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Determinants of inter-practice variation in ADHD diagnosis and stimulant prescribing: cross-sectional database study

Uy Hoang1, Anthony C James2, Harshana Liyanage1

  • 1Department of Clinical and Experimental medicine, University of Surrey, Guildford, UK.

BMJ Evidence-Based Medicine
|February 16, 2019
PubMed

Insights

Early recognition of attention deficit hyperactivity disorder (ADHD) is crucial. This study found significant variations in ADHD diagnosis age and stimulant prescribing by general practices, influenced by family and socioeconomic factors.

Area of Science:

  • Pediatric Health
  • Neurodevelopmental Disorders
  • General Practice Research

Background:

  • Early identification and treatment of attention deficit hyperactivity disorder (ADHD) in children are vital for positive developmental outcomes.
  • Variations in diagnostic age and treatment approaches for ADHD exist within healthcare systems.
  • Understanding factors influencing ADHD diagnosis and management is essential for equitable care.

Purpose of the Study:

  • To investigate variations in the age of ADHD diagnosis among children within a nationwide general practice network.
  • To examine differences in stimulant prescribing rates for children diagnosed with ADHD across general practices.
  • To identify child, parental, household, and general practice characteristics associated with these variations.

Main Methods:

  • A cross-sectional study utilized data from the Royal College of General Practitioners (RCGP) Research and Surveillance Centre (RSC) network in 2016.
  • Included 353,774 children under 19 years across 158 general practices, with linked parent and child data.
  • Analyzed age of first ADHD diagnosis and stimulant medication prescription rates, exploring associated demographic and practice-level factors.

Main Results:

  • The mean age of ADHD diagnosis was 10.5 years, with considerable inter-practice variation.
  • Approximately 41.2% of children with ADHD received stimulant medication, also showing significant practice-level differences.
  • Later ADHD diagnosis was linked to larger families and greater age differences between adults and children; stimulant prescribing was higher in less deprived practices.

Conclusions:

  • Significant disparities exist in the age of ADHD diagnosis and stimulant prescribing across UK general practices.
  • Family structure (number of children, age gaps) and socioeconomic status of the practice area influence ADHD diagnosis timing and treatment.
  • Targeted support for families with more children and further investigation into socioeconomic influences on prescribing are warranted.

Keywords:
mental healthprimary care

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