HealthDay News — Most preschool-aged children with attention-deficit/hyperactivity disorder (ADHD) are not offered first-line, evidence-based behavioral treatment, according to a research letter published online Oct. 18 in JAMA Pediatrics.

Yair Bannett, M.D., from the Stanford University School of Medicine in California, and colleagues assessed the rates of pediatricians’ recommendations of parent training in behavior management (PTBM) for parents of 4- to 5-year-olds who had an ADHD diagnosis, had ADHD symptoms, or were prescribed ADHD medications. The analysis included electronic records from 192 children seen at one of 10 primary care practices within a community-based pediatric health care network in the San Francisco area.

The researchers found that the most common treatment recommendation was not PTBM but rather routine/habit modifications (41 percent), including dietary modifications (reduced sugar intake) and supplements (e.g., ω-3 fatty acids), sleep hygiene, and limited screen time. Only 11 percent of patients received referrals for PTBM in ADHD-related visits. Nearly three in 10 medical records had mention of primary care provider-provided counseling on PTBM, including handouts. The primary care provider prescribed ADHD medications for 32 patients and only 28 percent of them had PTBM recommendations documented, including four patients for whom the primary care provider recommended PTBM before prescribing the first medication. Patients with public insurance were less likely to receive a PTBM recommendation (adjusted relative risk, 0.87) versus those with private insurance.


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“These study findings offer an opportunity for quality improvement initiatives to increase primary care provider adherence to clinical practice guidelines — thus establishing early access to behavioral treatment for patients with an ADHD diagnosis or ADHD symptoms,” the authors write.

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