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

 

RACHEL MARTIN, HOST:

The majority of children enrolled¹ in the federal Medicaid program are not getting appropriate treatment for attention deficit² hyperactivity disorder³, or ADHD. That's the conclusion of a new report from a federal watchdog agency. NPR's Patti Neighmond has more.

PATTI NEIGHMOND, BYLINE⁴: 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 toll⁵. Her 5-year-old daughter became anxious and depressed⁶. 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 qualified⁷ 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 Inspector⁸ 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 practitioner⁹ 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 diagnosis¹⁰, 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, irritability¹¹, 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 oppositional¹² behaviors and aggression¹³, 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, helping¹⁴ 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.

1 enrolled   

adj.入学登记了的v.[亦作enrol]( enroll的过去式和过去分词 )；登记，招收，使入伍（或入会、入学等），参加，成为成员；记入名册；卷起，包起

参考例句：

• They have been studying hard from the moment they enrolled. 从入学时起，他们就一直努力学习。 来自《简明英汉词典》
• He enrolled with an employment agency for a teaching position. 他在职业介绍所登了记以谋求一个教师的职位。 来自《简明英汉词典》

2 deficit   

n.亏空，亏损；赤字，逆差

参考例句：

• The directors have reported a deficit of 2.5 million dollars.董事们报告赤字为250万美元。
• We have a great deficit this year.我们今年有很大亏损。

3 disorder   

n.紊乱，混乱；骚动，骚乱；疾病，失调

参考例句：

• When returning back,he discovered the room to be in disorder.回家后，他发现屋子里乱七八糟。
• It contained a vast number of letters in great disorder.里面七零八落地装着许多信件。

4 byline   

n.署名；v.署名

参考例句：

• His byline was absent as well.他的署名也不见了。
• We wish to thank the author of this article which carries no byline.我们要感谢这篇文章的那位没有署名的作者。

5 toll   

n.过路(桥)费；损失，伤亡人数；v.敲(钟)

参考例句：

• The hailstone took a heavy toll of the crops in our village last night.昨晚那场冰雹损坏了我们村的庄稼。
• The war took a heavy toll of human life.这次战争夺去了许多人的生命。

6 depressed   

adj.沮丧的，抑郁的，不景气的，萧条的

参考例句：

• When he was depressed,he felt utterly divorced from reality.他心情沮丧时就感到完全脱离了现实。
• His mother was depressed by the sad news.这个坏消息使他的母亲意志消沉。

7 qualified   

adj.合格的，有资格的，胜任的，有限制的

参考例句：

• He is qualified as a complete man of letters.他有资格当真正的文学家。
• We must note that we still lack qualified specialists.我们必须看到我们还缺乏有资质的专家。

8 inspector   

n.检查员，监察员，视察员

参考例句：

• The inspector was interested in everything pertaining to the school.视察员对有关学校的一切都感兴趣。
• The inspector was shining a flashlight onto the tickets.查票员打着手电筒查看车票。

9 practitioner   

n.实践者，从事者；(医生或律师等)开业者

参考例句：

• He is an unqualified practitioner of law.他是个无资格的律师。
• She was a medical practitioner before she entered politics.从政前她是个开业医生。

10 diagnosis   

n.诊断，诊断结果，调查分析，判断

参考例句：

• His symptoms gave no obvious pointer to a possible diagnosis.他的症状无法作出明确的诊断。
• The engineer made a complete diagnosis of the bridge's collapse.工程师对桥的倒塌做一次彻底的调查分析。

11 irritability   

n.易怒

参考例句：

• It was the almost furtive restlessness and irritability that had possessed him. 那是一种一直纠缠着他的隐秘的不安和烦恼。
• All organisms have irritability while alive. 所有生物体活着时都有应激性。

12 oppositional   

反对的，对抗的

参考例句：

• I wish to forcefully grasp fragile and entirely oppositional poles, allowing them to coexist. 我想要强押起脆弱的、完全相斥的两端，让他们共存。
• Robot Soccer game is an international and high-tech oppositional activity that develops rapidly in recent years. 机器人足球比赛是近年来在国际上迅速开展起来的高技术对抗活动。

13 aggression   

n.进攻，侵略，侵犯，侵害

参考例句：

• So long as we are firmly united, we need fear no aggression.只要我们紧密地团结，就不必惧怕外来侵略。
• Her view is that aggression is part of human nature.她认为攻击性是人类本性的一部份。

14 helping   

n.食物的一份&adj.帮助人的，辅助的

参考例句：

• The poor children regularly pony up for a second helping of my hamburger. 那些可怜的孩子们总是要求我把我的汉堡包再给他们一份。
• By doing this, they may at times be helping to restore competition. 这样一来, 他在某些时候,有助于竞争的加强。