美国国家公共电台 NPR Most Kids On Medicaid Who Are Prescribed ADHD Drugs Don't Get Proper Follow-Up（在线收听）

RACHEL MARTIN, HOST:

The majority of children enrolled in the federal Medicaid program are not getting appropriate treatment for attention deficit hyperactivity disorder, or ADHD. That's the conclusion of a new report from a federal watchdog agency. NPR's Patti Neighmond has more.

PATTI NEIGHMOND, BYLINE: Elizabeth Cavey knows just how important it is to get a child with ADHD diagnosed and treated as soon as possible. For her daughter, the first year of school - kindergarten - was a disaster.

ELIZABETH CAVEY: She was constantly being reprimanded and forced to sit still. And she's a bright child, but she kept falling further and further behind in learning letters and language because she could not concentrate.

NEIGHMOND: The pressure and stress took its toll. Her 5-year-old daughter became anxious and depressed. It was a constant struggle, says Cavey. But on the last day of kindergarten, her daughter finally was diagnosed with ADHD. She was prescribed medication and qualified for special help at school.

CAVEY: She would have teachers that they could tell when she was just overwhelmed and when something was really hard. And they'd say, you know what? Let's go get a drink of water. And they'd walk down the hall, and they could get her back and focused.

NEIGHMOND: But that kind of success is not the case for the majority of children enrolled in Medicaid, according to Brian Whitley with the Office of Inspector General.

BRIAN WHITLEY: Nationwide, over 500,000 Medicaid-enrolled children newly prescribed an ADHD medication did not receive any timely follow-up care.

NEIGHMOND: They didn't see a health care provider for a month after being prescribed medication. And 1 in 5 of those children didn't see a health care provider for nearly a year.

WHITLEY: That's a long time to be on powerful medications without a practitioner checking for side effects or even how well the medication is working.

NEIGHMOND: Pediatrician Tanya Froehlich with Cincinnati Children's Hospital Medical Center says it can take months to determine the exact right dose of medication.

TANYA FROEHLICH: We start at the lowest possible dose. In many cases, that low dose isn't effective, and we have to titrate upward for them to get benefit.

NEIGHMOND: And if children aren't followed up soon after diagnosis, those medication adjustments just don't happen.

FROEHLICH: And so we're not giving them the most effective treatment possible.

NEIGHMOND: And side effects of the medication may go unnoticed.

FROEHLICH: Effects on the appetite as well as effects on sleep, headaches, stomachaches, changes in mood, irritability, anxiety.

NEIGHMOND: Ideally, Froehlich says, children should be seen soon after being prescribed medication and then another two times throughout the year. The OIG report didn't explore why children don't receive timely care. It could be parents or doctors not following through.

The OIG report also finds nearly half the children prescribed ADHD medication did not receive behavioral therapy, which is a shame, says Froehlich, because when kids are treated with both medication and therapy, they have the very best outcomes.

FROEHLICH: And we see things like decreased parent-child conflict, decreased oppositional behaviors and aggression, fewer academic difficulties and improved social skills when kids are getting that combination of medication plus behavioral therapy.

NEIGHMOND: For younger kids, behavior therapy focuses on the family, helping set structured routines - consistent wakeup times, mealtimes and bedtimes. It teaches how to reward children for successes, like getting homework done on time.

FROEHLICH: Maybe they have 15 minutes of special time with their parents as a reward. Or maybe they get to be the one who chooses the TV show that they watch together.

NEIGHMOND: When kids get older, therapy focuses on them - teaching organizational skills, like using a planner and timer to get homework done. In a written statement, Medicaid officials say they agree with the recommendations to develop strategies for more effective treatment for children with ADHD, as well as helping states provide better, more timely follow-up care.

Patti Neighmond, NPR News.