Some Progress Made, but More to Do Ahead

Trends in Diagnosis Rates and Treatment Use among Children with Attention Deficit/Hyperactivity Disorder (ADHD) in the United States (US) from 2010 to 2017

ADHD is one of the most common neurodevelopmental disorders during childhood. Common symptoms of ADHD include inattention, impulsivity, and fidgety behavior. The estimated prevalence of diagnosed ADHD has increased significantly, by approximately 50%, in the past two decades [1].

Several factors have contributed to this increase, including: better understanding of ADHD by healthcare providers and the public; new standards for diagnosis; incentive to diagnose (e.g., extra exam time); and improved access to health insurance and behavioral health services. Additionally, the reported prescribing rates for ADHD medications have also increased dramatically [2]. This raises concerns of appropriate use of ADHD medications among children as care guidelines recommend use of behavioral therapy as the first line of treatment for preschool children and ADHD medications in conjunction with behavioral therapy (i.e., combined therapy) for school aged children.

With ADHD diagnosis and medication prescriptions on the rise, it is crucial to better understand the trend for diagnosis and treatment pattern for ADHD among American children over time. HealthCore, in collaboration with the Blue Cross Blue Shield Association, conducted a study investigating the impact of attention deficit hyperactivity disorder among commercially insured children from 2010-2017.

Findings

• Diagnosis is significantly increasing by 31 percent – 4.8 percent to 6.1 percent, from 2010 to 2017.
• Diagnosis rates vary by age, gender, and geography. ADHD diagnosis is more common among boys, middle school age children, and in South region.
• Four in ten Children with ADHD have other behavioral health conditions.
• The increased use of behavioral therapy alone (from 8 percent to 12 percent) paired with the decreased use of medication alone (56 percent to 49 percent), were encouraging given the known side effects associated with ADHD medications.
• There is wide variation in ADHD medication use across geographic regions.
• Children living in the South region are more likely to use medication alone to manage their ADHD.

ADHD is one of the most common behavioral health conditions affecting children in the United States. Over the past eight years, ADHD diagnoses have continued to increase, especially among middle school-aged children, boys, and children living in the South region. Although the increased use of behavioral therapy alone paired with the decreased use of medication alone were encouraging given the known side effects associated with ADHD medications, the wide variation in ADHD medication use across geographic regions highlights opportunity to better educate parents and providers on the effectiveness of the combined therapy and coverage of behavioral therapy, in order to improve quality of care for children with ADHD. These ADHD trends indicate a need to continue focusing on the diagnosis and treatment for a growing number of American children.

[1] Xu G, Strathearn L, Liu B, Yang B, Bao W. Twenty-Year Trends in Diagnosed Attention Deficit/Hyperactivity Disorder Among US Children and Adolescents, 1997-2016. JAMA Netw Open. 2018 Aug 3;1(4):e181471.

[2] Chai G, Governale L, McMahon AW, Trinidad JP, Staffa J, Murphy D. Trends of outpatient prescription drug utilization in US children, 2002–2010. Pediatrics. 2012 Jul;130(1):23–31.