Large Gaps Exist Preventing Better ADHD Care for Pediatric Patients


Large Gaps Exist Preventing Better ADHD Care for Pediatric Patients

Mark Olfson, MD, MPH

Credit: Rutgers University

There remains major gaps in care when it comes to treating pediatric patients with attention deficit/hyperactivity disorder (ADHD), including not seeking and receiving outpatient mental health care.1

A team, led by Mark Olfson, MD, MPH, Department of Psychiatry, College of Physicians and Surgeons, Columbia University and the New York State Psychiatric Institute, described the current state of ADHD medication use and lifetime outpatient mental health care in a large national sample of pediatric patients with ADHD.

There are many unmet needs for pediatric patients with ADHD that prevent better care.

The Study

In the study, the investigators used data from the cross-sectional survey from the first wave of the Adolescent Brain and Cognitive Development Study (n = 11 723), which was conducted from June 1, 2016, to October 15, 2018 and included 1206 school aged children between 9 and 12 years who met parent-reported Diagnostic and Statistical Manual of Mental Disorders (Fifth Edition) criteria for current ADHD.

The investigators sought measures of current ADHD including stimulants and nonstimulants, lifetime outpatient mental health care, or either treatment.

Of the 11,723 patients included in the study, 1206 had parent-reported ADHD, 68.2% of which were boys. In addition, 12.9% (n = 149) were currently receiving ADHD medications.

The results show 15.7% (n = 121) of boys were treated with ADHD medications, compared to 7.0% (n = 28) of girls. In addition, 14.8% (n = 104) of white children were treated with ADHD medication, compared to 9.4% (n = 22) of Black children.

Other demographic trends include more children of parents without a high school education (32.2%; n = 9) than of parents with a bachelor’s degree or higher (11.5%; n = 84), and more children with the combined subtype of ADHD (17.0%; n = 83) than with the inattentive subtype (9.5%; n = 49).

The results also show 26.2% (n = 301) of the parent-reported ADHD had received outpatient mental health care at some point, while pediatric patients received outpatient mental health care were more likely to be from a parent who had a high school education (36.2%; n = 29) or some college (31.0%; n = 109) than a bachelor’s degree or higher (21.3%; n = 153), children with family incomes of less than $25,000 (36.5%; n = 66) or $25,000 to $49,999 (27.7%; n = 47) than $75,000 or more (20.1%; n = 125), and children with the combined subtype of ADHD (33.6%; n = 166) than with the predominantly inattentive subtype (20.0%; n = 101) or the hyperactive-impulsive subtype (22.4%; n = 34) of ADHD.

“This cross-sectional study of children with parent-reported ADHD suggests that most were not receiving ADHD medications and had never received outpatient mental health care. Gaps in treatment, which were not directly associated with socioeconomic disadvantage, underscore the challenges of improving communication and access to outpatient mental health care for children with ADHD,” the authors wrote.


Olfson M, Wall MM, Wang S, Laje G, Blanco C. Treatment of US Children With Attention-Deficit/Hyperactivity Disorder in the Adolescent Brain Cognitive Development Study. JAMA Netw Open. 2023;6(4):e2310999. doi:10.1001/jamanetworkopen.2023.10999

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