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23 Apr 2015

Raman SR et al. Psychiatr Serv 2015; 66: 617-624.

A large proportion of children who receive pharmacological treatment for ADHD do not continue in initial treatment for more than 6 months, reports a recent database study of UK patient records.

This study aimed to describe initial pharmacological treatment patterns among UK children with ADHD. Data were collected from patient records of 2878 children (aged 3–16 years; 84% male) diagnosed with ADHD between 1 January 1994 and 30 June 2006.* Of these patients, 75% were diagnosed between 2002 and 2006.

Results indicated that the average mean age at diagnosis increased from 7 years in 1995 to 10 years in 2006. Overall, 46% of children were prescribed medication; with only 20% of patients receiving medication on diagnosis date and then a further 18% within 30 days of diagnosis. Across all years, first-line medications prescribed included methylphenidate (94%), atomoxetine (4%) and dexamphetamine (2%). The majority of children (70%) remained on their initial medication for just 1 month with 35%, 27% and 22% remaining on first-line medication at 6, 9 and 12 months, respectively. Of children who received subsequent treatment courses (n=1038), untreated periods ranged between 3–12 months. Only two factors were positively associated with medication persistence: initial medication type (long-acting methylphenidate vs standard methylphenidate) and year of diagnosis (2002–2006 compared with 1994–2001). Initiation of treatment 1–2 years after diagnosis, compared with medication prescription on the diagnosis date, was associated with reduced medication persistence for initial treatment.

The use of prescription records is not directly indicative of whether these were filed/consumed. However, researchers concluded that only a minority of children prescribed medication continued with their treatment for over 6 months. Clinicians should examine medication use patterns and be aware that ADHD treatment discontinuation may be caused by a range of factors not reflected in patient records, and can have implications for treatment outcomes.

Read more about the use of pharmacological treatment for children with ADHD in UK primary care here

 

*Patients were followed from 1 year after ADHD diagnosis was registered until their 19th birthday (where possible). Please note that ADHD medications are not licensed for children under 6 years old.
Initial treatment course duration was defined as the time from initial medication prescription to the end of the treatment period of the last prescription; for the primary analysis, a 30-day grace period was used to determine treatment periods – missing ‘days supplied’ values given by prescriptions were set to 30 days, as per previous studies.
Medication persistence defined as an initial course of treatment lasting >6 months.

Raman SR, Marshall SW, Gaynes BN, et al. An observational study of pharmacological treatment in primary care of children with ADHD in the United Kingdom. Psychiatr Serv 2015; 66: 617-624.

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