There has been a significant rise in medication prescriptions for attention deficit hyperactivity disorder (ADHD) in England, according to new research.
The report, published in BMJ Mental Health, found that prescriptions have risen 18% year on year since the pandemic, which is higher than previously reported and masks wide regional variations in prescribing rates.
Five drugs are licensed for its treatment in the UK: three stimulants (methylphenidate, dexamfetamine, lisdexamfetamine) and two non-stimulants (atomoxetine, guanfacine). 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 drugs.
The researchers analysed data from the English Prescribing Dataset from April 2019 to March 2024, looking at prescription trends for the five currently licensed ADHD drugs at national, regional, and integrated care board (ICB) levels.
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 seven regions of England, but there were significant regional variations: London saw the highest annual increase of 28%, and the Northeast and Yorkshire saw the lowest, at 13%. Southeast England had the second-highest change in the annual prescription rate, almost 19.5%.
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.
The researchers say several factors may explain the substantial rise in prescription rates. Widespread disruption and increased psychological stress levels caused by the Covid-19 pandemic may also have driven up prescribing rates.
They added: “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.
“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.”
