Potential barriers to diagnosis and treatment of Attention-Deficit / Hyperactivity Disease (ADHD) in middle-income countries is imperative to minimise risk of negative outcomes from the disorder, according to a new study published in The Lancet.
Globally, the multinational study found that ADHD medication consumption increased by 9.72 per cent per year, from 1.19 Defined Daily Dose / ter in die or three times a day (DDD/TID) in 2015 to 1.43 DDD/TID in 2019, across 64 countries representing approximately 62.4 per cent of the world’s population.
The results also showed marked differences between geographical locations.
In 2019, the study said, pooled ADHD medication consumption rates were highest in North America (111.93 DDD/TID), followed by Oceania (34.52 DDD/TID), Western Europe (17.37 DDD/TID), and Northern Europe (11.72 DDD/TID).
ADHD medication consumption rates in all other regions were much lower, at less than 10 DDD/TID, despite some having upward trends between 2015 and 2019, the study found.
When the countries were ranked by their income levels, enhanced ADHD medication consumption was observed only in high-income countries, the study said.
Middle-income countries in the study, despite having much lower baseline ADHD consumption levels than ADHD prevalence, did not show any increases in ADHD medication consumption over time.
The study further noted that current ADHD prevalence estimates and rates of ADHD medication consumption in most middle-income countries are lower than the global epidemiological prevalence.
The annual average increase of ADHD medication consumption was only significant for high-income countries (39 countries; up by 11.28 per cent), the study found.
No significant changes in ADHD consumption rates were observed in the study for upper-middle (17 countries; up by 3.23 per cent) nor lower-middle-income countries (8 countries; up by 16.6 per cent).
In 2019, the pooled consumption rates of ADHD medication were 6.39 DDD/TID in high-income countries, 0.37 DDD/TID in upper-middle-income countries and 0.02 DDD/TID in lower-middle-income countries, the study found.
Overall, four regions, namely North America, Oceania, Western Europe, and Northern Europe, made up 85 per cent of multinational ADHD medication consumption study.
Even so, some of the fastest-growing regions in the study period, including South-eastern Asia, Eastern Asia, and Western Asia, were those with low consumption rates in 2015, indicating that these regions might be catching up to the multinational norms of ADHD medication use, the study said.
The study analysed the patterns observed to find that local ADHD prevalence estimates and geographical regions were not significantly associated with ADHD medication consumption.
The scientists said that when methodological differences were taken into account, the true prevalence of ADHD in contrast to the reported estimates from individual studies, did not increase over a 27-year time span, and was similar across geographical locations.
Thus, the study noted that the rise in ADHD medication consumption is unlikely to be associated with increased ADHD prevalence. It may, however, be due to increased recognition of the important role of pharmacological treatment of ADHD, the study said.
GDP per capita was a determinant factor for ADHD medication consumption, according to the scientists.
Although most regions noted a significant increase in ADHD medication consumption over time, no significant increase was observed when analyses were restricted to upper-middle and lower-middle income countries respectively.
As such, the multinational increase in ADHD medication consumption seems to be driven by high-income countries.
The study said that it was likely possible because of more affordable ADHD medication, more concerns about educational achievement, and a larger market generating interest from pharmaceutical companies in high-income countries.
However, the study found, consumption rates of ADHD medication were strikingly higher in high-income countries than in middle-income countries – more than ten-fold greater than that in upper-middle-income countries and more than hundred-fold greater than in lower-middle-income countries (LMIC).
Consumption rates of ADHD medication in middle-income countries were also considerably lower than the epidemiological prevalence of ADHD.
ADHD is a common neurodevelopmental disorder, with a worldwide population prevalence in epidemiological studies of around 7.2 per cent in children and 2.5 per cent in adults.
It is diagnosed based on the presence of pervasive, developmentally inappropriate, and impairing levels of hyperactivity, inattentiveness, and impulsivity.
When untreated, individuals with ADHD are prone to a wide range of poor outcomes such as defiant, disruptive, and antisocial behaviours, emotional problems, self-harm, substance misuse, educational underachievement and exclusion from school, difficulties with employment and relationships, and criminality.
Timely recognition, therefore, and appropriate treatment of ADHD are essential to enhance long-term well-beings of individuals with the condition.
The study obtained the multinational ADHD medication sales data from the IQVIA-Multinational Integrated Data Analysis System (MIDAS) database.
MIDAS captures multinational data on sales volume of specific pharmaceutical products from different distribution channels such as manufacturers, wholesalers, hospitals, and retail pharmacies, with international standardisation to allow comparisons of national sales volume.
ADHD medication, in this study, namely, amphetamines, methylphenidate, atomoxetine, clonidine, and guanfacine, were identified.
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