Trends in ADHD medication use in children and adolescents in five western countries, 2005–2012

Bachmann, Christian; Wijlaars, Linda; Kalverdijk, Luuk J.; Burcu, Mehmet; Glaeske, Gerd; Schuiling-Veninga, Catharina C M; Hoffmann, Falk; Aagaard, Lise; Zito, Julie Magno

doi:10.1016/j.euroneuro.2017.03.002

Cited by 113 publications

(128 citation statements)

References 49 publications

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“…In the UK, for example, reports suggest that only 0.73% of children and 0.06% of adults receive ADHD medication [7]. Even when patients have received a diagnosis, medication use varies widely across European countries [8], with medication use in the UK being relatively low. Issues experienced by people with ADHD in childhood can lead to considerable cognitive and behavioural impairment [9,10], affecting social behaviour, school work and family life [11,12].…”

Section: Introductionmentioning

confidence: 99%

Awareness of ADHD in primary care: stakeholder perspectives

et al. 2020

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Background: Attention Deficit Hyperactivity Disorder (ADHD) is underdiagnosed in many European countries and the process of accessing care and diagnosis is complex and variable. In many countries, general practitioners (GPs) refer on to secondary care where individuals receive an assessment and, if appropriate, a diagnosis and access to care. It is therefore essential that GPs have a clear understanding of the disorder and its care pathways. While previous studies have highlighted potential barriers in GPs' ADHD awareness, this qualitative study aims to further explore individual stakeholders' experiences. Methods: Semi-structured interviews explored the views of multiple stakeholders-GPs (n = 5), healthcare specialists (n = 5), patients (adults with ADHD n = 5) and parents (n = 5) with experience of the presentation and management of ADHD in primary care. These interviews were analysed using thematic analyses and following principles of grounded theory. Results: Stakeholders described ADHD assessment, diagnosis and treatment as an intricate process. Many factors affected this process such as complex pathways, lack of services, limited GP recognition and knowledge, and communicative difficulties between and within multiple stakeholders. Conclusion: This analysis underlines the significant impact that receiving (or not) a diagnosis can have, and further explores muddled ADHD care pathways, highlighting key issues around GP identification and the shortage of adult services. Implications for practice and future research are discussed, suggesting a strong need for more commissioned pathways and GP specific educational programs.

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Section: Introductionmentioning

confidence: 99%

Awareness of ADHD in primary care: stakeholder perspectives

et al. 2020

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“…Prescription stimulants such as methylphenidate and nonstimulants such as atomoxetine are labeled for the treatment of attention-deficit/hyperactivity disorder (ADHD) from age approximately 6 and above years, and are also commonly used in medical practice for the management of non-core symptoms of autism spectrum disorder (ASD) [1]. In the USA and in Europe, there has been a trend toward higher prescription rates of these drugs (hereon referred to as "ADHD medications") for both children and adults over the past 2 decades; nevertheless, use remains most common in middle childhood, and not all ADHD diagnosed individuals are prescribed ADHD medications [2][3][4][5][6][7].…”

Section: Introductionmentioning

confidence: 99%

Psychostimulants/Atomoxetine and Serious Cardiovascular Events in Children with ADHD or Autism Spectrum Disorder

2019

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Background Psychostimulants and atomoxetine have been shown to increase blood pressure, heart rate, and QT interval in children and adolescents; however, based on current literature, it is unclear if these "attention-deficit/hyperactivity disorder (ADHD) medications" are also associated with serious cardiovascular (SCV) events. We addressed this question in commonly exposed groups of children and adolescents with either ADHD or autism spectrum disorder (ASD). Methods Using commercial (years 2000-2016) and Medicaid (years 2012-2016) administrative claims data from the United States (US), we conducted two case-control studies, nested within respective cohorts of ADHD and ASD children aged 3-18 years. We defined cases by a composite outcome of stroke, myocardial infarction, or serious cardiac arrhythmia. For each case, we matched ten controls on age, sex, and insurance type. We conducted conditional logistic regression models to test associations between SCV outcomes and a primary exposure definition of current ADHD medication use. Additionally, we controlled for resource use, cardiovascular and psychiatric comorbidities, and use of medications in a variety of sensitivity analyses. Results We identified 2,240,774 children for the ADHD cohort and 326,221 children for the ASD cohort. For ADHD, 33.9% of cases (63 of 186) versus 32.2% of controls (598 of 1860) were exposed, which yielded an odds ratio (OR) and 95% confidence interval (CI) of 1.08 (0.78-1.49). For ASD, 12.5% of cases (6 of 48) versus 22.1% of controls (106 of 480) were exposed ]. Covariate-adjusted results and results for individual outcomes and other exposure definitions were consistent with no increased risk of SCV events. Conclusion Using large US claims data, we found no evidence of increased SCV risk in children and adolescents with ADHD or ASD exposed to ADHD medications. Key PointsAttention-deficit/hyperactivity disorder (ADHD) medications increase blood pressure, heart rate, and QT interval. It is unclear if they increase serious cardiovascular event rates.Current literature is based mainly on pre-2006 data and small samples, and has not considered subgroups of children with different medical diagnoses.Using data from 2000-2016, for US children aged 3-18 years, we found no evidence of increased serious cardiovascular risk in those exposed to ADHD medications.Findings were consistent for children with either ADHD or autism spectrum disorder.Presentation Information A partly similar analysis to the one shown here (ASD cohort only) has been accepted for poster presentation at the

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“…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].…”

Section: Introductionmentioning

confidence: 99%

“…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].…”

Section: Introductionmentioning

confidence: 99%

Parental Discussions Online through the Medical Discourse-lens

Lundin¹,

Erlandsson²

2017

J Child Dev Disord

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In the present study the research objective was to gain insights into parental communication on an open Internet forum where parents had the opportunity to discuss issues related to ADHD. In order for clinicians to help troubled children brought to the health clinic it may be important to learn more about the life situations of these troubled families as treatment options can require complex interventions for the whole family. Our aim was thus to go beyond the neurobiological medical model of ADHD, which does not take into account contextual factors. In today's society specialized online discussion forums are available for parents who seek support for various difficulties that arise in the family. The online forums are sources of research data. As research tools we used the narrative psychological approach for the analysis of 72 online narratives. These narratives provided support for that the parents embraced medical explanations for the difficulties experienced when raising children, despite obvious challenging life circumstances, such as for example being a single parent without social support. Even very young children had been given serious psychiatric medical diagnoses such as ADHD, Bipolar disorder, Mood disorders and Obsessive Compulsive Disorder. Some of them had been diagnosed with more than one of these disorders. The complexity of the parental narratives in the present study indicates that the neurobiological model is not sufficient enough to form the basis of a personalized and comprehensive care for vulnerable families.

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Trends in ADHD medication use in children and adolescents in five western countries, 2005–2012

Cited by 113 publications

References 49 publications

Awareness of ADHD in primary care: stakeholder perspectives

Awareness of ADHD in primary care: stakeholder perspectives

Psychostimulants/Atomoxetine and Serious Cardiovascular Events in Children with ADHD or Autism Spectrum Disorder

Parental Discussions Online through the Medical Discourse-lens

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