ICES research video series: Paul Kurdyak on ADHD rates and medication trends in Ontario

By Paul Henry / in , , /

Attention deficit hyperactivity disorder, or ADHD, is exactly as it’s named. “Attention deficit” refers to trouble sitting still; trouble staying focused on tasks; trouble concentrating over a prolonged period of time; and the hyperactivity aspect of this is the behavioral piece; is that you will notice the kids are fidgety; have trouble sitting still and it’s not enough to just have those symptoms; those symptoms have to be of sufficient severity and magnitude to actually have an impact on function. And the most common place where that becomes evident is in the school setting. ADHD, we all know, is a very common condition, and there are lots of studies showing that it’s a burden. We felt it was very important to have some robust Canadian information. At ICES in our mental health and addictions program we’re trying to catch up with the rest of ICES and the rest of the health care system more generally by shining a light on mental health and mental illness issues at the population level. When we look at historically what’s been done in that area, the area around child mental health is even less well-reported so we know very very little relative to adult mental health, and we certainly know very little about child mental health issues relative to the rest of the health care sector. This study uses work that was led by another ICES scientist Dr. Karen Tu and her colleagues who brought in electronic medical record information and linked it to the rest of the data we have at ICES. It’s a really rich source of information and we had access to 250,000 electronic medical record or EMR sources of data for kids; of which we took a random sample of 10,000 to make it more meaningful. What the scientists did, in particular the first author of the study Dr. Tanya Hauck, spent a laborious amount of time actually looking at each of these records to pull out kids with ADHD diagnoses based on a bunch of parameters, and used the fact that these EMRs are linked to our health data at ICES to get at their health service utilization information as well. It is as common as we think; the prevalence of ADHD in childhood is about five per cent, and as has been shown elsewhere, it’s more common, at least in the primary care setting where we’ve been looking at it, in males than females. The prevalence in males was about eight per cent, and the prevalence in females is about three per cent. The second piece had to do with what medications were being used to treat the disorder. Not surprisingly, 70 per cent of individuals who were deemed to have ADHD were treated with stimulants, and that’s what we should see, because that is the first-line treatment. Another finding was that twelve per cent of children and youth with ADHD were prescribed anti-psychotics. This seems like a high rate of anti-psychotic use, particularly when we found that one in four of the children and youth didn’t have any mental illness diagnoses, and of those that did have mental illness diagnoses, that most of them were not diagnoses that one would typically use atypical anti-psychotics for. And this becomes a risk/benefit issue. The risks of anti-psychotics are well known and particularly in children and youth, where children gain weight very quickly and develop signs and symptoms suggestive of early-onset diabetes and when you are using anti-psychotics with those risks and don’t carefully figure out the indications for use and the expected benefits, it becomes a problem. In our work with the ICES mental health program we always strive to place our efforts in areas where we think there is a real gap, but a real sense of importance, and I think the fact that we were able to figure out ways to identify children with ADHD is a very important piece of work because what we find is that it’s very common; and we found some findings that we need to follow up on, in order to provide the information that kids with ADHD, their families and policymakers need, the evidence they need to manage this very common condition.

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