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Research Letter
November 2014

Geographic Variation in Receipt of Psychotherapy in Children Receiving Attention-Deficit/Hyperactivity Disorder Medications

Author Affiliations
  • 1Center for Health Equity Research and Promotion, VA Pittsburgh Healthcare System, Pittsburgh, Pennsylvania
  • 2RAND Corporation, Pittsburgh, Pennsylvania
  • 3Division of General Medicine and Center for Pharmaceutical Policy and Prescribing, University of Pittsburgh, Pittsburgh, Pennsylvania
  • 4Department of Psychiatry, University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania
  • 5Express Scripts, St Louis, Missouri
  • 6Harvard Medical School, Department of Health Care Policy, Boston, Massachusetts
  • 7Department of Health Policy and Management, University of Pittsburgh Graduate School of Public Health, Pittsburgh, Pennsylvania
JAMA Pediatr. 2014;168(11):1074-1076. doi:10.1001/jamapediatrics.2014.1647

Attention-deficit/hyperactivity disorder (ADHD) is one of the most common childhood disorders, affecting an estimated 11% of boys and 4% of girls in the United States.1 Stimulant medications manage ADHD symptoms in most children.2,3 However, many parents prefer that treatment include some nonpharmacologic therapy,4,5 and combination behavioral therapy and pharmacotherapy may improve outcomes over either modality alone for many youth.3,6

Little is known about what proportion of children treated with ADHD medication also receive nonpharmacologic therapy (hereafter referred to as therapy) and how rates of combination therapy vary geographically. We used a large commercial claims database (MarketScan) linked to county-level information on the supply of psychologists to examine variation in receipt of therapy in children receiving ADHD medication.