September 20, 2023 – Medication errors amongst children taking medications to treat attention deficit hyperactivity disorder (ADHD) reported to U.S. poison control centers rose nearly 300% over a 22-year period, in response to a recent report within the Journal published study shows Pediatrics has found.
The dramatic increase is probably going attributable to a rise in ADHD medication prescriptions for youngsters. In 2019, nearly 10% of kids within the United States were diagnosed with ADHD, and about 3.3 million — or about 5% of all children within the country — had received a prescription for an ADHD medication, in response to the study authors.
“Because treatment errors are preventable, more attention should be paid to educating patients and caregivers and developing improved systems for dispensing and tracking child-safe medications,” the authors write.
Researchers analyzed data from the National Poison Data System from 2000 to 2021 for treatment errors related to ADHD medications in patients under 20 years old.
“As medicine changes, it's nice to look back at some of these things and see how some of these problems have changed,” said Natalie I. Rine, PharmD, co-author of the study and director of the Central Ohio Poison Center at Statewide Children's Hospital in Columbus.
The researchers identified 124,383 such errors that were reported to U.S. poison control centers through the study period. The frequency increased by 299%.
Two-thirds (66.6%) of the exposures involved children aged 6 to 12 years, three-quarters (76.4%) were males, and half (50.5%) involved stimulants and related compounds. Most (79.7%) treatment errors were related to exposure to a single substance. Almost 83% of patients didn't receive treatment in a hospital. But 2.3% were hospitalized and 4.2% had a “serious medical outcome,” the researchers noted.
The most typical scenarios were “accidentally taking or administering medication twice” (53.9%), followed by “accidentally taking or administering another person’s medication” (13.4%) and “incorrectly taking or administering medication” (12 .9%), in response to the researchers. Two percent were errors by a pharmacist or a nurse.
Easily avoidable
Rine said easy mistakes caused the errors, which were likely the results of busy households and distracted caregivers. She said the mistakes could easily be avoided by storing medications properly, keeping a medicine sheet to record what was taken and when, and using a pill box or considered one of many apps that might help Document medication dishing out.
“I think the most important thing is that many of these mistakes are preventable more than anything else,” Rine said.
The increase in ADHD diagnoses in children and resulting medication prescriptions are reasons for the nearly 300 percent increase in poison control calls. A 2018 study showed that the estimated prevalence of ADHD diagnoses amongst children and adolescents within the United States increased from 6.1% in 1997 to 1998 to 10.2% in 2015 to 2016. The CDC states that 6 million children and adolescents ages 3 to 17 have been diagnosed with ADHD and 62% have received ADHD medication.
Colleen Kraft, MD, a pediatrician at Children's Hospital Los Angeles, said she was not surprised by the reported increase in errors. In addition to the straightforward increase in ADHD diagnoses and prescriptions over the past twenty years, Kraft said the growing number of ADHD medications is a reason for more errors.
“Because we have so many different types of these medications, it's easy to get confused and make a mistake when giving them to a child,” she said.
Kraft also said that because ADHD can have a genetic component, some parents with undiagnosed and untreated ADHD could also be accountable for their child's medication – a scenario that results in errors.
Possible dangers
Not every overdose of ADHD medication is similar, Kraft emphasized. Double taking a stimulant resembling methylphenidate, more commonly referred to as Ritalin, or the mix of amphetamine and dextroamphetamine, or Adderall, may cause headaches, suppress appetite, and cause stomach upset, although these symptoms often disappear inside a couple of hours.
However, she noted that the usage of alpha-1 blockers is more concerning. Medications resembling guanfacine and clonidine are also used to treat hypertension and have a sedative effect. A double dose may cause blood pressure to drop to dangerous levels.
The most important limitation of the study, researchers said, was self-reporting bias, which could have led to underreporting of cases. Not every case where a mistake occurs involving a baby taking ADHD medication is reported to poison control, as some wait and will not call if their child has no symptoms.
“Our data is only as good as what callers report to us,” Rine said.