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.