The British Journal of Psychiatry (2009) 194: 273-277. doi: 10.1192/bjp.bp.107.045245
© 2009 The Royal College of Psychiatrists
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Attention-deficit hyperactivity disorder: treatment discontinuation in adolescents and young adults

Suzanne McCarthy

Centre for Paediatric Pharmacy Research, School of Pharmacy, University of London and Institute of Child Health, University College London

Philip Asherson

MRC Social Genetic and Developmental Psychiatry Centre, Institute of Psychiatry, London

David Coghill

Section of Psychiatry, University of Dundee, Ninewells Hospital and Medical School, Dundee

Chris Hollis

Division of Psychiatry, School of Community Health Sciences, Nottingham

Macey Murray

Centre for Paediatric Pharmacy Research, School of Pharmacy, University of London, and Institute of Child Health, University College London

Laura Potts

Mental Health and Neuroscience Clinical Trial Unit, Institute of Psychiatry, London

Kapil Sayal

Division of Psychiatry, School of Community Health Sciences, Nottingham

Ruwan de Soysa

Royal Liverpool Children's NHS Trust, Alder Hey, Liverpool

Eric Taylor

Department of Child and Adolescent Psychiatry, Institute of Psychiatry, London

Tim Williams

General Practice Research Database, Medicines and Healthcare Products Regulatory Agency, London

Ian C. K. Wong

Centre for Paediatric Pharmacy Research, School of Pharmacy, University of London and Institute of Child Health, University College London, UK

Correspondence: Ian C. K. Wong, Institute of Child Health, University College London, 29/39 Brunswick Square, London WC1N 1AX, UK. Email: ian.wong{at}pharmacy.ac.uk

Declaration of interest

I.C.K.W. was funded by a Department of Health Public Health Career Scientist Award at the time of the study. I.C.K.W., P.A., C.H., K.S. and E.T. are members of the National Institute for Health and Clinical Excellence guideline committee on ADHD. P.A. has attended advisory board meetings for Janssen-Cilag and Shire and has been reimbursed for talks at Janssen-Cilag, Eli Lilly and UCB Pharma sponsored meetings. D.C. is an advisory board member for Cephalon, Eli Lilly, Janssen Cilag, Shire and UCB-Celltech, and has research funding from Eli Lilly and Janssen-Cilag; he is on the professional board of the National Attention Deficit Disorder Information and Support Service (ADDISS) and is on the project group for the NHS Quality Improvement Scotland audit of ADHD care in Scotland. K.S. has received reimbursement of expenses by Janssen-Cilag, manufacturer of methylphenidate, for attending a conference. R.D.S. has been reimbursed by Janssen-Cilag, UCB Pharma and Lilly Pharmaceuticals, manufacturer of methylphenidate and atomoxetine, for attending several conferences, and has been paid by UCB Pharma for attending consultation workshops. The School of Pharmacy, University of London has received an educational grant from Janssen-Cilag.

Background

Symptoms of attention-deficit hyperactivity disorder (ADHD) are known to persist into adulthood in the majority of cases.

Aims

To determine the prevalence of methylphenidate, dexamfetamine and atomoxetine prescribing and treatment discontinuation in adolescents and young adults.

Method

A descriptive cohort study using the UK General Practice Research Database included patients aged 15–21 years from 1999 to 2006 with a prescription for a study drug.

Results

Prevalence of prescribing averaged across all ages increased 6.23-fold over the study period. Overall, prevalence decreased with age: in 2006, prevalence in males dropped 95% from 12.77 per 1000 in 15-year-olds to 0.64 per 1000 in 21-year-olds. A longitudinal analysis of a cohort of 44 patients aged 15 years in 1999 demonstrated that no patient received treatment after the age of 21 years.

Conclusions

The prevalence of prescribing by general practitioners to patients with ADHD drops significantly from age 15 to age 21 years. The fall in prescribing is greater than the reported age-related decrease in symptoms, raising the possibility that treatment is prematurely discontinued in some young adults in whom symptoms persist.


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