The trend in drug treatment of children suffering from Attention Deficit Hyperactivity Disorder (ADHD) has reached a plateau in the UK. This level off in drug treatment for ADHD was followed by a steep rise that had been observed for over 20 years. This shift in treatment trends for ADHD has been reviewed by researchers across the UK, in comparison with other European countries and the US. The significant findings have also been published in the online British Medicine Journal (BMJ) Open.
ADHD is a common behavioral disorder in children. Children with ADHD are characterized by hyperactive behavior and inability to pay attention to instructions. They struggle to focus on details, can’t sit still in a place and experience a constant urge to move around. Since these behaviors manifest in different situations and may last for a long time, the performance of children with ADHD is compromised both academically and socially. On an average, about 10% of school-age children are affected by ADHD and boys are three times more likely to develop ADHD than girls.
The treatment modalities for treating ADHD in children include medications, behavioral therapies and parental training. Medications for treating ADHD are being used since the 1960s and the usage of these drugs is also acknowledged by World Health Organization (WHO). In this regard, the list of essential medicines for common psychiatric disorders of WHO includes the drugs for treating ADHD.
The researchers reached their findings by seeking help from Clinical Practice Research Datalink (CPRD) records. CPRD is considered to be one of the largest collections of long term anonymised primary care medical records and it covers around 8% of the populations of the UK. Taken from this broad representative of UK population, these records provided information about ADHD prescription to children till the age of 16 between 1992 and 2013. However, the researchers used the data from 1995-2013 for ADHD drug prescriptions for their analysis.
This analysis included 14,748 children under the age of 16, out of which 85% of children with ADHD were boys. These children were prescribed at least one drug for treating ADHD and in 94% cases, the prescribed drug was Methylphenidate, a central nervous system stimulating drug which affects nerve cells and neurotransmitters that are directly involved in impulse control and hyperactivity.
About 58% of these children received their first prescribed drug between the ages of 6 and 11. On the contrary, about 4% children were first prescribed a drug when they were 5 years of age.
The use of these drugs saw a rise as we entered the 21st century. The drug use was increased by a factor of 35 from year 1995 to year 2008. In 1995, the rate was 1.5 per 10,000 children, which experienced a sharp rise to 50.7 per 10,000 in 2008. From 2008 onwards, the use of drug leveled off at 51.1 per 10,000 children through 2013.
It was also found that the rate of new prescriptions increased by a significant eight-fold over the same timeframe. It reached 10.2 per 10,000 children in 2007 with a subsequent plunge to 9.1 per 10,000 by the year 2013.
The change in drug treatment trends over time is reflective of the National Institute for Health and Care Excellence guidelines of 2008. It is also assumed that this change in drug may have also been influenced by the concerns that associated long term use of these drugs with detrimental effects on heart.
It was also observed that prescription rate of ADHD drugs in the UK was lower than in many other countries. This prescription rate was 10 times lower than in US, five times lower than in Germany and about four times lower than in the Netherlands. On the contrary, this prescription rate in UK was twice as much as in France.
Although the drug prescription for ADHD was lower in UK as compared to other countries, those who were prescribed a drug for the disorder, tended to have an extended duration for the drug use. According to the study, more than three out of four children in UK (about 77%) were being prescribed the drug, even one year after ADHD diagnosis. About 60% of these children continued with the treatment, two years after the diagnosis.
It was found that stopping the use of these drugs within a span of six years was higher in children between the ages of 11-15 years in comparison with children between the age brackets of 6-10 years. This indicates that the treatment may be stopped quite early for some children.
The researchers who have conducted this observational study have commented on the scope of their analysis, suggesting that it has outlined the treatment patterns for ADHD in children but the underlying causes behind this prescription pattern could not be determined by this study. It is noteworthy that the analysis only presented data according to drug prescription but did not include the data explaining whether the drug was taken or not after being prescribed. The researchers said, “Although the prevalence and incidence of ADHD drug use in children have substantially increased during the past two decades, it seems that it may have reached a plateau recently. Our study indicates a turning point in the patterns of ADHD drug prescribing in children in the UK.”
With this emerging trend shift in drug prescription for ADHD across the UK, a new avenue of research has opened up which can help further investigate the causes behind this shift. With this, improved treatment modalities can enter clinical practices for children with ADHD.