Evidence suggests that young people with ADHD are at high risk of ADHD treatment cessation during their transition from child to adult services (Newlove-Delgado et al. 2017). Despite recommendations in the 2008 National Institute for Health and Care Excellence (NICE) guidelines regarding the treatment of individuals with ADHD reaching adulthood, no UK study has examined all psychotropic prescribing in young people with ADHD since the guidelines were issued. This study aimed to address this gap in knowledge by describing primary care prescribing of ADHD and other psychotropic medications for young people with ADHD (Newlove-Delgado et al. 2019).
Using data from the UK Clinical Practice Research Datalink (CPRD), this study included individuals aged 10–20 years who had been diagnosed with ADHD at some point between birth and the end of the study period. ADHD diagnoses were defined as any of the 22 CPRD medical codes and primary care terms (based on International Statistical Classification of Diseases and Related Health Problems, 10th Revision [ICD-10] F90 categories) that related to an ADHD diagnosis. Prescriptions for ADHD and other psychotropic medications were identified by searching prescription records for codes referring to British National Formulary (BNF) medication categories.* Comorbid psychiatric diagnoses were identified by searching for codes relating to ICD-10 for the main categories of disorder.
The main results from the study are summarised below:
- Sample characteristics: Of 9390 participants with ADHD that met the inclusion criteria, 7876 (83.9%) participants were male.
- Psychiatric comorbidities: Over a median follow-up time of 8.7 years, 26.0% of participants received another psychiatric diagnosis, with the most common psychiatric comorbidities including autism-spectrum disorders (9.9%) and anxiety-depressive disorders (9.3%). Additionally, psychiatric comorbidity was significantly more prevalent in females compared with males (29.4% vs 25.3%; p = 0.001).
- Prescribing at any point during follow-up: 61.6% (95% confidence interval [CI] 60.6–62.5%) of all patients received ≥1 prescription for ADHD medication, whilst 24.9% (95% CI 24.0–25.8%) received ≥1 prescription for another psychotropic medication. Females had a higher prevalence of being prescribed a non-ADHD psychotropic medication (36.4% vs 22.7%; p < 0.001), particularly with respect to antidepressants and anxiolytics.
- Concurrent prescribing of ADHD and psychotropic medications: 8.8% (95% CI 8.3–9.4%) had a prescription for both an ADHD medication and a non-ADHD psychotropic medication within the same calendar year. Concurrent prescribing was more prevalent in females compared with males (11.1% vs 8.4%, respectively).
- Prescribing by age: Prevalence of prescribing ADHD medication fell from 37.8% (95% CI 36.6–38.9%) in 16-year-olds to 23.7% (95% CI 22.7–24.6%) in 18-year-olds; a similar trend was also evident in each year of the study period. Conversely, the prevalence of prescribing other psychotropic medication increased from the age of 16 onwards, increasing to 6.6% (95% CI 6.0–7.3%) in 18-year-olds.
A number of limitations should be taken into account when considering the strength of the findings reported in this study. In general, primary care databases fail to capture prescribing practices in specialist services that may include shorter-term trials. With regard to CPRD specifically, the prescribing practices for individuals who de-registered from their practice and did not re-register with a CPRD-affiliated practice would not have been captured. Furthermore, relying on clinician-coded diagnoses of ADHD to select cases may have introduced bias. Finally, the dataset did not include information on several important factors that may have influenced prescribing, including the severity of ADHD and any psychiatric comorbid conditions, or on the specific indication for the prescribed medication.
Overall, these results demonstrated a clear decline in the prevalence of ADHD prescribing during transition from child to adult services in the UK, with a parallel rise in the prevalence of other psychotropic prescribing. Furthermore, girls with ADHD were more likely to be diagnosed with a psychiatric comorbidity alongside ADHD and to be prescribed non-ADHD psychotropic medication. The authors concluded that there is a need for sustainable models of ADHD care for young adults, which should be facilitated by appropriate training and specialist services.
Read more about the prescribing patterns for young people with ADHD here
*ADHD medication prescriptions were identified by searching for prescription records coded with any of the CPRD product codes referring to BNF categories of ADHD medication (e.g. stimulants, dated within the study period). Other psychotropic medication prescriptions were identified by searching for records of medications included in the BNF Sections 4.1, 4.2 and 4.3 (e.g. anxiolytics, antidepressants, mood stabilisers and drugs used in psychoses and related disorders)
Newlove-Delgado T, Ford TJ, Hamilton W, et al. Prescribing of medication for attention deficit hyperactivity disorder among young people in the Clinical Practice Research Datalink 2005–2013: analysis of time to cessation. Eur Child Adolesc Psychiatry 2018; 27: 29-35.
Newlove-Delgado T, Hamilton W, Ford TJ, et al. Prescribing for young people with attention deficit hyperactivity disorder in UK primary care: analysis of data from the Clinical Practice Research Datalink. Atten Defic Hyperact Disord 2019; Epub ahead of print.