Underuse of behaviour therapy for young children with ADHD highlights gap between guidance and practice

Despite clinical guidelines recommending behaviour therapy as the initial treatment for children under six, US data reveal significant underutilisation, raising concerns over access and adherence to best practices.

New federal data suggest that behaviour therapy remains underused for children with attention deficit hyperactivity disorder, even though the Centres for Disease Control and Prevention says it should be the first treatment for children under 6. The agency says parent training in behaviour management is the preferred starting point for that age group because it helps families build routines, expectations and reinforcement strategies before medication is considered.

That advice matters because young children are more likely to experience side effects from ADHD medicines and the long-term effects of those drugs in very young patients are not as well studied. The CDC says behaviour therapy can be as effective as medication in easing symptoms and may produce benefits that last for years after treatment ends. HealthyChildren.org, which is run by the American Academy of Pediatrics, describes the approach as one that changes the environments around a child, rather than focusing only on the child’s emotions.

Even so, the CDC’s data show a wide gap between guidance and practice. Nearly 2 million U.S. children with ADHD did not receive ADHD-specific treatment in 2022, according to the agency. A national parent survey found about 30% of children with ADHD received neither medication nor behaviour therapy, up from 23% in 2016. Roughly 32% received both types of treatment, and the number receiving behaviour therapy rose from 2.5 million to 2.8 million over the same period.

Experts say the treatment choice should depend partly on age. For children under 6, the CDC and the American Academy of Pediatrics recommend parent training in behaviour management first. For children 6 and older, the CDC says a combination of medication and behaviour therapy is usually advised. The agency also notes that ADHD diagnosis and treatment vary sharply by state, with behaviour treatment rates ranging from 39% to 62%, a sign that access and local practice still shape care as much as medical guidance does.