Children in foster care three times more likely to have ADHD diagnosis

Researchers already knew that attention-deficit/hyperactivity disorder (ADHD) was the most common behavioral health diagnosis among children enrolled in Medicaid. A new study to be presented at the American Academy of Pediatrics 2015 National Conference & Exhibition in Washington, DC, found that children in foster care were three times more likely than others to have an ADHD diagnosis.

Researchers at the Centers for Disease Control and Prevention (CDC) examined 2011 Medicaid outpatient and prescription drug claims from multiple states across the United States. Among their key findings:

• More than 1 in 4 children between the ages of 2 and 17 who were in foster care had received an ADHD diagnosis, compared to about 1 in 14 of all other children in Medicaid.
• Children with ADHD who were in foster care were also more likely to have another disorder, with roughly half also diagnosed with conditions such as oppositional defiant disorder, depression, or anxiety. This is compared to about 1 in 3 children with ADHD in Medicaid who were not in foster care.
• Among children with an ADHD diagnosis, those in foster care were as likely as others to be treated with ADHD medication but were more likely to have received psychological services; About 3 out of 4 of the children with ADHD in foster care received some psychological care in 2011.

Lead author Melissa Danielson, MSPH, a statistician with the CDC's National Center on Birth Defects and Developmental Disabilities, said findings that children in foster care experience high rates of ADHD along with other, simultaneous behavioral disorders as compared to their peers in Medicaid shows a substantial need for medical and behavioral services within this group. The high proportion of children with ADHD in foster care who receive psychological services was promising, she said, especially since behavior therapy is recommended as the first-line treatment for preschoolers with ADHD and is preferred in conjunction with medication as treatment for school-aged children with ADHD.

"As we work to improve the quality of care for children with ADHD, it will be important to consider the needs of special populations, including those in foster care," Ms. Danielson said. "Working together, primary care and specialty clinicians can best support the health and long-term well-being of children with ADHD."