Prevalence and Predictors of Multimodal Treatment Among US Adults Newly Diagnosed With ADHD

Introduction: Although a combined treatment of prescription medication and psychotherapy provides long -term bene fi ts for adults with attention de fi cit/hyperactivity disorder (ADHD), little is known about the prevalence of receiving such multimodal treatment. This study investigated trends in the prevalence and correlates of multimodal treatment among U.S.-insured adults newly diagnosed with ADHD. Methods: 495,180 U.S. adults from the Komodo Healthcare Map with newly diagnosed ADHD in 2017 - 2021 were included. Descriptive statistics were used to estimate trends in the prevalence of treatment (no treatment, prescription-only, psychotherapy-only, or both) within 3 months from the index ADHD diagnosis. Multinomial logistic regression was used to examine patient and provider characteristics associated with ADHD treatment. Analysis was conducted in May 2023. Results: From 2017 to 2021, the prevalence of newly diagnosed ADHD adults receiving multimodal, prescription-only, and psychotherapy-only treatment within 3 months following their fi rst diagnosis increased from 12.9% to 21.4%, 30.2% to 33.3%, and 18.4% to 20.4%, respectively. Over the same period, the prevalence of newly diagnosed ADHD adults receiving no treatment declined from 38.5% to 25%. Relative to their counterparts, the odds of receiving multimodal ADHD treatment were signi fi cantly lower ( p < 0.05) for men, older adults, adults with multiple co-existing conditions, Medicaid and Medicare bene fi ciaries, and those living in socially disadvantaged areas. Furthermore, the odds of receiving multimodal treatment were higher ( p < 0.05) for adults who saw a nurse practitioner, physician assistant, or behavioral care (non-physician) provider on their fi rst visit with an ADHD diagnosis, compared to those who saw a physician. Conclusions: 25% of newly diagnosed ADHD adults received no treatment in 2021 and 53.7% only received a single-modality treatment - raising concerns about the potential implications of untreated ADHD or insuf fi cient treatment on the persistence of ADHD-related impairments, morbidity, productivity, and downstream healthcare cost. The study also highlighted potential sociodemographic, clinical, and provider disparities in ADHD treatment. Am J Prev Med 2024;66(4):707 - 716. (c) 2023 American Journal of Preventive Medicine. Published by Elsevier Inc. All rights reserved.