La prescription de méthylphénidate chez l’enfant et l’adolescent en France : caractéristiques et évolution entre 2010 et 2019

Abstract

ContextPsychotropic drugs are often prescribed to alleviate the symptoms of Attention Deficit/Hyperactivity Disorder (ADHD) in children and adolescents. However, the governmental regulations of this prescription, its prevalence and its time evolution during the last two decades have greatly varied among developed countries. In France, methylphenidate is the only drug authorized for pediatric ADHD. Here, we describe the pattern of methylphenidate prescription in France from 2010 to 2019 and several clinical, demographic, institutional and social parameters associated with this prescription. MethodsWe analyzed the pattern of methylphenidate prescription through the French Social Security database that includes 87% of the French population. Our retrospective cohort included 144,509 patients aged 0 to 17 years who received at least one methylphenidate prescription between 2010 and 2019. ResultsBetween 2010 and 2019, methylphenidate prescription increased by +56% for incidence and +116% for prevalence. The prevalence of methylphenidate prescription among 3–17-year-olds reached in 2019 between 0.61% and 0.75% of the pediatric population. Boys are predominantly medicated (82.5% to 80.8% of prescriptions over the period). The median duration of treatment among 6-year-olds in 2011 was 5.5 years. The youngest children received the longest treatment duration. The number of deliveries per patient and per year increased over the period, suggesting that treatment durations increased from 2010 to 2019. Diagnoses associated with methylphenidate prescription did not always correspond to the therapeutic indication or the marketing authorization. Among children receiving a first prescription of methylphenidate, 22.8% also received one or more other psychotropic drugs during the same year. Most of these co-prescriptions were outside approved indications. A quarter of initiations and half of renewals were made outside governmental recommendations. The prescription distribution suggests that a minority of practitioners and of hospital services were involved in most of the methylphenidate prescriptions. Among young patients treated with methylphenidate, educational and psychotherapeutic follow-up decreased from 4.1 in 2010 to 0.8% in 2019. French children and adolescents, who were the youngest in their class (born in December rather than January), were more likely to be prescribed methylphenidate (+54% average over the period). Children from disadvantaged families had an increased risk of ADHD medication. DiscussionIn European and North American countries, the prevalence of ADHD medication has stabilized or showed a clear trend toward stabilization since 2008. In contrast, in France, the prevalence of methylphenidate prescription has steadily increased from 2003 to now (2019) so much so that the 2019 French prevalence exceeds that observed in UK. The reasons that might explain such an increase are discussed.