ADD/ADHD Treatment in United States

United States

Attention-deficit/hyperactivity disorder (ADHD) is one of the most common neurobehavioral disorders in childhood. It is marked by an ongoing pattern of inattention, hyperactivity-impulsivity or both. There are three types of ADHD, characterized by the most prominent symptoms: primarily hyperactive-impulsive type, primarily inattentive type (previously referred to as attention deficit disorder [ADD]) and combined type. The prevalence of ADHD has been steadily increasing over the last two decades, some of which may be attributable to increased diagnoses rather than increased incidence. It is usually first diagnosed in childhood and often lasts into adulthood. Common symptoms of ADHD include:

• Daydreaming a lot.
• Being impulsive.
• Forgetting or losing things frequently. 
• Talking too much.

It is important to diagnose and treat ADHD early. The impulsivity and inattention associated with ADHD increase the risk of injury and make it difficult to engage in healthy sleep, diet or physical activity habits. If left untreated, ADHD can lead to significant problems in education, employment and personal relationships. Further, it is common for ADHD to occur with other disorders, such as learning disorders, anxiety or depression. 

Most children with attention-deficit/hyperactivity disorder do not receive the treatment recommended by the American Academy of Pediatrics: Behavioral therapy for children under age 6 and a combination of medication treatment and behavioral therapy for children ages 6 and older.

Barriers to ADHD treatment include lack of training, time and resources for proper screening, reluctance or unease around prescribing medication from health care providers and misconceptions and stigma surrounding ADHD. The proportion of children with ADHD who are taking medication to treat their ADHD is higher among:

• Children from higher-income families compared with those from lower-income families.
• Non-Hispanic white and non-Hispanic Black children compared with Hispanic children and children identified as non-Hispanic other race. A higher proportion of non-Hispanic Black children also received behavioral treatment than Hispanic children and children identified as non-Hispanic other race.
• Children with insurance compared with those without insurance. Also, a higher proportion of insured children received behavioral treatment than uninsured children.

Strategies to increase access to and improve the quality of ADHD treatment among children include:

• Updating the pediatric and family medicine residency curricula to focus more on prevention, early diagnosis and treatment of mental health issues. 
• Developing and supporting collaborative care models that involve rapid access to behavioral and mental health experts and consultants. 
• Encouraging post-training learning programs for health care providers and educators on behavioral and developmental health to increase confidence in providing services. 
• Providing better training among primary care providers to increase accurate knowledge of ADHD.

The organization, Children and Adults with ADHD (CHADD) maintains a National Resource Center on ADHD for parents, educators and health care providers. Moreover, the program has toolkits that guide parents and caregivers through their options for ADHD management among children.

Healthy People 2030 has a goal to increase the proportion of children and adolescents with ADHD who get appropriate treatment.

Foy, Jane Meschan, Cori M. Green, Marian F. Earls, Arthur Lavin, George LaMonte Askew, Rebecca Baum, Evelyn Berger-Jenkins, et al. “Mental Health Competencies for Pediatric Practice.” Pediatrics 144, no. 5 (November 1, 2019): e20192757. https://doi.org/10.1542/peds.2019-2757. 

French, Blandine, Kapil Sayal, and David Daley. “Barriers and Facilitators to Understanding of ADHD in Primary Care: A Mixed-Method Systematic Review.” European Child & Adolescent Psychiatry 28, no. 8 (August 1, 2019): 1037–64. https://doi.org/10.1007/s00787-018-1256-3. 

Wolraich, Mark L., Joseph F. Hagan, Carla Allan, Eugenia Chan, Dale Davison, Marian Earls, Steven W. Evans, et al. “Clinical Practice Guideline for the Diagnosis, Evaluation, and Treatment of Attention-Deficit/Hyperactivity Disorder in Children and Adolescents.” Pediatrics 144, no. 4 (October 1, 2019): e20192528. https://doi.org/10.1542/peds.2019-2528.