Attention-deficit hyperactivity disorder in children and young persons during the COVID-19 pandemic. A temporal trends analysis of electronic heath records in Greater Manchester, England

Abstract

Background

The incidence of attention-deficit hyperactivity disorder (ADHD) in children and young people has increased in recent years. Disease frequency varies according to sociodemographic characteristics. There are seasonal patterns in ADHD diagnosis and prescribing with rates falling during school holidays. COVID-19 societal restrictions may have exacerbated ADHD symptoms. Electronic health records were utilised to examine temporal trends throughout the pandemic in the diagnosis and treatment of ADHD by ethnicity and social deprivation in Greater Manchester, England.

Methods

We conducted a time-series analysis of all diagnosed episodes of ADHD and associated medication prescribing among patients aged 1–24 years using the Greater Manchester Care Record (GMCR). The 60-month observation period was split into four temporal phases: Pre-pandemic (1/2019–2/2020); Pandemic Phase 1 (3/2020–6/2021); Pandemic Phase 2 (7/2021–12/2022) and Post-Pandemic (1/2023–12/2023). Rate ratios by sex, age, ethnicity, and neighbourhood-level Indices of Multiple Deprivation (IMD) quintile were modelled using negative binomial regression.

Results

Overall, ADHD incidence and medication prescribing rates increased throughout the study period. Rates of increase were much higher in females than in males. Particularly large increases in ADHD incidence and medication prescribing were observed in Asian females, with post-pandemic incidence rates being seven times higher compared to the Pre-Pandemic phase. In addition, the ADHD medication prescribing rate was 90% higher for Asian females than for White females. Results showed a large increase in incidence and prescribing rates in the least deprived group, particularly in males where incidence rates increased by 83% compared to the most deprived quintile.

Conclusions

ADHD incidence and prescribing rates differ between sociodemographic groups, plausibly due to cultural and behavioural differences in the way ADHD symptoms are presented or perceived. It is therefore important that there is greater understanding of how different demographic subgroups exhibit ADHD behaviour to help ensure timely diagnosis and access to the required support.