Trends in prescription of psychotropic medications to children and adolescents in Australian primary care from 2011 to 2018

Klau, Julie; Bernardo, Carla de Oliveira; González‐Chica, David Alejandro; Raven, Melissa; Jureidini, Jon

doi:10.1177/00048674211067720

Cited by 22 publications

(41 citation statements)

References 37 publications

(86 reference statements)

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“…We observed a doubling in the prevalence of ADHD medicine use between 2013 and 2020; these findings are in line with recent data on Australian general practitioner psychotropic prescriptions to children and adolescents (Klau et al, 2021). During a similar time period, ADHD medicine use among children increased to a similar extent in Finland (Vuori et al, 2020) but less markedly in New Zealand (D’Souza et al, 2020) and the United Kingdom (Masarwa et al, 2022).…”

Section: Discussionsupporting

confidence: 91%

Patterns of attention deficit hyperactivity disorder medicine use in the era of new non-stimulant medicines: A population-based study among Australian children and adults (2013–2020)

Bruno

Havard

Gillies

et al. 2022

Aust N Z J Psychiatry

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Background and aims: New therapeutic options such as lisdexamfetamine and guanfacine have recently become available for the treatment of attention deficit hyperactivity disorder. We described contemporary patterns of attention deficit hyperactivity disorder medicine use among children, adolescents and adults in Australia. Methods: This population-based study used dispensing data for a 10% random sample of Australian residents between July 2012 and December 2020. We estimated the annual prevalence and incidence of attention deficit hyperactivity disorder medicines, second-line guanfacine use and examined concurrent medicine use of both stimulants and non-stimulants. We followed incident users for up to 5 years and analysed treatment persistence using a novel proportion of people covered method. Analyses were stratified by attention deficit hyperactivity disorder medicine, sex and age group; young children (0–5 years), children (6–12 years), adolescents (13–17 years), young adults (18–24 years) and adults (⩾25 years). Results: We observed a twofold increase in the overall prevalence of attention deficit hyperactivity disorder medicine use between 2013 and 2020, from 4.9 to 9.7 per 1000 persons. Incident use also increased across all age groups and both sexes, with the most pronounced increases among adolescent females (from 1.4 to 5.3 per 1000 persons). Stimulant treatment persistence after 5 years was highest among those initiating treatment as young children (64%) and children (69%) and lowest among those initiating treatment in adolescence (19%). Concurrent use of stimulants and non-stimulants was more common among males and younger age groups. Most children (87%) initiating guanfacine had prior dispensings of attention deficit hyperactivity disorder medicines. Conclusion: We observed increasing attention deficit hyperactivity disorder medicine use in Australia, especially among young females. Nevertheless, treatment rates remain lower than the estimated prevalence of attention deficit hyperactivity disorder across all subpopulations. Poor long-term treatment persistence in adolescence may warrant improved clinical monitoring of attention deficit hyperactivity disorder in patients transitioning from paediatric to adult care. Reassuringly, use of newly approved guanfacine appeared to be in accordance with guidelines among children.

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Section: Discussionsupporting

confidence: 91%

Patterns of attention deficit hyperactivity disorder medicine use in the era of new non-stimulant medicines: A population-based study among Australian children and adults (2013–2020)

Bruno

Havard

Gillies

et al. 2022

Aust N Z J Psychiatry

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“…The second, third and fifth points raised by Freeman (5), those of the availability of drugs, vested interests, and industry profits, are all closely connected. The drugs remain readily available, and recent decades have witnessed an ever-increasing upward trajectory in their use worldwide (4,(9)(10)(11)(12)(13), indicating that drug companies invested in ADHD are making healthy profits. Although space precludes a discussion of competing interests, a list at the end of The World Federation of ADHD International Consensus Statement (3) is testament to the extent of pharmaceutical involvement.…”

Section: Discussionmentioning

confidence: 99%

“…As noted above (3), ADHD occurs in developed and developing nations at a prevalence rate of 5.9% of youth and 2.5% of adults. Correspondingly, the evidence of worldwide increases in stimulant dispensing (4,(9)(10)(11)(12)(13), indicates a wide acceptance of ADHD as a psychiatric disorder.…”

Section: Introductionmentioning

confidence: 99%

The scientific integrity of ADHD: A critical examination of the underpinning theoretical constructs

Mills

2022

Front. Psychiatry

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Prior to the establishment and promotion of ADHD as a psychiatric disorder, the labels “minimal brain dysfunction” (MBD), “hyperactivity” (HA), and “learning disability” (LD) were diagnostic terms for children with hard-to-manage behaviors. At the time, these labels and the treatment interventions, especially the heavy reliance on stimulant medications, were subject to criticism. Nearly half a century later, these criticisms apply equally to ADHD, suggesting a disturbing lack of progress in this area of child psychiatry. Therefore, the aim of this article is to examine the scientific integrity of ADHD, to establish why this is the case. I use a philosophy of science framework to track the initial thinking, the plausibility, and the acceptance of ADHD. I establish that ADHD, along with the evolving biomedical model for psychiatry, was accepted in the third edition of the American Psychiatric Association's (APA) Diagnostic and Statistical Manual (DSM-III) as the result of bias and compromise between theorists' of different persuasions. Although initial ideas are expected to be subjective, they also need to demonstrate plausibility prior to empirical investigation. Research from the disciplines of biological psychiatry and cognitive psychology influenced the creation of ADHD, so I critically examine specific ideas that underpinned these disciplines at that time. I find these to be implausible and not congruent with current scientific knowledge, this extends to more recent theory. I conclude there is little good reason to consider DSM-III's concept of ADHD as empirically confirmed, nor do I find good reason to expect such confirmation will be forthcoming.

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“…Prescribing of medications used to treat mental health conditions in children has increased in various international contexts [ 10 , 11 ] with notable rises in prescriptions of antidepressants [ 12 , 13 ] and medications to treat Attention Defecit Hyperactivity Disorder particularly among boys [ 14 , 15 ] from the 1990s up until the 2010s. Analysis of mental health prescribing in parts of the United Kingdom has previously been conducted for people of all ages, but this did not include a detailed exploration of trends in younger age groups [ 16 , 17 ].…”

Section: Introductionmentioning

confidence: 99%

Inequalities in children’s mental health care: analysis of routinely collected data on prescribing and referrals to secondary care

et al. 2023

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Background One in eight children in the United Kingdom are estimated to have a mental health condition, and many do not receive support or treatment. The COVID-19 pandemic has negatively impacted mental health and disrupted the delivery of care. Prevalence of poor mental health is not evenly distributed across age groups, by sex or socioeconomic groups. Equity in access to mental health care is a policy priority but detailed socio-demographic trends are relatively under-researched. Methods We analysed records for all mental health prescriptions and referrals to specialist mental health outpatient care between the years of 2015 and 2021 for children aged 2 to 17 years in a single NHS Scotland health board region. We analysed trends in prescribing, referrals, and acceptance to out-patient treatment over time, and measured differences in treatment and service use rates by age, sex, and area deprivation. Results We identified 18,732 children with 178,657 mental health prescriptions and 21,874 referrals to specialist outpatient care. Prescriptions increased by 59% over the study period. Boys received double the prescriptions of girls and the rate of prescribing in the most deprived areas was double that in the least deprived. Mean age at first mental health prescription was almost 1 year younger in the most deprived areas than in the least. Referrals increased 9% overall. Initially, boys and girls both had an annual referral rate of 2.7 per 1000, but this fell 6% for boys and rose 25% for girls. Referral rate for the youngest decreased 67% but increased 21% for the oldest. The proportion of rejected referrals increased steeply since 2020 from 17 to 30%. The proportion of accepted referrals that were for girls rose to 62% and the mean age increased 1.5 years. Conclusions The large increase in mental health prescribing and changes in referrals to specialist outpatient care aligns with emerging evidence of increasing poor mental health, particularly since the start of the COVID-19 pandemic. The static size of the population accepted for specialist treatment amid greater demand, and the changing demographics of those accepted, indicate clinical prioritisation and unmet need. Persistent inequities in mental health prescribing and referrals require urgent action.

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Trends in prescription of psychotropic medications to children and adolescents in Australian primary care from 2011 to 2018

Cited by 22 publications

References 37 publications

Patterns of attention deficit hyperactivity disorder medicine use in the era of new non-stimulant medicines: A population-based study among Australian children and adults (2013–2020)

Patterns of attention deficit hyperactivity disorder medicine use in the era of new non-stimulant medicines: A population-based study among Australian children and adults (2013–2020)

The scientific integrity of ADHD: A critical examination of the underpinning theoretical constructs

Inequalities in children’s mental health care: analysis of routinely collected data on prescribing and referrals to secondary care

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