Treatment services for children with ADHD: A national perspective

Objective: To summarize knowledge on treatment services for children and ad olescents with attention-deficit hyperactivity disorder (ADHD), trends in s ervices from 1989 to 1996, types of services provided, service mix, and bar riers to care. Method: A review of the literature and analyses from 2 natio nal surveys of physician practices are presented. Results: Major shifts hav e occurred in stimulant prescriptions since 1989, with prescriptions now co mprising three fourths of all visits to physicians by children with ADHD. B etween 1989 and 1996, related services, such as health counseling, for chil dren with ADHD increased 10-fold, and diagnostic services increased 3-fold. Provision of psychotherapy, however, decreased from 40% of pediatric visit s to only 25% in the same time frame. Follow-up care also decreased from mo re than 90% of visits to only 75%. Family practitioners were more likely th an either pediatricians or psychiatrists to prescribe stimulants and less l ikely to use diagnostic services, provide mental health counseling, or reco mmend follow-up care. About 50% of children with identified ADHD seen in re al-world practice settings receive care that corresponds to guidelines of t he American Academy of Child and Adolescent Psychiatry. Physicians reported significant barriers to service provision for these children, including la ck of pediatric specialists, insurance obstacles, and lengthy waiting lists . Conclusions: The trends in treatment services and physician variations in service delivery point to major gaps between the research base and clinica l practice. Clinical variations may reflect training differences,unevenness in the availability of specialists and location of services, and changes i n health care incentives.