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Article: Cessation of attention deficit hyperactivity disorder drugs in the young (CADDY) - A pharmacoepidemiological and qualitative study

TitleCessation of attention deficit hyperactivity disorder drugs in the young (CADDY) - A pharmacoepidemiological and qualitative study
Authors
Issue Date2009
Citation
Health Technology Assessment, 2009, v. 13 n. 50, p. 1-120 How to Cite?
Abstract
Objectives: To estimate the prevalence of attention deficit hyperactivity disorder (ADHD) pharmacological treatment, and its demographic and clinical details, and to estimate the proportion of patients in the target group who stopped ADHD treatment and investigate possible factors for continuation or cessation of treatment. Design: A pharmacoepidemiological study using an automated database and a qualititative study using patient interviews. Part 1 was a pharmacoepidemiological study that provided accurate data on use and cessation of ADHD drugs. Part 2 was an in-depth interview study to investigate the reasons, processes and outcomes of treatment cessation. Setting: Part 1: primary care using the General Practice Research Database (GPRD). Part 2: secondary and tertiary care paediatric clinics, child and adolescent mental health and adult mental health clinics in London, Nottingham, Dundee and Liverpool. Participants: Part 1: patients were 15-21 years old during the study period (1 January 2001 and 31 December 2004), had at least one prescription for methylphenidate, dexamfetamine or atomoxetine and had at least 1 year of research-standard data available in the GPRD. Part 2: patients fulfilled Part 1 criteria, had a diagnosis of ADHD as detected by a predefined algorithm and had been treated with methylphenidate, dexamfetamine or atomoxetine for at least 1 year. Child and adolescent psychiatrists, adult psychiatrists and paediatricians involved in the treatment of young people with ADHD were also interviewed as part of the study. Results: Part 1: prevalence of prescribing averaged across all ages increased eightfold, from 0.26 per 1000 patients in 1999 to 2.07 per 1000 patients in 2006. The increase in prevalence in the younger patients was less evident in the older patients. Prevalence in 15-year-old males receiving a study drug prescription increased from 1.32 per 1000 patients in 1999 to 8.31 per 1000 patients in 2006, whereas the prevalence in 21-yearolds rose from 0 per 1000 patients in 1999 to 0.43 per 1000 patients in 2006. Survival analysis showed that the rate of treatment cessation largely exceeded the estimated rate of persistence of ADHD. The reduction in prescribing was most noticeable between 16 and 17 years of age. Kaplan-Meier analysis showed that approximately 18% of patients restarted treatment if they had stopped treatment after the age of 15. Patients who restarted treatment were more likely to restart within the first year following treatment cessation. Part 2: the Child Health and Illness Profile (CHIP) was chosen as the quality of life questionnaire for the Part 2 study because the CHIP-CE scale has been validated in children with ADHD in the UK. Because of the age range of participants, the adolescent version (CHIP-AE) was administered to patients after interview. Of the 15, a total of nine patients finished the questionnaire. Interviews showed that although some young people felt able to cope after stopping medication, others felt the need to restart to control symptoms. Some patients had difficulty re-engaging with services and clinicians recognised the lack of services for young adults. Patients continuing on treatment considered cessation as an option for the future, but were concerned about the process of stopping and its impact on behaviour. Conclusions: Part 1 study demonstrated that the prevalence of prescribing by GPs to patients with ADHD dropped significantly from age 15 to 21. The fall in prescribing was greater than the reported age-related decrease in symptoms, raising the possibility that treatment is prematurely discontinued in some young adults where ADHD symptoms persist. Part 2 of the study identified that some young adults had difficulty in obtaining treatment after discharge from paediatric services. Future work should include randomised placebo-controlled trials into long-term treatment with stimulants, particularly methylphenidate. © 2009 Queen's Printer and Controller of HMSO. All rights reserved.
Persistent Identifierhttp://hdl.handle.net/10722/171392
ISSN
2013 Impact Factor: 5.116
2013 SCImago Journal Rankings: 1.803
References

 

Author Affiliations
  1. University of Dundee
  2. King's College London
  3. Medical Research Council
  4. School of Pharmacy University of London
  5. Royal Liverpool Children's NHS Trust
  6. Queen's Medical Centre
  7. ADDISS
DC FieldValueLanguage
dc.contributor.authorWong, ICKen_US
dc.contributor.authorAsherson, Pen_US
dc.contributor.authorBilbow, Aen_US
dc.contributor.authorClifford, Sen_US
dc.contributor.authorCoghill, Den_US
dc.contributor.authorDesoysa, Ren_US
dc.contributor.authorHollis, Cen_US
dc.contributor.authorMccarthy, Sen_US
dc.contributor.authorMurray, Men_US
dc.contributor.authorPlanner, Cen_US
dc.contributor.authorPotts, Len_US
dc.contributor.authorSayal, Ken_US
dc.contributor.authorTaylor, Een_US
dc.date.accessioned2012-10-30T06:13:50Z-
dc.date.available2012-10-30T06:13:50Z-
dc.date.issued2009en_US
dc.identifier.citationHealth Technology Assessment, 2009, v. 13 n. 50, p. 1-120en_US
dc.identifier.issn1366-5278en_US
dc.identifier.urihttp://hdl.handle.net/10722/171392-
dc.description.abstractObjectives: To estimate the prevalence of attention deficit hyperactivity disorder (ADHD) pharmacological treatment, and its demographic and clinical details, and to estimate the proportion of patients in the target group who stopped ADHD treatment and investigate possible factors for continuation or cessation of treatment. Design: A pharmacoepidemiological study using an automated database and a qualititative study using patient interviews. Part 1 was a pharmacoepidemiological study that provided accurate data on use and cessation of ADHD drugs. Part 2 was an in-depth interview study to investigate the reasons, processes and outcomes of treatment cessation. Setting: Part 1: primary care using the General Practice Research Database (GPRD). Part 2: secondary and tertiary care paediatric clinics, child and adolescent mental health and adult mental health clinics in London, Nottingham, Dundee and Liverpool. Participants: Part 1: patients were 15-21 years old during the study period (1 January 2001 and 31 December 2004), had at least one prescription for methylphenidate, dexamfetamine or atomoxetine and had at least 1 year of research-standard data available in the GPRD. Part 2: patients fulfilled Part 1 criteria, had a diagnosis of ADHD as detected by a predefined algorithm and had been treated with methylphenidate, dexamfetamine or atomoxetine for at least 1 year. Child and adolescent psychiatrists, adult psychiatrists and paediatricians involved in the treatment of young people with ADHD were also interviewed as part of the study. Results: Part 1: prevalence of prescribing averaged across all ages increased eightfold, from 0.26 per 1000 patients in 1999 to 2.07 per 1000 patients in 2006. The increase in prevalence in the younger patients was less evident in the older patients. Prevalence in 15-year-old males receiving a study drug prescription increased from 1.32 per 1000 patients in 1999 to 8.31 per 1000 patients in 2006, whereas the prevalence in 21-yearolds rose from 0 per 1000 patients in 1999 to 0.43 per 1000 patients in 2006. Survival analysis showed that the rate of treatment cessation largely exceeded the estimated rate of persistence of ADHD. The reduction in prescribing was most noticeable between 16 and 17 years of age. Kaplan-Meier analysis showed that approximately 18% of patients restarted treatment if they had stopped treatment after the age of 15. Patients who restarted treatment were more likely to restart within the first year following treatment cessation. Part 2: the Child Health and Illness Profile (CHIP) was chosen as the quality of life questionnaire for the Part 2 study because the CHIP-CE scale has been validated in children with ADHD in the UK. Because of the age range of participants, the adolescent version (CHIP-AE) was administered to patients after interview. Of the 15, a total of nine patients finished the questionnaire. Interviews showed that although some young people felt able to cope after stopping medication, others felt the need to restart to control symptoms. Some patients had difficulty re-engaging with services and clinicians recognised the lack of services for young adults. Patients continuing on treatment considered cessation as an option for the future, but were concerned about the process of stopping and its impact on behaviour. Conclusions: Part 1 study demonstrated that the prevalence of prescribing by GPs to patients with ADHD dropped significantly from age 15 to 21. The fall in prescribing was greater than the reported age-related decrease in symptoms, raising the possibility that treatment is prematurely discontinued in some young adults where ADHD symptoms persist. Part 2 of the study identified that some young adults had difficulty in obtaining treatment after discharge from paediatric services. Future work should include randomised placebo-controlled trials into long-term treatment with stimulants, particularly methylphenidate. © 2009 Queen's Printer and Controller of HMSO. All rights reserved.en_US
dc.languageengen_US
dc.relation.ispartofHealth Technology Assessmenten_US
dc.subject.meshAdolescenten_US
dc.subject.meshAdrenergic Uptake Inhibitors - Administration & Dosage - Pharmacologyen_US
dc.subject.meshAttention Deficit Disorder With Hyperactivity - Drug Therapy - Epidemiology - Psychologyen_US
dc.subject.meshAttitude To Healthen_US
dc.subject.meshCentral Nervous System Stimulants - Administration & Dosage - Pharmacologyen_US
dc.subject.meshContinuity Of Patient Careen_US
dc.subject.meshCross-Sectional Studiesen_US
dc.subject.meshDextroamphetamine - Administration & Dosage - Pharmacologyen_US
dc.subject.meshDrug Utilization Reviewen_US
dc.subject.meshFamily Practiceen_US
dc.subject.meshFemaleen_US
dc.subject.meshGreat Britain - Epidemiologyen_US
dc.subject.meshHumansen_US
dc.subject.meshMaleen_US
dc.subject.meshMedication Adherenceen_US
dc.subject.meshMethylphenidate - Administration & Dosage - Pharmacologyen_US
dc.subject.meshOutcome And Process Assessment (Health Care)en_US
dc.subject.meshPharmacoepidemiologyen_US
dc.subject.meshPhysician's Practice Patternsen_US
dc.subject.meshPropylamines - Administration & Dosage - Pharmacologyen_US
dc.subject.meshQuality Of Lifeen_US
dc.subject.meshSurvival Analysisen_US
dc.subject.meshWithholding Treatmenten_US
dc.subject.meshYoung Adulten_US
dc.titleCessation of attention deficit hyperactivity disorder drugs in the young (CADDY) - A pharmacoepidemiological and qualitative studyen_US
dc.typeArticleen_US
dc.identifier.emailWong, ICK:wongick@hku.hken_US
dc.identifier.authorityWong, ICK=rp01480en_US
dc.description.naturelink_to_subscribed_fulltexten_US
dc.identifier.doi10.3310/hta13500en_US
dc.identifier.pmid19883527en_US
dc.identifier.scopuseid_2-s2.0-73449121930en_US
dc.relation.referenceshttp://www.scopus.com/mlt/select.url?eid=2-s2.0-73449121930&selection=ref&src=s&origin=recordpageen_US
dc.identifier.volume13en_US
dc.identifier.issue50en_US
dc.identifier.spage1en_US
dc.identifier.epage120en_US
dc.identifier.scopusauthoridWong, ICK=7102513915en_US
dc.identifier.scopusauthoridAsherson, P=35402700900en_US
dc.identifier.scopusauthoridBilbow, A=35739710800en_US
dc.identifier.scopusauthoridClifford, S=15020293400en_US
dc.identifier.scopusauthoridCoghill, D=6603562184en_US
dc.identifier.scopusauthoridDeSoysa, R=35740182200en_US
dc.identifier.scopusauthoridHollis, C=7006624553en_US
dc.identifier.scopusauthoridMcCarthy, S=26323217800en_US
dc.identifier.scopusauthoridMurray, M=7403583537en_US
dc.identifier.scopusauthoridPlanner, C=15519885100en_US
dc.identifier.scopusauthoridPotts, L=26323388900en_US
dc.identifier.scopusauthoridSayal, K=6701748666en_US
dc.identifier.scopusauthoridTaylor, E=7403206584en_US

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