Changing patterns of treatment and prescribers of stimulants for children, adolescents and young adults with attention deficit hyperactivity disorder in New South Wales, Australia: evidence for a treatment bottleneck? - A database study.

Abstract

ObjectiveInvestigate the treatment patterns and prescribers of stimulants for attention deficit hyperactivity disorder (ADHD) in young people in New South Wales (NSW).MethodLongitudinal cohort study of persons born after 1983 and prescribed stimulants for ADHD as per the NSW Ministry of Health Controlled Drugs Data Collection. Results were analyzed descriptively: a) treatment prevalence by year; age; sex; b) speciality of prescribers over time; c) rate of transition from paediatrics to adult psychiatry. The main analysis covered 2003-2015, with data on general practitioner prescribing to 2023.ResultsTreatment prevalence rates were highest at age 10 (22.8 per 1000 person years), declining among teenagers and stabilizing in adulthood at 2.5 per 1000. The childhood male treatment predominance (4:1) resolved to 1.6:1 in adulthood. Paediatricians were the main prescribers until age 20. The average annual percent increase in prescribers was: adult psychiatry - 13%, general practice - 20%, paediatrics - 2.6%. Only 6.3% of treated children had transitioned to adult psychiatrists by age 25; 50% starting treatment with adult psychiatrists had no previous treatment records.ConclusionsThe proportion on treatment and the male predominance declined substantially with age. Future studies may determine whether increased prescribing by general practitioners and psychiatrists reduces treatment attrition during adolescence.