SOURCES: Walid Gellad, M.D., M.P.H., adjunct researcher, RAND Corp., Santa Monica, Calif.; Emma Sciberras, D.Psych., clinical psychologist, Murdoch Childrens Research Institute, Melbourne, Australia; R. Scott Benson, M.D., psychiatrist, Pensacola, Fla., and past speaker of the American Psychiatric Association Assembly; Sept. 22, 2014, JAMA Pediatrics, online
THURSDAY, Sept. 25, 2014 (HealthDay News) -- Only one of four American children who has health insurance and has been prescribed medication to treat attention-deficit/hyperactivity disorder (ADHD) also receives some form of talk therapy, according to a new study.
The findings raise concerns that doctors may just be prescribing pills for behavior problems, rather than targeting kids' specific difficulties through judicious use of medication and therapy, said lead author Dr. Walid Gellad, an adjunct scientist at RAND Corporation, a nonprofit research organization.
"Drug therapy targets the core symptoms of ADHD, but when you talk about other aspects of functioning like educational performance and conduct problems, it appears that talk therapy may improve outcomes for many children," Gellad said. "In some kids, it is better than drug therapy alone," he added.
Access to therapy is extremely restricted in some parts of the country, Gellad and his colleagues found. In nearly 200 counties in the United States, fewer than one in 10 children receiving ADHD medication also received therapy.
The findings run counter to current guidelines for the treatment of ADHD, said Dr. Emma Sciberras, a clinical psychologist at the Murdoch Childrens Research Institute in Melbourne, Australia.
"Clinical guidelines for the treatment of ADHD clearly advise that pharmacological treatment for ADHD should be combined with psychological interventions," Sciberras said.
"This is because studies have shown that a combined approach -- using both medication and psychological therapies -- is the most effective treatment for ADHD," she added.
In their study, the researchers combed through a commercial insurance claims database to identify more than 300,000 children aged 17 or younger who filled a prescription for ADHD medication in 2010. Then, they looked to see whether the kids also received therapy that year.
The children were covered by private insurance and hailed from more than 1,500 counties in the United States, representing more than 90 percent of the nation's population.
"These are kids who are covered by what is considered pretty good insurance when it comes to mental health care, although we can't be certain what their benefits are from this data alone," Gellad said.
Despite their top-notch health coverage, just under 25 percent of children prescribed ADHD medication also received therapy, according to the study.
About 13 percent of the children had at least four therapy visits, and 7 percent had eight or more therapy visits, the study reported.
The kids' access to therapy varied widely -- as much as sixfold -- depending on where they lived, the researchers found.
For example, the study found twice as many children with ADHD received therapy in Sacramento County (about 48 percent) than Miami-Dade County (nearly 20 percent). And, that's even though both communities have a comparable supply of licensed psychologists, the researchers said.
"When you see rates that are under 10 percent, is it that everyone has access but their doctor has decided they don't need it, or is it that not everyone has access?" Gellad asked.
Gellad noted that many children with ADHD do fine on medication alone, and do not need additional therapy.
But medication is not the key for every issue that crops up with ADHD, said Dr. Scott Benson, a psychiatrist in Pensacola, Fla., and past speaker of the American Psychiatric Association Assembly.
"You can't just sit around and fiddle with doses of medicine to solve all of the problems that ADHD kids have," Benson said. "You have to target specific problems."
Benson added that ADHD is a condition that lends itself to coverage by private insurance.
Therapists generally need only a handful of sessions to target and treat specific issues. Examples of these issues include a child having trouble making friends or engaging in irritable outbursts while getting ready for school. At the same time, long-term delving into a child's past has not proven effective in helping a child with ADHD, Benson said.
"It's usually brief, a few visits. This is not seeing these children in therapy for years. It's a very brief, targeted intervention," he said. "If I say I need eight visits to address problems getting along with other kids, then insurance companies know how to handle that."
The findings were published as a research letter in the Sept. 22 online edition of JAMA Pediatrics.
For more about ADHD, visit the U.S. National Institute of Mental Health.