New research finds that drug treatment of attention-deficit hyperactivity disorder (ADHD) in kids may have leveled off in UK.
Experts report, however, that use of pharmacological agents lasts much longer in the U.K. than it does in rest of Europe or US.
Investigators discovered use of the medications may have reached a plateau in the UK, following a steep rise in the number of prescriptions for these medicines over the past 20 years.
Study findings appear online in the journal BMJ Open.
Drugs are one of several treatment options for ADHD, which includes parental training and behavioral therapies.
ADHD drugs have been in use since the 1960s and are on the World Health Organization’s list of essential medicines for common psychiatric disorders. The researchers base their findings on an analysis of Clinical Practice Research Datalink (CPRD) records, relating to children up to the age of 16 who had been prescribed at least one drug to treat ADHD between 1992 and 2013.
The CPRD is one of the world’s largest collections of long term anonymized primary care medical records. It is broadly representative of the UK population, covering around eight percent of the total.
The researchers analyzed the data to estimate trends in ADHD prescribing patterns among children between 1995 and 2013, and the length of treatment for those diagnosed with the condition.
During this period, 14,748 children under the age of 16 (85 percent of them boys) were given at least one prescription for an ADHD drug, with methylphenidate accounting for 94 percent of all prescriptions.
Over half (58 percent) of the children received their first prescription between the ages of six and 11; around four percent were five years old when they were first prescribed an ADHD drug. The use of these drugs in this age group soared by a factor of 35, from 1.5 per 10,000 children in 1995 to 50.7/10,000 in 2008, after which it seemed to level off at 51.1/10,000 children by 2013.
The rate of new prescriptions rose eight fold over the same timeframe, reaching 10.2 per 10,000 children in 2007, but subsequently falling to 9.1/10,000 in 2013. These patterns may reflect the impact of National Institute for Health and Care Excellence guidelines issued in 2008, and/or concerns about the potential impact on the heart of long term use, suggest the researchers.
UK prescribing rates for ADHD drugs are considerably lower than they are in many other countries, the researchers point out. They are 10 times lower than in the US, up to five times lower than in Germany, and four times lower than in the Netherlands, although UK rates are twice as high as in France.
Nevertheless, the course of treatment tends to be longer than in these countries, the published evidence indicates. More than three out of four UK children (around 77 percent) were still being prescribed ADHD drugs one year after diagnosis and 60 percent were still on treatment two years later.
The probability of stopping ADHD drugs within six years seemed to be higher in 11-15 year olds than it was in six to 10 year olds, the data showed, which may indicate that treatment is being stopped too early among young adults, say the researchers.
Investigators note that the study was observational in nature, therfore their analysis cannot determine the causes behind the prescribing patterns they found.
Furthermore, the data relate only to the issuing of prescriptions, and not to their being dispensed or drugs actually taken.
Nevertheless, they conclude: “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.”
Source: British Medical Journal