CEPAC meeting focuses on ADHD treatments

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The spring CEPAC meeting last Friday at the University of New Hampshire was a deep dive into research comparing treatments for Attention Deficit Hyperactivity Disorder (ADHD). CEPAC is a New England regional public advisory group convened to consider the clinical and cost effectiveness of competing treatments. CEPAC includes clinicians, academics, patient advocates and (nonvoting) payer representatives. Diagnoses of ADHD have risen significantly in recent years affecting at least 5 million US children between the ages of 4 and 17. Boys are more likely to be diagnosed and children from lower income families are nearly twice as likely to be diagnosed. The condition has been linked to worse outcomes in social functioning, academic performance, adolescent substance abuse, and delinquent behavior. It is estimated that ADHD costs the US economy over $30 billion/year. Treatments include stimulant and non-stimulant medications, and behavioral training including parent behavior training, school-based interventions, and other forms of therapy. There are not enough rigorous clinical trials comparing each intervention to placebo, partly for ethical reasons that few are willing to relegate some families to no intervention at all. Given that, by the end of the there was a consensus among CEPAC members that Parent Behavior Training (PBT) is the preferred approach for preschoolers, resorting to medications only if PBT is not available or doesn’t work, in concordance with the professional societies. There was some question about adequate access to PBT in some areas of New England. For school-age children, there was consensus that medications work. I was surprised that side effects and long term impacts are not as common as generally thought, but still significant and many children discontinue drugs because of them. The next meeting will be in December and may be in CT.