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Do preschool children with ADHD get the behavioral therapy they need?


At the 2022 Pediatric Academic Societies meeting, Shruti Mittal, MD, FAAP, looked at how many children with attention-deficit/hyperactivity disorder get started on behavioral therapy before medication in the preschool years.

With existing guidelines from the American Academy of Pediatrics and the Society for Developmental and Behavioral Pediatrics recommending behavioral therapy (BT) as a first-line treatment for preschool-age children with attention-deficit/hyperactivity disorder (ADHD), Shruti Mittal, MD, FAAP, assistant professor and developmental and behavioral pediatrician at Levine Children’s Hospital in Matthews, North Carolina, set out to present the frequency of, and factors associated with, physician-documented receipt of BT in preschool-age children with ADHD. “To our knowledge, no studies have examined this receipt of BT from physicians, prior to medication initiation,” she explained. There is also limited research with provided details about specific types of behavioral therapy received in these children.

The DBPnet (Developmental Behavioral Pediatrics Research Network) study included a review of 497 manual charts of children aged less than 6 years who were seen by a developmental-behavioral pediatrician at 7 different sites, and were started on an alpha 2 agonist or stimulant. Most (82.9%) also had coexisting conditions, such as autism spectrum disorder or disruptive behavioral disorder. Of the group, the number of children documented to have received any BT was low (45% did; the majority of children, 55% did not). Receipt of BT varied across sites, as did coexisting conditions, and although published guidelines do specify the need for evidence-based behavior interventions, the receipt of parent training in behavior management and applied behavioral analysis was low.

“Given the significant variability in receipt of BT…further research is needed to identify factors that improve BT access and delivery,” observed Mittal. Additionally, more research is needed on availability of therapy in each state, as well as insurance reimbursement for specific types of behavioral therapy, which may be a factor in why the majority of preschoolers with ADHD are not getting BT.

Mittal S, Bax A, Blum NJ, et al. Receipt of behavioral therapy in preschool-age children with ADHD initiated on medications: a DBPNet study. Pediatric Academic Societies 2022; April 24, 2022. Denver, Colorado.

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