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Health Sciences Clinical Professor of Family Medicine, University of California, Irvine, California
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As an organization accredited by the ACCME, Medscape, LLC, requires everyone who is in a position to control the content of an education activity to disclose all relevant financial relationships with any commercial interest. The ACCME defines "relevant financial relationships" as financial relationships in any amount, occurring within the past 12 months, including financial relationships of a spouse or life partner, that could create a conflict of interest.
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Health Sciences Clinical Professor of Family Medicine, University of California, Irvine, California
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The prevalence of attention-deficit/hyperactivity disorder (ADHD) among children and adolescents has been a matter of debate for decades. There is substantial geographic variability in the diagnosis and treatment of ADHD, and the prevalence may also have changed based on the very definition of ADHD in different versions of the Diagnostic and Statistical Manual of Mental Disorders (DSM).
Thomas and colleagues assessed research on the prevalence of ADHD among persons younger than age 18 years: 175 studies published between 1975 and 2013 were included in a meta-analysis to determine the pooled estimate prevalence rate, which was 7.2%.[1] The prevalence appeared to be stable regardless of the version of DSM, but there was some increase in the prevalence of ADHD over time. The prevalence values from North American studies were approximately 2% higher than those reported in research from Europe, and the prevalence of ADHD appeared about 3% higher in the Middle East compared with North America.
The number of children and adolescents taking ADHD medications appears to be increasing in the United States, and that increase may affect the risk for drug-related adverse events and overdose. The current study uses the National Poison Data System to assess trends in potentially dangerous exposures to drugs used to treat ADHD.
Unintentional and intentional pediatric exposures to stimulant medication for ADHD are an increasing problem in the United States and affect children of all ages, new research suggests.
From 2000 through 2014, there were 156,365 calls to US poison control centers related to exposures to ADHD medications among children and adolescents 19 years of age and younger, reports a study published online May 21 in Pediatrics.[2]
"That averaged about 200 calls each week, or about 1 call every 50 minutes," lead investigator Gary Smith, MD, from Nationwide Children's Hospital, Columbus, Ohio, said in a journal podcast.
"Exposures associated with suspected suicide or medication abuse and misuse among adolescents is a particular concern, especially because these result more commonly in serious medical outcomes," added Dr Smith.
The overall rate of ADHD medication exposures increased by 71.2% from 2000 to 2011. This increase was followed by a nonsignificant 6.2% decline from 2011 to 2014. Methylphenidate and amphetamine medications each accounted for roughly 45% of the exposures.
Half of Teenage Exposures Intentional
The majority of exposures involved boys (65.3%) aged 12 years and younger (76.0%).
In children younger than 6 years, exposure to ADHD medications was associated with "exploratory behavior" common in this age group, such as accessing improperly stored medications, Dr Smith said.
Exposures among children aged 6 to 12 years were most often associated with therapeutic errors, such as being given or taking too much medication, or taking a dose too soon after taking the previous dose.
Intentional medication exposures, including suspected suicide and medication abuse or misuse, were reported most often among teenagers aged 13 to 19 years. "In fact, roughly half of reported exposures in teenagers were intentional, and exposures among teens were more likely to result in serious medical outcomes than in younger children," Dr Smith noted.
The vast majority of unintentional or intentional pediatric exposures to ADHD medications happened at home. Most children who experienced exposure (about 60%) did not receive treatment at a healthcare facility. However, about 6% were admitted to a hospital for medical treatment, and there were 3 deaths.
The most common clinical effects involved the cardiovascular or neurologic system and included agitation and/or irritability, tachycardia, and hypertension. These are consistent with the known mechanisms of action of stimulant medication, the researchers note.
"The increasing number and rate of reported ADHD medication exposures during the study period is consistent with the increasing trends in ADHD diagnosis and medication prescribing," Dr Smith said.
Strategies to prevent unintentional and intentional exposure to ADHD medications include educating parents, caregivers, and adolescents, as well as safely storing and disposing medications; use of unit dose packaging, such as blister packs; and increased use of nonpharmacologic interventions for ADHD, said Dr Smith.
He added that there is a need for studies that evaluate the effectiveness of strategies to prevent these pediatric medication exposures.
The researchers point out that it is likely that their study underestimates the frequency of pediatric ADHD medication exposures because clonidine and guanfacine were excluded and because not all exposures are reported to poison control centers.
The study authors have disclosed no relevant financial relationships.
Pediatrics. Published online May 21, 2018.
