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While one in 20 children in Australia have been diagnosed with ADHD, a Melbourne study has found that children being prescribed ADHD medication inconsistently take their medication, going without treatment on average 40 per cent of the time.
The study, led by the Murdoch Children’s Research Institute (MCRI) with contributions from researchers from the University of Melbourne, The Royal Children’s Hospital and Deakin University, drew its findings from The Longitudinal Study of Australian Children.
They found that of the 3,537 children in the study, 166 (3.6%) had redeemed a prescription for ADHD at some stage.
“It’s an important figure because in practical terms it’s a proxy for [levels of] moderate to severe ADHD. ADHD affects about five per cent of all kids, but not all children with ADHD get diagnosed, and not all kids with ADHD do or should get prescribed medication,” says Associate Professor Daryl Efron, a paediatrician at Royal Children's Hospital and senior research fellow at the Murdoch Children's Research Institute.
Children with mild ADHD can manage using strategies that don’t include medication, says Associate Professor Efron. However, for four out of five ADHD-diagnosed children medication is a useful support. Associate Professor Efron says that given ADHD is a chronic condition, this medication should usually be taken medium to long term if prescribed.
It’s one reason researchers were concerned to learn that medication use appeared to drop for many children with ADHD over time.
They found that for the first 90 days a child was prescribed ADHD medication, 81 per cent of those prescriptions were filled. However, things changed significantly after the 90 day mark. From this point, only 54 per cent of expected prescriptions were filled.
Furthermore, this drop in medication use stayed low: rates didn’t come back up to those early numbers until children had been taking the medication for five to six years.
While researchers suspected adherence to ADHD medication was inconsistent in many cases, the data provided some of the first hard evidence showing that children diagnosed with ADHD inconsistently take their prescribed medication.
The challenges of staying on medication long term.
Although medical practitioners have long known it is challenging for anyone to stay on medication long term, they were surprised when they analysed the data on ADHD medication use.
“Persistence with any long-term medication is far from optimal for anyone on any medication. But we were surprised that kids who should be on medication were not picking up their prescriptions from the chemist 40 per cent of the time,” Associate Professor Efron says.
Given that approximately 90 per cent of children with ADHD respond well to at least one of the available medications, medication is often recommended as first line treatment for children with moderate to severe impairing ADHD.
As ADHD is a chronic condition, Associate Professor Efron says there is a strong argument treatment should be provided consistently for several years, making these fluctuations in taking the medication a concern.
He says the discrepancy was too large to be explained by children only taking medication on school days, an explanation some have thought might be causing the drop.
How can ADHD impact a child’s behaviour?
Associate Professor Efron says ADHD is simply a shorthand term for children who have a certain set of difficulties.
“Of course, every child with ADHD is different, and all have different personalities and sets of difficulties and strengths. With that in mind, children with ADHD simply have more difficulty than their same age peers and more difficulty than peers with the same overall intelligence in sustaining their focus on a task,” Associate Professor Efron says.
“They tend to be impulsive, are easily distracted, and find it hard to sustain their focus on something that’s not of high interest to them.”
Medication can support children with ADHD by helping them with the focus needed for tasks like reading or spelling.
“Most kids can harness the energy to do something because they know it’s important. Anyone with ADHD – adult or child – will find that more taxing,” Associate Professor Efron says.
Medication adherence lower in lower socioeconomic families
The researchers discovered that the inconsistent use of medication was also more prevalent in lower socioeconomic families.
“That wasn’t the focus of this work but we know from other work that there are barriers to equitable medical care in Australia. We also know for any family that [getting on and] staying on ADHD medication is not easy: in Australia you need to see a paediatrician or child psychiatrist – even getting those appointments can be difficult,” he says.
Another challenge for families lies in the fact that a lot of the work involved in diagnosing ADHD happens in the private sector. This can mean that out of pocket costs are a barrier for some families, even before they consider the cost of ongoing prescriptions.
Although ADHD medications are subsidised through the Pharmaceutical Benefits Scheme, dispensing fees can be $20 or $30.
It all adds up to a situation where children from socially disadvantaged families who were prescribed ADHD medication were less likely to consistently take it.
“We know low socio economic families can find it more difficult to attend medical appointments, with factors including appointment costs, transport difficulties and missed work all potentially contributing,” Associate Professor Efron says.