Latest trends in ADHD drug prescribing patterns in children in the UK: prevalence, incidence and persistence

Raphaelle Beau-Lejdstrom, Ian Douglas, Stephen J W Evans, Liam Smeeth, Raphaelle Beau-Lejdstrom, Ian Douglas, Stephen J W Evans, Liam Smeeth

Abstract

Objectives: To investigate attention deficit and hyperactivity disorder (ADHD) drug prescribing in children under 16 years old in the UK between 1992 and 2013.

Methods: All patients under 16 registered in the Clinical Practice Research Datalink (CPRD) with a minimum of 1 year of observation time and who received at least one prescription of any ADHD drug between 1 January 1992 and 31 December 2013.Trends in prevalence and incidence of use of ADHD drugs in children were calculated between 1995 and 2013 and persistence in new users was estimated.

Results: The prevalence of ADHD drug use in children under 16 increased 34-fold overall, rising from 1.5 95% CI (1.1 to 2.0) per 10 000 children in 1995 to 50.7 95% CI (49.2 to 52.1) per 10 000 children in 2008 then stabilising to 51.1 95% CI (49.7 to 52.6) per 10 000 children in 2013. The rate of new users increased eightfold reaching 10.2 95% CI (9.5 to 10.9) per 10 000 children in 2007 then decreasing to 9.1 95% CI (8.5 to 9.7) per 10 000 children in 2013. Although prevalence and incidence increased rather steeply after 1995, this trend seems to halt from 2008 onwards. We identified that 77%, 95% CI (76% to 78%) of children were still under treatment after 1 year and 60% 95% CI (59% to 61%) after 2 years.

Conclusions: There was a marked increase in ADHD drug use among children in the UK from 1992 until around 2008, with stable levels of use since then. UK children show relatively long persistence of treatment with ADHD medications compared to other countries.

Keywords: Medication trends; Medication use; attention deficit and hyperactivity disorder; attention deficit and hyperactivity disorder drugs; paediatric mental health.

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Figures

Figure 1
Figure 1
Annual prevalence rates of ADHD drugs per 10 000 children under sixteen between 1995 and 2013 in the CPRD database, N=14, 748. Denominators are mid-year counts of children under sixteen in the CPRD. ADHD, attention deficit and hyperactivity disorder; CPRD, Clinical Practice Research Datalink.
Figure 2
Figure 2
Incidence of ADHD drug initiation per 10 000 children under sixteen between 1995 and 2013 (N=10, 561) Met IR= immediate release; Met XL=extended release. ADHD, attention deficit and hyperactivity disorder.
Figure 3
Figure 3
Gender specific incidence of methylphenidate treatment initiation in children under sixteen per 10, 000 children between 1995 and 2013, N=10, 561.
Figure 4
Figure 4
Time-to-discontinuation (90 days interruption) of all ADHD treatments in children, N=9,451. ADHD, attention deficit and hyperactivity disorder.
Figure 5
Figure 5
Time-to-discontinuation (90 days interruption) of all ADHD treatments in all children, according to the age of start of treatment, N=9,451. ADHD, attention deficit and hyperactivity disorder.

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