First-line Behavioral Health Treatment Prior to Stimulant or Alpha-2 Agonist Use for Preschoolers on Kentucky Medicaid in 2017

Objective: We aimed to assess the degree to which the American Academy of Pediatrics' (AAP) clinical guidelines were followed when treating attention deficit/hyperactivity disorder (ADHD) in preschoolers. Method: Using Medicaid claims for children 4 to 5 years of age receiving their first dose of stimulants/alpha-2 agonists in 2017 (n = 836), we determined if BH was received prior to initiation of medication. We examined predictors after controlling for confounders. Results: More than half the sample did not receive first-line BH, which did not differ by demographics. Those receiving BH prior to medication had a higher rate of receiving an ADHD diagnosis. Only three diagnoses were significant in multivariate (OR 13.8, 95% CI [1.7-115.1]) analyses. Conclusion: More than half the sample did not, conservatively, meet the AAP clinical recommendations. Further research is needed to identify targets for intervention. Limitations are noted.

Automated summary

The study aimed to evaluate the adherence to the American Academy of Pediatrics' clinical guidelines in treating ADHD in preschoolers. Using Medicaid claims data, it was found that more than half of the sample did not receive the recommended behavioral therapy prior to medication initiation. Those who received behavioral therapy had a higher rate of ADHD diagnosis. Only three diagnoses were significant in multivariate analyses. Conclusion: More research is needed to identify intervention targets. Limitations are acknowledged.