A National Profile of Attention-Deficit Hyperactivity Disorder Diagnosis and Treatment Among US Children Aged 2 to 5 Years.

The NSCH and NS-CSHCN asked different populations: the NSCH covered all noninstitutionalized US children, while the NS-CSHCN covered only children who met special health care need criteria, so treatment patterns in the CSHCN group may not represent all young children with ADHD. The surveys were conducted in different years, and the 2007 to 2008 NSCH did not include a cell phone sample, which limits comparison over time. Response rates were low, 46.7% for the 2007 to 2008 NSCH, 23.0% for the 2011 to 2012 NSCH, and 25.5% for the 2009 to 2010 NS-CSHCN, so nonresponse bias is possible. ADHD diagnosis, severity, co-occurring conditions, and medication use were parent reported and were not validated against medical records or clinical evaluation. Some medications reported for ADHD may have been prescribed for a co-occurring condition rather than ADHD. Behavioral treatment was defined broadly, parent training was not explicitly listed and may have been underreported, and only treatment in the past year was counted. Many subgroup estimates were unstable because the sample of young children with ADHD was small, so demographic findings may not be reliable. The analysis did not adjust for multiple comparisons because it was exploratory, so some significant subgroup differences may be false positives. The study cannot tell whether non-stimulant use followed failed stimulant treatment or was used for a co-occurring condition.

The surveys were conducted by the Centers for Disease Control and Prevention's National Center for Health Statistics, with direction and funding from the Health Resources and Services Administration. The authors declare no conflict of interest.

Do not read this as evidence that medication or behavioral treatment improves young children's outcomes. The paper reports parent-reported diagnosis and treatment patterns from surveys, not randomized treatment results.