Prescribing for young people with attention deficit hyperactivity disorder in UK primary care: analysis of data from the Clinical Practice Research Datalink
Newlove-Delgado T, Hamilton W, Ford TJ, Stein K, Ukoumunne OC. Atten Defic Hyperact Disord. 2019 Feb 7. doi: 10.1007/s12402-019-00288-6.
Guest Commentary by Dr. Margaret Weiss: This study finds prescribing of first line treatment for ADHD declined between 16 and 18 years, although these critical years are a peak period for risk and functional impairment.
Guidance on management of attention deficit hyperactivity disorder (ADHD) in the UK was issued by the National Institute for Clinical Excellence in 2008. No UK study has examined all psychotropic prescribing in young people with ADHD since the introduction of the guidance; this is especially relevant due to the high prevalence of psychiatric comorbidity in this population.
The aim of this study was to describe primary care prescribing of ADHD and other psychotropic medications for young people with ADHD. The analysis of records of patients with an ADHD diagnosis in the UK Clinical Practice Research Datalink from 2005 to 2013 was performed. Estimation of the prevalence of prescribing of ADHD and other psychotropic medications over 8-year follow-up for cases aged 10-20 years in 2005 was carried out. Of 9390 ADHD cases, 61.6% [95% confidence interval (CI) 60.6-62.5%] had a prescription at some point for ADHD medication.
Prescribing of other psychotropic medications was higher in girls than in boys (36.4% vs. 22.7%; p < 0.001). ADHD prescribing prevalence declined steeply between the ages of 16 and 18 from 37.8% (95% CI 36.6-38.9) to 23.7% (95% CI 22.7-24.6%). There was a parallel increase in prescribing of other psychotropics from 3.8% (95% CI 3.4-4.3%) to 6.6% (95% CI 6.0-7.3%).
There is scope to optimise the management of ADHD and psychiatric comorbidities in young people, and there is a need for sustainable models of ADHD care for young adults, supported by appropriate training and specialist services.
* Dr. Margaret Weiss is Director of Clinical Research, Child Psychiatry at Cambridge Health Alliance, Harvard University. Her commentary reflects her own opinion. It is not approved or necessarily representative of the CADDRA board.