ADHD Drug Misuse in Kids a Growing Problem

Megan Brooks

May 23, 2018

Unintentional and intentional pediatric exposures to stimulant medication for attention-deficit/hyperactivity disorder (ADHD) are an increasing problem in the United States and affects children of all ages, new research suggests.

From 2000 through 2014, there were 156,365 calls to US poison control centers related to exposures to ADHD medications among children and teenagers 19 years of age and younger, reports a study published online May 21 in Pediatrics.

"That averaged about 200 calls each week, or about one call every 50 minutes," lead investigator Gary Smith, MD, Nationwide Children's Hospital, Columbus, Ohio, said in a journal podcast.

"Exposures associated with suspected suicide or medication abuse and misuse among adolescents is a particular concern, especially because these result more commonly in serious medical outcomes," added Smith.

The overall rate of ADHD medication exposures increased by 71% from 2000 to 2011. This increase was followed by a nonsignificant 6% decline from 2011 to 2014. Methylphenidate and amphetamine medications each accounted for roughly 45% of the exposures.

Half of Teen Exposures Intentional

The majority of exposures involved boys (65%) aged 12 years and younger (76%).

In children younger than 6 years, exposure to ADHD medications was associated with "exploratory behavior" common in this age group, such as accessing improperly stored medications, Smith said.

Exposures among children aged 6 to 12 years were most often associated with therapeutic errors, such as being given or taking too much medication, or taking a dose too soon after taking the previous dose.

Intentional medication exposures, including suspected suicide and medication abuse or misuse, were reported most often among teenagers aged 13 to 19 years. "In fact, roughly half of reported exposures in teenagers were intentional, and exposures among teens were more likely to result in serious medical outcomes than in younger children," Smith noted.

The vast majority of unintentional or intentional pediatric exposures to ADHD medications happened at home. Most children who experienced exposure (about 60%) did not receive treatment at a healthcare facility. However, about 6% were admitted to a hospital for medical treatment, and there were three deaths.

The most common clinical effects involved the cardiovascular or neurologic system and included agitation and/or irritability, tachycardia and hypertension. These are consistent with the known mechanisms of action of stimulant medication, the researchers note.

"The increasing number and rate of reported ADHD medication exposures during the study period is consistent with the increasing trends in ADHD diagnosis and medication prescribing," Smith said.

Strategies to prevent unintentional and intentional exposure to ADHD medications include educating parents, caregivers, and adolescents, as well as safely storing and disposing medications; use of unit dose packaging, such as blister packs; and increased use of nonpharmacologic interventions for ADHD, said Smith.

He added that there is a need for studies that evaluate the effectiveness of strategies to prevent these pediatric medication exposures.

The researchers point out that it is likely that their study underestimates the frequency of pediatric ADHD medication exposures because clonidine and guanfacine were excluded and because not all exposures are reported to poison control centers.

The study authors have disclosed no relevant financial relationships.

Pediatrics. Published online May 21, 2018. Article

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