From the Journals

Racial, ethnic differences exist ADHD treatment of Medicaid-enrolled youth

Publish date: May 16, 2017
By
Catherine Cooper Nellist

 

FROM PEDIATRICS

ADHD medication persistence and adherence are lower among African American and Hispanic children than white children who are enrolled in Medicaid, reported Janet R. Cummings, PhD, and her associates at the Rollins School of Public Health at Emory University, Atlanta.

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Data came from the 2008-2011 Medicaid Analytic eXtract Files for nine states involving a sample of 172,322 children aged 6-12 years continuously enrolled in Medicaid who initiated attention-deficit hyperactivity disorder medication; a second sample of 157,449 children who also were continuously enrolled in Medicaid through the continuation and maintenance (C&M) phase of treatment; and a third sample of 62,263 children who were continuously enrolled and received continuous medication treatment during the C&M phase.

Overall, quality of care for Medicaid-enrolled children receiving ADHD treatment is poor. Of those who initiated medications, 59% visited a provider within 30 days, 64% received at least two other doctor visits, and 38% received combined treatment with any psychotherapy visit. Sixty percent did not fill the ADHD prescription for enough days, 70% had no psychotherapy visit, and 42% stopped treatment.

The percentage that had any follow-up visit in the initiation phase was lower among African American children than among white children (56% vs. 61%, P less than .001), while Hispanic children were more likely than were white children to receive adequate follow-up in the initiation phase (63% vs. 61%; P less than .001) as well as in the C&M phase (71% vs. 63%; P less than .001). In children who continued medication, African American and Hispanic children were more likely than were white children to receive any psychotherapy (42% and 49% vs. 35%; P less than .001).

“The adjusted rate of discontinuing medication was 22.4% points higher (P less than .001) among African American versus white youth and 16.7% points higher (P less than .001) among Hispanic versus white youth,” Dr. Cummings and her associates said. “These findings are in line with research indicating that racial/ethnic minority parents may prefer psychosocial treatments over medication for ADHD.”

In terms of stopping treatment, the percentages were significantly higher among African American (51%) and Hispanic (45%) children than among white children at 36% (P less than .001).

“Higher rates of medication discontinuation among minority youth could be due to differences in cultural health beliefs and/or concerns about ADHD medication treatment. African American parents are less likely than white parents to conceptualize ADHD as a medical condition requiring treatment and may be less willing to administer psychotropic medication to a child due to beliefs about medication efficacy and side effects. ADHD medication is associated with an increased risk of adverse effects ... and a substantial proportion of treatment discontinuation is due to these adverse effects,” the researchers said.

Read more in Pediatrics (2017 May 16. doi: 10.1542/ peds. 2016-2444).

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Adult ADHD: Pharmacologic treatment in the DSM-5 era