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ADHD: Insurance and Mental Health Service Use
Patricia N Pastor1, Alan E Simon1, Cynthia A Reuben1
11 National Center for Health Statistics, Centers for Disease Control and Prevention, Hyattsville, MD, USA.
Insights
Children with ADHD often use medication and mental health services, but insurance status significantly impacts access. Uninsured children with ADHD are less likely to receive needed services for emotional and behavioral difficulties.
Area of Science:
- Pediatric Health Services Research
- Child and Adolescent Psychiatry
- Health Insurance and Access to Care
Background:
- Attention-deficit/hyperactivity disorder (ADHD) is a prevalent neurodevelopmental disorder in children.
- Emotional and behavioral difficulties (EBD) associated with ADHD require timely and appropriate interventions.
- Insurance status is a critical determinant of healthcare access and utilization for pediatric conditions.
Purpose of the Study:
- To examine mental health service utilization for emotional and behavioral difficulties (EBD) among children diagnosed with ADHD.
- To investigate disparities in service use based on insurance coverage (private, public, or uninsured).
- To compare the receipt of medication, non-medication services, and no services across different insurance groups.
Main Methods:
- Analysis of parent-reported data from the 2010-2013 National Health Interview Survey.
- Inclusion of children aged 4-17 with a diagnosed case of ADHD.
- Categorization of service use into medication, other non-medication services, and no services for EBD.
Main Results:
- Among children with ADHD, 56.0% used medication, 39.8% contacted a mental health professional, and 20.4% received special education services for EBD.
- Medication use was significantly higher for privately or publicly insured children compared to uninsured children (P < .001).
- Uninsured children were more likely to receive no services (48.8%) compared to all children (28.9%) (P < .001), while publicly insured children received more non-medication services than privately insured children (P < .001).
Conclusions:
- Insurance coverage is strongly associated with mental health service utilization for children with ADHD and associated EBD.
- Uninsured children face significant barriers to accessing necessary mental health care, including medication and non-medication interventions.
- Targeted interventions and policy considerations are needed to reduce service disparities and improve care access for all children with ADHD, irrespective of insurance status.
Abstract:
We describe mental health service use by insurance among children aged 4 to 17 with diagnosed attention-deficit/ hyperactivity disorder (ADHD). Using parent reports from 2010-2013 National Health Interview Survey, we estimate the percentage that received services for emotional and behavioral difficulties (EBD): medication, other nonmedication services, and none (neither medication nor other nonmedication services). Among children with diagnosed ADHD, 56.0% had used medication for EBD, 39.8% had contact with a mental health professional, 32.2% had contact with a general doctor about the child's EBD, and 20.4% received special education services for EBD. Medication use was more often reported for privately or publicly insured children than uninsured children ( P < .001), and uninsured children more often received no services ( P < .001). Publicly insured children were more likely than privately insured children to receive other nonmedication services ( P < .001). Less than a third (28.9%) of all children received no services as compared to almost half (48.8%) of uninsured children.
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