Abstract
BackgroundADHD guidelines in the UK suggest that children and adults who respond to pharmacological treatment should continue for as long as remains clinically effective, subject to regular review. To what extent patients persist with treatment from childhood and adolescence into adulthood is not clear. This study aims to describe, in UK primary care, the persistence of pharmacological treatment for patients with ADHD who started treatment aged 6–17 years and to estimate the percentage of patients who continued treatment from childhood and adolescence into adulthood.MethodsThe Health Improvement Network (THIN) database was used to identify patients with ADHD who received their first prescription for methylphenidate/ dexamfetamine/atomoxetine, aged 6–17 years. Patients were monitored until their ‘censored date’ (the earliest of the following dates: date the last prescription coded in the database ended, end of the study period (31st December 2008), date at which they transferred out of their practice, date of death, the last date the practice contributed data to the database). Persistence of treatment into adulthood was estimated using Kaplan Meier analysis.Results610 patients had follow-up data into adulthood. 213 patients (93.4% male) started treatment between 6–12 years; median treatment duration 5.9 years. 131 (61.5%) stopped before 18 years, 82 (38.5%) were still on treatment age ≥18 years. 397 patients (86.4% male) started treatment between 13–17 years; median treatment duration was 1.6 years. 227 (57.2%) stopped before 18 years, 170 (42.8%) were still on treatment age ≥18 years. The number of females in both age categories was too small to formally test for differences between genders in persistence of treatment.ConclusionPersistence of treatment into adulthood is lower (~40%) compared with published rates of persistence of the condition (~65% when symptomatic definition of remission used). Due to the limited number of patients with data past 18 years, it is important that ongoing monitoring of prescribing into later adulthood is undertaken, particularly to observe the effects of recommendations in new guidelines.
Highlights
Attention deficit hyperactivity disorder (ADHD) guidelines in the United Kingdom (UK) suggest that children and adults who respond to pharmacological treatment should continue for as long as remains clinically effective, subject to regular review
The aim of the study is to estimate the persistence of pharmacological treatment for ADHD into adulthood for patients who started their treatment in childhood, or in adolescence, and to estimate the percentage of children and adolescents, stratified by gender, who continued longterm treatment for ADHD into adulthood, in the UK primary care setting
The Health Improvement Network (THIN) contains anonymised computerised information entered by general practitioners (GPs) in the UK
Summary
ADHD guidelines in the UK suggest that children and adults who respond to pharmacological treatment should continue for as long as remains clinically effective, subject to regular review. This study aims to describe, in UK primary care, the persistence of pharmacological treatment for patients with ADHD who started treatment aged 6–17 years and to estimate the percentage of patients who continued treatment from childhood and adolescence into adulthood. Compared to children and adolescents, adults with ADHD are more likely to exhibit inattentive symptoms, as overt hyperactive symptoms tend to diminish with age [10]. They continue to suffer from symptoms such as the inability to sustain attention over a long period of time, disorganisation, forgetfulness and poor time management skills. Rates of separation and divorce have been reported to be higher in adults with ADHD [10,11]
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