Where ADHD Patients Receive Talk Therapy in the US

Feb 10, 2015
Our research found that children using ADHD medications in some counties were six times more likely to be also receiving behavioral therapy than similar patients in other counties.
  • Attention Disorders
  • Children

When patients being prescribed stimulants for attention deficit hyperactivity disorder (ADHD) also receive complementary behavioral therapy, their health outcomes improve. However, only a quarter of U.S. children on ADHD medications are treated with this dual approach, according to a first-of-its-kind Express Scripts study recently published in the Journal of the American Medical Association Pediatrics (JAMA Pediatrics).  

A child’s geographic region influences available treatment options, and these variations are substantial. Express Scripts research found that children using ADHD medications in some U.S. counties were six times more likely to also be receiving behavioral therapy than similar patients in other parts of the country.

In some counties, the difference is likely attributed to access to such services. But for many areas, this was not the case. Nearly 50% of children on ADHD medications in Sacramento County, Calif., received therapy along with their prescription drug regimen. Meanwhile, in Miami-Dade County, Fla. – an area with the same number of licensed psychologists per capita – only 20% of these ADHD patients also received behavioral therapy.

In addition, the study found:

  • Less than a quarter of children on ADHD drugs received any behavioral therapy in the same year they received medication
  • 13% had at least four therapy visits and 7% had eight or more therapy visits
  • In 200 counties, fewer than 1 in 10 children getting ADHD medication received any talk therapy

The Implications for Failing to Provide Therapy to ADHD Patients

ADHD is one of the most common childhood disorders. Approximately 11% of boys and 6% of girls are being treated with stimulant medications.

In 2013, among traditional therapy classes, attention disorders ranked sixth in total U.S. drug spending. Costs associated with treating this condition continue to rise. Although children are still the primary users of ADHD medication, the number of adults using these medications increased 53.4% from 2008 to 2012, according to another Express Scripts report, Turning Attention to ADHD.

The lack of therapeutic services for children may be linked to increased prevalence of use of ADHD medications in young adults. As children age into young adulthood, supportive behavioral therapy can help them learn coping skills to manage their condition without medication and reduce the need for medication during their adult life.


  • Using a large commercial claims database, researchers studied records of more than 300,000 children ages 17 and younger who had received a prescription medication for ADHD
  • The study included statistically relevant samples from 1,516 counties across the U.S.
  • Researchers looked at how many children receive some amount of talk therapy along with medication
comments powered by Disqus