Five-Fold Increase in National Prevalence Rates of Attention-Deficit/Hyperactivity Disorder Medications for Children and Adolescents with Autism Spectrum Disorder, Attention-Deficit/Hyperactivity Disorder, and other Psychiatric Disorders: A Danish Register-Based Study

Abstract

Objective: The purpose of this study was to estimate the prevalence and time trends in prescriptions of methylphenidate, dexamphetamine, and atomoxetine in children and adolescents, within three diagnostic groups: 1) autism spectrum disorder (ASD), 2) attention-deficit/hyperactivity disorder (ADHD), and 3) other psychiatric disorders. Methods: Data from six different national registers were used and merged to identify a cohort of all children and adolescents born in Denmark between 1990 and 2001 (n = 852,711). Sociodemographic covariates on cohort members and their parents and lifetime prescriptions of methylphenidate, dexamphetamine, and atomoxetine were extracted from the registers. Prescriptions were also stratified by duration ( < 6 months. vs. ‡ 6 months). Results: Sixteen percent of 9698 children and adolescents with ASD (n = 1577), 61% of 11,553 children and adolescents with ADHD (n = 7021) and 3% of 48,468 children and adolescents with other psychiatric disorders (n = 1537) were treated with one or more ADHD medications. There was a significant increase in prescription rates of these medications for all three groups. From 2003 to 2010, youth 6-13 years of age with ASD, ADHD, and other psychiatric disorders had 4.7-fold (4.4-4.9), 6.3-fold (6.0-6.4), and 5.5-fold (5.0-5.9) increases, respectively, in prescription rates of ADHD medications. Conclusion: This is the largest study to date assessing stimulant treatment in children and adolescents with ASD, and is the first prospective study quantifying the change over time in the prevalence of treatment with ADHD medications in a population-based national cohort of children and adolescents with ASD. The prevalence of stimulant treatment in youth with ASD of 16% is consistent with earlier studies. The past decade has witnessed a clear and progressive increase in the prescription rates of medications typically used to treat ADHD in children and adolescents in Denmark. This increase is not limited to only those with ADHD, but includes others with neuropsychiatric disorders, including ASD. The risks and benefits of this practice await further study.

Pediatric Psychopharmacological Research in the Post EU Regulation 1901/2006 Era

“…Research clearly shows that the rate of pediatric psychotropic prescribing is on the rise (Dalsgaard, Nielsen, & Simonsen, 2013;Wong, Murray, Camilleri-Novak, & Stephens, 2004;, a fact that highlights the need for an increase in the number of registration trials. In addition, to address the needs and questions of clinicians from routine clinical settings, registration studies should be followed up and complemented by naturalistic, observational trials ("Anwendungsbeobachtungen"), which allow assessment of the use of the respective medication for a given indication and/or population in that environment.…”

Parental Discussions Online through the Medical Discourse-lens

“…Prescriptions of stimulants in the UK for example rose from about 6000 a year in 1994 to over 1 million by 2013 [55]. The number of children on drug treatment has increased in several countries in recent years [57][58][59]. This increase in drug treatment is seen in all ages, ranging from young children to adolescents, and the use of medical increase also continues into adulthood [59,60].…”

“…The number of children on drug treatment has increased in several countries in recent years [57][58][59]. This increase in drug treatment is seen in all ages, ranging from young children to adolescents, and the use of medical increase also continues into adulthood [59,60]. Yet, research on the long-term effects of stimulant medicines is scant [57,61].…”

Is the evidence base of methylphenidate for children and adolescents with attention-deficit/hyperactivity disorder flawed?

“…The increase in methylphenidate use in many European countries and many other parts of the world [1,2,4], has raised a considerable concern in society about the possible overtreatment of children with psychostimulants. European guidelines for best practice from the healthcare associations and authorities for the treatment of attention deficit hyperactivity disorder (ADHD) recommend that methylphenidate (which has a marketing authorization as part of a comprehensive treatment program for ADHD in children aged 6 years and above) should only be the first treatment choice in case of severe levels of symptoms and impairment associated with ADHD.…”