OBJECTIVES : ADHD affects about 11% of children aged 4-17 years in the US. The symptoms of ADHD impact not only on the child, but also on parents, families and society. Although pharmacotherapy is key to ADHD management, research has shown behavioral therapies can be helpful in relieving ADHD symptoms. The study aimed to investigate the prevalence and pattern of psychotherapy/mental Health counseling for children with ADHD in US. ambulatory care settings.

METHODS : A retrospective population-based study was conducted by analyzing a national database from the US. National Ambulatory Medical Care Survey. Patients 17 years of age or younger with a diagnosis of ADHD were included. A series of weighted descriptive analyses were used to estimate the prevalence of psychotherapy/mental Health counseling. A weighted logistic regression was performed to examine the counseling services across various patient and physician characteristics. All analyses utilized SAS PROC SURVEY applications and incorporated sample weights and standard errors to adjust for the complex sampling design.

RESULTS : Among 884.7 million outpatient visits that took place in 2014, 7.7 million visits were encountered from children with ADHD diagnosis. Male accounted for more than twice of ADHD visits than female (67.4% vs. 32.6%). 85.5% of the children received at least one medication for ADHD treatment including CNS and non-CNS stimulants. However, only 3.6% of the children got referral for a mental health counseling; and 7.8% of them received a psychotherapy. The results of the weighted logistic regression showed no significant factor associated with the counselling after controlling for race, region, payment type, and physician specialty.

CONCLUSIONS : This study found that children with ADHD were not commonly received any referral for psychotherapy and mental Health counseling from their ambulatory care providers. It is important to recognize potential benefits from alternative treatment options and bring coalitions together to improve ultimate patient-centered outcomes.