Factors associated with treatment mode and termination among preschoolers with ADHD in Taiwan
Yi-Ting Lien1, Hsueh-Han Yeh, Wei-Tsuen Soong
1Ms. Lien and Dr. Chen are with the Center for Neuropsychiatric Research, National Health Research Institutes (NHRI), Miaoli, Taiwan. They are also with the Institute of Public Health, National Yang Ming University, Taipei, Taiwan. Ms. Yeh is with Michigan State University, East Lansing. Dr. Soong is with St. Joseph's Hospital, Yunlin County, Taiwan. Dr. Jeng is with the School and Graduate Institute of Physical Therapy, National Taiwan University, Taipei. Dr. Huang is with the Institute of Hospital and Health Care Administration, Taipei. Send correspondence to Dr. Chen (e-mail: chuanychen@ym.edu.tw ).
Insights
Treatment initiation for preschool ADHD is high, but one-year retention is low. Factors like poverty and rural origin, and initial treatment by a psychiatrist, predict early termination, highlighting access barriers.
Area of Science:
- Pediatric Psychiatry
- Child Psychology
- Health Services Research
Background:
- Attention-Deficit/Hyperactivity Disorder (ADHD) is a common neurodevelopmental disorder in preschool children.
- Early diagnosis and treatment are crucial for managing ADHD symptoms and improving long-term outcomes.
- Understanding factors influencing treatment continuity is essential for effective care delivery.
Purpose of the Study:
- To investigate how family and healthcare provider characteristics influence treatment initiation, mode, and termination in preschoolers with newly diagnosed ADHD.
- To identify predictors of treatment discontinuation within the first year of diagnosis.
Main Methods:
- A cohort of 3,583 preschoolers diagnosed with ADHD was identified from Taiwan's National Health Insurance Research Database.
- Logistic regression and time-dependent survival analyses were employed to assess associations.
- Data included individual characteristics and healthcare records on medication and non-medication treatments.
Main Results:
- Over 80% of children initiated treatment within a month; 41% started with combined therapy.
- Only 25% of children remained in treatment after 12 months.
- Rehabilitation treatment alone showed the lowest termination rate (p<.001). Poverty, rural origin, and initial psychiatric treatment predicted higher termination rates.
Conclusions:
- Family and provider factors significantly impact ADHD treatment initiation, modality, and one-year retention in Taiwan's universal healthcare system.
- High treatment termination rates underscore the need to address access barriers for young children with ADHD.
- Future interventions should focus on ensuring comprehensive and continuous care for preschoolers with mental and developmental disorders.
Objectives:
This study examined the extent to which characteristics of family and health care providers predict treatment initiation, treatment mode, and treatment termination among preschool children with newly diagnosed ADHD.
Methods:
A cohort of 3,583 preschoolers with ADHD was identified from the National Health Insurance Research Database of Taiwan. Individual characteristics and health care records, including medication and nonmedication treatment, were documented. Logistic regression and time-dependent survival analyses were used to evaluate association estimates.
Results:
Over 80% of the children with newly diagnosed ADHD received initial treatment within a month of diagnosis, with 41% starting with combined treatment. Only one-quarter remained in treatment by the end of 12 months. In the first year, the termination rate was lowest for those who received rehabilitation treatment only (log-rank test, p<.001). Predictors of termination varied by treatment mode. For combined treatment, factors that marginally increased the likelihood of treatment termination were coming from a family in poverty (adjusted hazard ratio [AHR]=1.72) or from a rural region (AHR=1.40). Receiving initial treatment from a psychiatrist was associated with an increased likelihood of treatment termination for children receiving psychosocial treatment (AHR=1.80, 95% confidence interval [CI]=1.46-2.22) and combined treatment (AHR=1.38, CI=1.20-1.60).
Conclusions:
Family and service provider characteristics appeared to have differential effects on initial receipt and mode of treatment and on one-year treatment termination among preschoolers with ADHD in Taiwan's universal health insurance program. Future efforts should aim at reducing access barriers to comprehensive and continuous health care for very young children with mental or developmental disorders.
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