Article: The epidemiology of pharmacologically treated attention deficit hyperactivity disorder (ADHD) in children, adolescents and adults in UK primary care

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Publisher Website: 10.1186/1471-2431-12-78
Scopus: eid_2-s2.0-84862300420
PMID: 22712630

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Title	The epidemiology of pharmacologically treated attention deficit hyperactivity disorder (ADHD) in children, adolescents and adults in UK primary care
Authors	McCarthy, S5 6 Wilton, L2 Murray, ML2 Hodgkins, P1 Asherson, P4 Wong, ICK2 3
Issue Date	2012
Publisher	BioMed Central Ltd. The Journal's web site is located at http://www.biomedcentral.com/bmcpediatr/
Citation	BMC Pediatrics, 2012, v. 12, article no. 78 [How to Cite?] DOI: http://dx.doi.org/10.1186/1471-2431-12-78
Abstract	BACKGROUND: Attention Deficit Hyperactivity Disorder (ADHD) is a common neurodevelopmental disorder characterised by the symptoms of inattention, impulsivity and hyperactivity. ADHD was once perceived as a condition of childhood only; however increasing evidence has highlighted the existence of ADHD in older adolescents and adults. Estimates for the prevalence of ADHD in adults range from 2.5-4%. Few data exist on the prescribing trends of the stimulants methylphenidate and dexamfetamine, and the non-stimulant atomoxetine in the UK. The aim of this study was to investigate the annual prevalence and incidence of pharmacologically treated ADHD in children, adolescents and adults in UK primary care. METHODS: The Health Improvement Network (THIN) database was used to identify all patients aged over 6 years with a diagnosis of ADHD/hyperkinetic disorder and a prescription for methylphenidate, dexamfetamine or atomoxetine from 2003-2008. Annual prevalence and incidence of pharmacologically treated ADHD were calculated by age category and sex. RESULTS: The source population comprised 3,529,615 patients (48.9% male). A total of 118,929 prescriptions were recorded for the 4,530 patients in the pharmacologically treated ADHD cohort during the 6-year study. Prevalence (per 1000 persons in the mid-year THIN population) increased within each age category from 2003 to 2008 [6-12 years: from 4.8 (95% CI: 4.5-5.1) to 9.2 (95% CI: 8.8-9.6); 13-17 years: from 3.6 (95% CI: 3.3-3.9) to 7.4 (95% CI: 7.0-7.8); 18-24 years: from 0.3 (95% CI: 0.2-0.3) to 1.1 (95% CI: 1.0-1.3); 25-45 years: from 0.02 (95% CI: 0.01-0.03) to 0.08 (95% CI: 0.06-0.10); >45 years: from 0.01 (95% CI: 0.00-0.01) to 0.02 (95% CI: 0.01-0.03). Whilst male patients aged 6-12 years had the highest prevalence; the relative increase in prescribing was higher amongst female patients of the same age - the increase in prevalence in females aged 6-12 years was 2.1 fold compared to an increase of 1.9 fold for their male counterparts. Prevalence of treated ADHD decreased with increasing age. Incidence (per 1000 persons at risk in the mid-year THIN population) was highest for children aged 6-12 years. CONCLUSIONS: A trend of increasing prescribing prevalence of ADHD drug treatment was observed over the period 2003-2008. Prevalence of prescribing to adult patients increased; however the numbers treated are much lower than published estimates of the prevalence of ADHD. This study has added to the limited knowledge on ADHD prescribing in primary care, particularly in the area of drug treatment in adulthood.
ISSN	1471-2431 2011 Impact Factor: 1.885 2011 SCImago Journal Rankings: 0.155
DOI	http://dx.doi.org/10.1186/1471-2431-12-78
PubMed Central ID	PMC3472167

DC Field	Value
dc.contributor.author	McCarthy, S
dc.contributor.author	Wilton, L
dc.contributor.author	Murray, ML
dc.contributor.author	Hodgkins, P
dc.contributor.author	Asherson, P
dc.contributor.author	Wong, ICK
dc.date.accessioned	2012-09-20T08:00:13Z
dc.date.available	2012-09-20T08:00:13Z
dc.date.issued	2012
dc.description.abstract	BACKGROUND: Attention Deficit Hyperactivity Disorder (ADHD) is a common neurodevelopmental disorder characterised by the symptoms of inattention, impulsivity and hyperactivity. ADHD was once perceived as a condition of childhood only; however increasing evidence has highlighted the existence of ADHD in older adolescents and adults. Estimates for the prevalence of ADHD in adults range from 2.5-4%. Few data exist on the prescribing trends of the stimulants methylphenidate and dexamfetamine, and the non-stimulant atomoxetine in the UK. The aim of this study was to investigate the annual prevalence and incidence of pharmacologically treated ADHD in children, adolescents and adults in UK primary care. METHODS: The Health Improvement Network (THIN) database was used to identify all patients aged over 6 years with a diagnosis of ADHD/hyperkinetic disorder and a prescription for methylphenidate, dexamfetamine or atomoxetine from 2003-2008. Annual prevalence and incidence of pharmacologically treated ADHD were calculated by age category and sex. RESULTS: The source population comprised 3,529,615 patients (48.9% male). A total of 118,929 prescriptions were recorded for the 4,530 patients in the pharmacologically treated ADHD cohort during the 6-year study. Prevalence (per 1000 persons in the mid-year THIN population) increased within each age category from 2003 to 2008 [6-12 years: from 4.8 (95% CI: 4.5-5.1) to 9.2 (95% CI: 8.8-9.6); 13-17 years: from 3.6 (95% CI: 3.3-3.9) to 7.4 (95% CI: 7.0-7.8); 18-24 years: from 0.3 (95% CI: 0.2-0.3) to 1.1 (95% CI: 1.0-1.3); 25-45 years: from 0.02 (95% CI: 0.01-0.03) to 0.08 (95% CI: 0.06-0.10); >45 years: from 0.01 (95% CI: 0.00-0.01) to 0.02 (95% CI: 0.01-0.03). Whilst male patients aged 6-12 years had the highest prevalence; the relative increase in prescribing was higher amongst female patients of the same age - the increase in prevalence in females aged 6-12 years was 2.1 fold compared to an increase of 1.9 fold for their male counterparts. Prevalence of treated ADHD decreased with increasing age. Incidence (per 1000 persons at risk in the mid-year THIN population) was highest for children aged 6-12 years. CONCLUSIONS: A trend of increasing prescribing prevalence of ADHD drug treatment was observed over the period 2003-2008. Prevalence of prescribing to adult patients increased; however the numbers treated are much lower than published estimates of the prevalence of ADHD. This study has added to the limited knowledge on ADHD prescribing in primary care, particularly in the area of drug treatment in adulthood.
dc.description.nature	published_or_final_version
dc.identifier.citation	BMC Pediatrics, 2012, v. 12, article no. 78 [How to Cite?] DOI: http://dx.doi.org/10.1186/1471-2431-12-78
dc.identifier.doi	http://dx.doi.org/10.1186/1471-2431-12-78
dc.identifier.hkuros	207134
dc.identifier.issn	1471-2431 2011 Impact Factor: 1.885 2011 SCImago Journal Rankings: 0.155
dc.identifier.pmcid	PMC3472167
dc.identifier.pmid	22712630
dc.identifier.scopus	eid_2-s2.0-84862300420
dc.identifier.uri	http://hdl.handle.net/10722/164474
dc.identifier.volume	12, article no. 78
dc.language	eng
dc.publisher	BioMed Central Ltd. The Journal's web site is located at http://www.biomedcentral.com/bmcpediatr/
dc.publisher.place	United Kingdom
dc.relation.ispartof	BMC Pediatrics
dc.rights	BMC Pediatrics. Copyright © BioMed Central Ltd.
dc.rights	Creative Commons: Attribution 3.0 Hong Kong License
dc.title	The epidemiology of pharmacologically treated attention deficit hyperactivity disorder (ADHD) in children, adolescents and adults in UK primary care
dc.type	Article

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Author Affiliations

Shire Pharmaceuticals LLC
UCL
The University of Hong Kong Li Ka Shing Faculty of Medicine
Medical Research Council
Cork University Hospital
University College Cork