may include behavioral therapy. The investigators at the CDC failed to find any increase in the use of psychological services overall. In fact, they found a small decrease in the percentage of children and adolescents receiving psychological services since the release of these guidelines in 2011.

According to the CDC, opportunities for children and adolescents especially those recently diagnosed with ADHD, to receive behavioral therapy, (which can be just as effective as medicine but without the risk of side effects) are being missed.

Investigators examined claims data from 5 to 7 million youths who were insured by Medicaid between 2008 and 2011 along with claims data from another million children who were insured through employer-sponsored insurance, the most common form of private insurance.

For the second year in a row, there has been an increase in the number of children and adolescents being treated with psychotropic medications overall, with….Wait for it….. ADHD medications compromising the majority of this increase in males. Over these past 2 years, there has also been an increase in Mental Health and/or Substance Abuse Treatment hospital admissions. Although the rate of growth for these hospital admissions is equal amongst girls and boys, girls continue to significantly outnumber boys in these hospital admissions.
CURRENT TREATMENT OVERWHELMINGLY INCLUDES MEDICATION ONLY

dt_160404_adhd_800x600_v3

DISCLAIMER:  Please know, I’m not hating on Meds.  They’ve come a long way and are a crucial part of many patients’ treatment.  Medication alone for the treatment ADHD is short sighted and has the potential to do more harm than good.   Oh yeah, it also goes against recommended treatment guidelines too.

According to a report published the Centers for Disease Control and Prevention, more than 6.4 million US children aged 4–17 years have had attention-deficit/hyperactivity disorder (ADHD) diagnosed. The percentage of US children diagnosed with ADHD has increased by 3%–5% per year since the 1990s. Relatedly, the percentage of children in this age group taking ADHD medication also has increased by about 7% per year from 2007–2008 to 2011–2012.

According to a report published the Centers for Disease Control and Prevention, more than 6.4 million US children aged 4–17 years have had attention-deficit/hyperactivity disorder (ADHD) diagnosed. The percentage of US children diagnosed with ADHD has increased by 3%–5% per year since the 1990s. Relatedly, the percentage of children in this age group taking ADHD medication also has increased by about 7% per year from 2007–2008 to 2011–2012.

Regardless of whether they are covered by Medicaid or employer-sponsored insurance, about 75% of children who are diagnosed with the disorder receive some sort of psycho-stimulant medication, the report indicates. Similar studies found the same trend in adolescents as well as children.

Examining the latest data from 2014, analyses indicated that for young children with ADHD who were covered under employee-sponsored insurance, 42% received some form of psychological service and that 76% received medication for ADHD.

To put it in clearer terms, less than half of children covered by employer-sponsored insurance in care for ADHD receive any form of psychological services. Increasing referral and availability of appropriate behavioral services could help many families with young children who have ADHD.
BEHAVIORAL THERAPY WORKS (FOR MANY PSYCHIATRIC DISORDERS)

Behavioral Therapy is a form of treatment in which parents learn specific ways to help improve their child’s behavior. Children and adolescents with ADHD have challenging behaviors, and by the time their parents get to clinicians, they are tired and worried about their child. “It’s like having your own personal coach for dealing with challenging behaviors,” according to Dr. Georgina Peacock, director of the CDC’s Division of Human Development and Disability. “Behavioral therapy is a form of treatment in which parents learn specific ways to help improve their child’s behavior,” she added.

Behavioral therapy, as recommended by the AAP, strengthens the relationship between the parent and the child, while giving parents more effective tools for helping their child learn positive behaviors.

A Behavioral Therapist teaches parents how to provide positive attention and to set and communicate rules. Parents who use these strategies report that their child does learn to control their behavior better, and this, in turn, helps the child not only at home but at school and in the child’s relationships with others.
NO FREE LUNCH

It’s important that parents understand that Behavioral Therapy does take some (often a lot of) work, time, and effort.  The painstaking efforts are often monumental and can change a child’s life trajectory, and these benefits can be lifelong.  It is a proven tool that can make a huge difference for a young child with ADHD.

It’s also important to remember that contrary to convention, the condition does not necessarily represent a learning impairment as much as it does a decision-making impairment according to a comprehensive evaluation of the neural processes of children with attention-deficit/hyperactivity disorder (ADHD) carried out by researchers at the University Clinics for Child and Adolescent Psychiatry, University of Zurich and University College London’s Wellcome Trust Centre for Neuroimaging. The scientists utilized functional magnetic resonance imaging (fMRI) and electroencephalography (EEG) simultaneously. The combination of the 2 modalities allows for an evaluation that overcomes the weaknesses of either method.
POTENTIAL TREATMENT BARRIERS BEYOND MEDICATION(S) ONLY

One of the challenges in providing behavioral training to parents is that in many areas, there are no trained professionals to deliver the therapy. Parents may also lack the resources or insurance coverage to participate in behavioral therapy training.

According to Dr. George DuPaul a leading researcher of ADHD in Children at Lehigh University, “There is clear evidence, based on many controlled studies…that behavioral parent training should be the first choice for treating ADHD in young children.”

“When behavioral parent training is implemented consistently, it can lead to greater parent understanding of behavioral principles, increased use of positive parenting strategies, and enhanced parent-child relationships, and it may delay initiation of stimulant medication as well,” he added.

The mental health community along with pediatricians should respond to this issue by educating parents, as pediatricians tend to be the first line of healthcare for young children and often know these children since birth. Additionally, perhaps it’s time for revising the treatment guidelines to better communicate this issue with pediatricians and mental health clinicians. I’ve seen countless children who are brought to me for treatment after the ADHD medications that some pediatricians prescribe lack the efficacy required to break the circular reference and improve life for the entire family.
If your child or adolescent has ADHD and is 5 years old or older, feel free to contact me to schedule a consultation.

 

REFERENCES

Gleason, M.M., et al. (2007). Psychopharmacological Treatment for Very Young Children: Contexts and Guidelines. Journal of the American Academy of Child and Adolescent Psychiatry, 46(12) 1532-1572.
DOI: 10.1097/chi.0b013e3181570d9e
Retrieved from:
http://www.jaacap.com/article/S0890-8567(09)61867-0/pdf

Hauser TU, Iannaccone R, Ball J, et al. (2014). Role of the Medial Prefrontal Cortex in Impaired Decision Making in Juvenile Attention-Deficit/Hyperactivity Disorder. JAMA Psychiatry, 71(10):1165-1173. doi:10.1001/jamapsychiatry.2014.1093.
Retrieved from:
http://archpsyc.jamanetwork.com/article.aspx?articleid=1897301#ArticleInformation

Public Health Law Research, (2015) Prior Authorization Policies for Pediatric ADHD Medication Prescriptions.
Retrieved from:
http://lawatlas.org/files/upload/ADHD%20Prior%20Authorization%20Policies_Report.pdf

Subcommittee On Attention-Deficit/ Hyperactivity Disorder, Steering Committee On Quality Improvement and Management. (2011). ADHD: Clinical Practice Guideline for the Diagnosis, Evaluation, and Treatment of Attention-Deficit/ Hyperactivity Disorder in Children and Adolescents. Pediatrics, 128(5), 1007-1022.
Retrieved from:
http://www.pediatrics.org/cgi/doi/10.1542/peds.2011-2654

Visser SN, Danielson ML, Wolraich ML, et al. (2016). National and State-Specific Patterns of Attention Deficit/Hyperactivity Disorder Treatment Among Insured Children Aged 2–5 Years — United States, 2008–2014. Vital Signs, 65(17);443-450.
DOI: http://dx.doi.org/10.15585/mmwr.mm6517e1.
Retrieved from:
http://www.cdc.gov/mmwr/volumes/65/wr/mm6517e1.htm?s_cid=mm6517e1_w

The Real Dash: SingleFATHER; TechGeek, MovieFreak, Music/TV/Reading/Writing Junkie, Psychotherapist, RUNNER, Meditator. Mad useful/less info. If that's not enough....see my links.....

Tagged with: , , , , ,
Posted in #Child Psychology, #Mental Health, #Parenting, #Psychology, #Psychotherapy, ADHD, Uncategorized

Leave a Reply

Please log in using one of these methods to post your comment:

WordPress.com Logo

You are commenting using your WordPress.com account. Log Out / Change )

Twitter picture

You are commenting using your Twitter account. Log Out / Change )

Facebook photo

You are commenting using your Facebook account. Log Out / Change )

Google+ photo

You are commenting using your Google+ account. Log Out / Change )

Connecting to %s

Enter your email address to subscribe to this blog and receive notifications of new posts by email.

Join 452 other followers

Follow me on Twitter
Main Office
516.232.8582 Office
EMERGENCY & PHONE SESSIONS ARE AVAILABLE

Answering Service Hotline - 24/7:
516.610.0534
%d bloggers like this: