Attention, Please

The enactment of the Patient Protection and Affordable Care Act of 2010 expands Medicaid benefits to scores of previously uninsured children, but the quality of that care may be lacking.

A recent study uncovered the clinical severity of children with ADHD in primary care and community mental-health clinics is similar, but treatment quality varies widely for the disorder, according to a new report from Dr. Bonnie Zima and colleagues appearing in the December issue of the Journal of the American Academy of Child and Adolescent Psychiatry.

"Findings from this study identify several areas for quality improvement for ADHD (attention deficit hyperactivity disorder) care within the managed care Medicaid program studied," the study authors report.

These areas include: alignment of the child's clinical severity with provider type, frequency of follow-up visits, stimulant medication use in specialty mental health, agency data infrastructure to document delivery of evidence-based psychosocial treatments, and stimulant medication refill prescription persistence.

"The enduring symptoms, impairment, and poor academic achievement of the children who remain in care and those untreated underscores the public health significance of improving the quality of care for publicly insured children with ADHD," said the authors.

The report sends a message of urgency for Medicaid-financed community care reform for children with the disorder as well as closer clinical monitoring and improvements in medication management.

ADHD, often genetic, is one of the most commonly diagnosed behavioral disorders in children and is often accompanied by other behavioral and/or developmental problems. Children should have at least six attention symptoms or six activity and impulsivity symptoms to be diagnosed with ADHD.