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Children on Medicaid: Less Likely to Stick with ADHD Treatment

A new study finds that children with ADHD who are on Medicaid received poor quality of care and discontinue treatment at high rates.




May 25, 2017

Children on Medicaid are unlikely to be offered comprehensive ADHD care, and, as a result, are more likely to discontinue treatment, a new study published in Pediatrics finds. The study found that racial disparities affected which children have (and maintain) access to well-rounded treatment.

Researchers used nine states’ Medicaid data from 2008 to 2011 to identify 172,322 children between the ages of six and 12 who started ADHD medication during that period. Of those, less than 40 percent were offered behavior therapy alongside their medication regimen — despite the fact that medication plus therapy has repeatedly shown better results than either treatment alone. Black and Hispanic children were slightly more likely than their white peers to receive combined treatment, the authors said, but the overall numbers of children receiving combined therapy was still low.

No matter what kind of treatment was given, however, many of the children didn’t stick to it. More than 60 percent of the patients who started medication discontinued it during the study — and more than 40 percent stopped their treatment plans altogether. Black and Hispanic children were more likely (22.4 percent, and 16.7 percent, respectively) than their white counterparts to discontinue medication or other treatments.

The high dropout rate was most likely due to inadequate follow-up care, the researchers said, since only 60 percent of children received the correct amount of monitoring — with black children least likely to have their treatment plans adequately monitored. This was especially concerning, the study’s authors said, since black and Hispanic children with ADHD have long struggled to get access to adequate care.

“These higher rates of medication discontinuation among minority youth also translated into higher rates of discontinuing treatment,” said author Dr. Janet Cummings of Emory University. “One approach to reduce the rate of treatment dropout and improve these disparities would be to do a better job of connecting families to behavioral therapy services if the child discontinues medication.”

“However,” she acknowledged in an interview with Reuters Health, “many communities have a shortage of mental health specialists that can provide these services and that accept Medicaid.

“It is critical for policymakers to invest more resources into expanding the availability of psychotherapy services in settings that may be more accessible to these families — such as federally qualified health centers and school-based health clinics,” she said.

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