Primary care doctors recommend medication more often than behavior management training (PTBM) to parents of children with attention deficit/hyperactivity disorder (ADHD) within the Packard Children’s Health Alliance, a community based pediatric health care network in the San Francisco, California. PTBM is a first-line treatment for children aged 4-5 with ADHD. A research letter published in JAMA Pediatrics emphasizes the need for early access to behavioral treatment for preschoolers with ADHD.

The doctors who authored the letter analyzed primary care professionals (PCP) documentation from electronic health records (EHRs) to find out the rate of PTBM recommendation for patients aged 4 to 5 years old with an ADHD diagnosis, ADHD symptoms, or who were prescribed ADHD medication.

Out of 22,714 total children, 192 had an ADHD diagnosis or ADHD symptoms. Of these 32 (17%) were prescribed ADHD medication.

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The most common treatment recommendations (41%) involved habit modifications: dietary modifications such as reduced sugar intake, fatty acid supplements, improved sleep hygiene and limited screen time. A total of 21 (11%) of patients received a PTBM referral and 29% received mention of PTBM; for example, receiving a brochure. Of the 32 patients prescribed medication, 9 (28%) also received a PTBM recommendation.

Patients with public insurance were less likely to receive a PTBM referral compared with those with private insurance. This underscores “the need to identify barriers that drive disparities in recommended treatments,” the authors state.

The data query had its limitations. Using an ADHD diagnosis and symptom codes during the search may have limited results, as did relying on PCP documentation and limiting the search to within the Packard Children’s Health Alliance network.

“These study findings offer an opportunity for quality improvement initiatives to increase PCP adherence to clinical practice guidelines — thus establishing early access to behavioral treatment for patients with an ADHD diagnosis or ADHD symptoms — with the goal of mitigating long term morbidity.”


Bannett Y, Gardner RM, Posada J, Huffman LC, Feldman HM. Rate of Pediatrician Recommendations for Behavioral Treatment for Preschoolers With Attention-Deficit/Hyperactivity Disorder Diagnosis or Related Symptoms. JAMA Pediatr. Published online October 18, 2021. doi:10.1001/jamapediatrics.2021.4093

This article originally appeared on Psychiatry Advisor