Multimodal treatment for ADHD among youths in three medicaid subgroups: Disabled, foster care, and low income
ABSTRACT This study compared the use of treatments for attention-deficit hyperactivity disorder (ADHD) among three distinct subpopulations of Medicaid-insured youths who have very different mental health needs and patterns of service use: those with federally documented disability, those in foster care, and those in families with low income.
This one-year, cross-sectional study of community mental health services used administrative data. Individuals who were younger than 20 years, who were continuously enrolled in one Mid-Atlantic state Medicaid program, and who had two or more medical encounters associated with an ADHD diagnosis in 1998 were identified (N=1,296). Measures of the use of mental health services were the number of different classes of psychopharmacologic medications, the psychopharmacologic regimen, and the combined use of pharmacotherapy and psychotherapy treatments (multimodal treatment).
Use of multiple psychopharmacologic agents was greater in the disabled and foster care groups compared with the low-income group. Significantly fewer mental health provider visits, but greater use of stimulant treatment only, were observed in the low-income group compared with the other groups. Youths in the disabled group were significantly more likely than youths in the low-income group, but not more likely than youths in the foster care group, to receive multimodal treatments. Children in foster care were significantly more likely than those in the other groups to use a substance abuse service.
Among a cohort of Medicaid-enrolled youths with ADHD, co-existing psychiatric disorders and complex psychopharmacologic treatments were more common in the disabled and foster care groups than in the low-income group. Youths with disabilities were significantly more likely than youths in the low-income group to receive multimodal treatment.
SourceAvailable from: Francisco Xavier Castellanos[Show abstract] [Hide abstract]
ABSTRACT: The purpose of this study is to examine the use of prescribed psychoactive medications in a prospective cohort of children shortly after they entered foster homes; and to identify demographics, maltreatment history, psychiatric diagnoses including ADHD comorbidity, and level of aggression that contribute to prescribed use of stimulant and atypical antipsychotic medication over time. The sample included N = 252 children (nested in 95 sibling groups) followed for three years up to 4 yearly waves. Nearly all (89%) met criteria for at least one of eight psychiatric diagnoses and 31% (75/252) used one or more prescribed psychoactive medications. Over half (55%) were diagnosed with Attention Deficit Hyperactivity Disorder (ADHD); of these 38% used stimulants and 36% used atypical antipsychotics. Of the 75 medicated children, 19% received ≥3 different classes of drugs over the course of the study. Stimulants (69%) and atypical antipsychotics (65%) were the most frequently used drugs among medicated children. Adjusted odds ratios (AOR) showed that male gender (AOR = 3.2; 95% CI = 1.5-9.3), African American vs Latino ethnicity (AOR = 5.4; 95% CI = 2.1-14.2), ADHD regardless of Oppositional Defiant (ODD) or Conduct (CD) comorbidity (AOR = 6.0, 95% CI = 1.3-27.5), ODD or CD (AOR = 11.1, 95% CI = 2.1-58.6), and Separation Anxiety (AOR = 2.0, 95% CI = 1.0-4.0) psychiatric disorders were associated with the use of prescribed stimulants; while male gender (AOR = 3.8, 95% CI = 1.5-9.3), African American vs Latino (AOR = 5.1, 95% CI = 1.2-9.2) or Mixed/Other ethnicity (AOR = 3.3, 95% CI = 1.9-13.7), ADHD regardless of ODD or CD comorbidity (AOR = 5.8, 95% CI = 1.2-28.7), ODD or CD (AOR = 13.9, 95% CI = 3.3-58.5), Major Depression/Dysthymia (AOR = 2.8, 95% CI = 1.1-6.7) psychiatric disorders, and history of sexual abuse (AOR = 4.6, 95% CI = 1.3-18.4) were associated with the use of prescribed atypical antipsychotics. The aggressive use of atypical antipsychotics, which has unknown metabolic risks, suggests that the efficacy and safety of such treatment strategies for psychiatrically ill children in foster care should be monitored.PLoS ONE 01/2013; 8(1):e54152. DOI:10.1371/journal.pone.0054152 · 3.53 Impact Factor
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ABSTRACT: Working poor single mothers must often make difficult choices as they negotiate structural forces such as the employment and legal arenas and social service agencies and address domestic duties to sustain their families. The structure versus agency discourse is used here as a theoretical backdrop to chronicle the experiences of one such family. Results from a case study analysis of a White, working poor, single mother of three identify specific structural constraints and corresponding decisions as well as ways in which strategically positioned social services and community organizations may assist such families in experiencing upward mobility.Journal of Poverty 06/2008; 12(2):175-200. DOI:10.1080/10875540801973575
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ABSTRACT: In many of their cases, child and family social workers, particularly those involved with abuse and neglect, will find themselves also working with children who have been diagnosed with attention deficit hyperactivity disorder (ADHD). The paper reviews current understandings and debates about the nature and causes of ADHD. Although modern evidence suggests the neurobiological basis of the condition and the effectiveness of medication in treating the behaviour, it is also recognized that the quality of the child's caregiving and social environment plays a significant role in the aetiology, maintenance and treatment of ADHD. Recognizing the part that psychosocial elements play in understanding the condition, child and family social workers can be valued members of multidisciplinary teams treating ADHD in which they offer support to parents, helping them to understand and manage their ADHD-diagnosed child.Child & Family Social Work 02/2010; 15(3):265 - 275. DOI:10.1111/j.1365-2206.2009.00666.x · 0.93 Impact Factor