Black and Hispanic children enrolled in Medicaid are significantly more likely to discontinue pharmacological treatment for attention-deficit/hyperactivity disorder when compared with Medicaid-enrolled white children, according to study results.
“Pharmacotherapy — especially stimulant medication — is effective at reducing core ADHD symptoms, and it is received by more than nine-tenths of youth with an ADHD–related health care visit,” Janet R. Cummings, PhD, associate professor in the department of health policy and management within the Rollins School of Public Health, Emory University, and colleagues wrote. “Yet, rates of ADHD medication adherence and persistence are low among Medicaid-enrolled youth in general, and even lower among [black] and Hispanic children than non-Hispanic and white children.”
Janet R. Cummings
To estimate the differences in care quality and treatment continuation for children with ADHD enrolled in Medicaid, the researchers collected data concerning those who began ADHD medication and were enrolled in Medicaid from 2008 to 2011. They then analyzed how many children received adequate follow-up care in starting as well as continuing medication and maintenance (C&M) phases.
Researchers also assessed whether children received both medication and psychotherapy as opposed to medication alone, and whether a child discontinued medication useor discontinued all treatment, including therapy.
Cummings and colleagues determined that three-fifths of all children included (n = 172,322) received adequate care in both the initiation and C&M phases, and less than two-fifths used both medication and psychotherapy. More than three-fifths of the children discontinued medication, and more than four-tenths discontinued all treatment, including psychotherapy.
Regarding race and ethnicity, black children were less likely to have satisfactory follow-up care in both phases when compared with white children. Conversely, Hispanic children were more likely to receive adequate care in both phases. Both black and Hispanic children more frequently used a combined treatment of medication and psychotherapy than whites. Black and Hispanic children were much more likely to discontinue medication (22.4%, 16.7%) or disengage from all treatment (13.1%, 9.4%) when compared with white children.
“[Black] parents are less likely than white parents to conceptualize ADHD as a medical condition requiring treatment and may be less willing to administer psychotropic medication to a child due to beliefs about medication efficacy and side effects,” Cummings and colleagues wrote.
The researchers also call for more studies to be done on whether “higher rates of medication discontinuation among minority youth are driven by racial and ethnic differences in child experiences with side effects, parent perspectives of these side effects or both.” — by Katherine Bortz
Disclosure: The researchers report no relevant financial disclosures.