August 2019

While ADHD Diagnosis Rises, Treatment Patterns Fall Short

What else can you do to help your pediatric patients with Attention-Deficit/Hyperactivity Disorder (ADHD)? The American Academy of Pediatrics (AAP) recommends both behavioral therapy and medication for children 6 years of age and older. For preschool children, 4 to 5 years old, the first line of treatment is behavioral therapy. If the response is not enough, medication may be added.¹

A Blue Cross Blue Shield Association and Blue Health Intelligence^® (BHI) study titled, The Impact of Attention Deficit Hyperactivity Disorder on the Health of America’s Children, looked at claims data among children diagnosed with ADHD. The children were between the ages of 2 and 18 and covered by commercial health insurance. The findings showed a large gap between what the AAP recommends and actual practice. Of children diagnosed with ADHD in 2017:²

• 27% received what the AAP recommends, both behavioral therapy and medication.
• 49% received only medication.
• 12% received only behavioral therapy.

The study revealed trends that show the importance of diagnosis and proper treatment of ADHD:²

• ADHD is one of the most common behavioral health conditions affecting kids in the U.S.
• Diagnoses increased by 31% from 2010 to 2017 in children 2 to 18 years old.
• ADHD is considered the second-most impactful condition affecting children’s health in the U.S. It accounts for 16% of the impact of all health conditions on Generation Z (0-19 years old).
• Four in 10 children with ADHD also have at least one other behavioral health condition, including:
• Depression
• Anxiety
• Learning disorders
• Disruptive behavioral disorders
• Autism Spectrum Disorder (ASD)

Rates of depression and anxiety increase in children with ADHD from preschool to middle school. The rates increase sharply in high school students. Rates of learning disorders, disruptive behavioral disorders and ASD are most common in preschool children with ADHD. The rates decrease sharply from preschool to elementary school and continue to decrease in high school kids.  

¹ AAP, ADHD: Clinical Practice Guideline for the Diagnosis, Evaluation, and Treatment of Attention-Deficit/Hyperactivity Disorder in Children and Adolescents, November 2011, https://pediatrics.aappublications.org/content/pediatrics/128/5/1007.full.pdf   

² Heatlh of America Report, The Impact of Attention Deficit Hyperactivity Disorder on the Health of America’s Children, March 28, 2019, https://www.bcbs.com/the-health-of-america/reports/impact-of-adhd-attention-deficit-hyperactivity-disorder-on-health-of-americas-children

The material presented here is for informational/educational purposes only, is not intended to be medical advice or a definitive source for coding claims and is not a substitute for the independent medical judgment of a physician or other health care provider. Health care providers are encouraged to exercise their own independent medical judgment based upon their evaluation of their patients’ conditions and all available information, and to submit claims using the most appropriate code(s) based upon the medical record documentation and coding guidelines and reference materials. References to other third-party sources or organizations are not a representation, warranty or endorsement of such organization. Any questions regarding those organizations should be addressed to them directly. The fact that a service or treatment is described in this material is not a guarantee that the service or treatment is a covered benefit and members should refer to their certificate of coverage for more details, including benefits, limitations and exclusions. Regardless of benefits, the final decision about any service or treatment is between the member and their health care provider.