Prescriptions for attention deficit hyperactivity disorder (ADHD) in England have risen 18% year on year since the pandemic. This is higher than previously reported, and masks wide regional variations in prescribing rates, finds research published in the open access journal BMJ Mental Health.
The trends likely reflect growing public and professional awareness of the condition, driven in part by social media, as well as the potential impact of COVID-19, suggest the researchers. But the regional variations point to inequalities in access to care, they add.
ADHD is common in children, with a global prevalence of around 7%, note the researchers, while its prevalence in symptomatic adults is also on the rise, with a reported rate of nearly 7%.
Five drugs are licensed for its treatment in the UK: three stimulants (methylphenidate, dexamfetamine, lisdexamfetamine); and two non-stimulants (atomoxetine, guanfacine). And in the absence or lack of availability of alternative treatment options, such as psychological or behavioural therapy, these drugs have a key role in ADHD management, say the researchers.
Several studies have reported an increase in ADHD prescriptions in England since the COVID-19 pandemic, but most of these studies were based on the old NHS structure—before the introduction of 42 integrated care systems—and/or focused on specific groups or types of drug.
And little is currently known about the potential influence of other factors, such as social deprivation, inequalities, and mental health needs, they add.
To explore this further, they mined the English Prescribing Dataset from April 2019 to March 2024, looking at prescription trends for the 5 currently licensed ADHD drugs at national, regional, and integrated care board (ICB) levels.
The findings showed that prescriptions increased significantly from around 25 items per 1000 people in 2019-20, before the advent of the pandemic to 41.55 items in 2023-24, with an average annual increase of 18% nationally—higher than previously reported.
Methylphenidate remained the most frequently prescribed drug (19 items/1000 people), but the highest increase was for lisdexamfetamine, prescriptions for which increased by 55% year on year, rising from 2.86 items/1000 people in 2019-20 to 8.68 items in 2023-24.
ADHD prescriptions rose in all 7 regions of England, but there were significant regional variations: London saw the highest annual increase of 28%; the Northeast and Yorkshire saw the lowest at 13%.
The second highest change in the annual prescription rate of almost 19.5% was in Southeast England.
Prescribing trends also varied widely at the ICB level. The NHS Birmingham and Solihull ICB witnessed the highest increase in prescriptions of almost 51.5%, but with considerable variation within the ICB itself. The smallest increase of just over 4.5% was in NHS Norfolk and Waveney ICB.
Further analysis showed significant statistical associations between socioeconomic factors and ADHD prescriptions, particularly ethnicity and deprivation, but also age and inequality.
Several factors may explain the substantial rise in prescription rates, say the researchers. "Increased public and professional awareness, partly driven by social media platforms like TikTok and Instagram, has likely encouraged more people to seek assessment, diagnosis and treatment," they write.
And they caution: "There is a pressing need for research into effective methods for vetting and moderating ADHD-related information on social media platforms to ensure that awareness efforts do not inadvertently spread misinformation."
The widespread disruption and increased psychological stress levels caused by the COVID-19 pandemic may also have driven up prescribing rates, they suggest.
"While our study has identified significant changes in prescription patterns during and after the pandemic, it is crucial to determine whether these trends represent a temporary shift or a more permanent change in ADHD prescriptions," they emphasise.
And they conclude: "The significant rise in ADHD prescriptions across England highlights the urgent need for policies that address both regional and socioeconomic disparities in ADHD care access. Targeted efforts should be made to meet the needs of each region by identifying specific barriers to care and their root causes."
