"The groundwork of all happiness is health." - Leigh Hunt

Errors within the treatment of ADHD patients have increased dramatically over the past twenty years

September 20, 2023 – Medication errors reported to U.S. poison control centers amongst children stoning up to treat attention deficit hyperactivity disorder (ADHD) have increased by nearly 300% over a 22-year period, in line with a latest study published within the journal Pediatrics has found.

The dramatic increase is probably going on account of an increase in prescriptions for ADHD medications 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, the study authors said.

“Because treatment errors are preventable, more attention should be paid to educating patients and caregivers and developing improved, child-safe systems for medication dispensing and tracking,” the authors write.

The 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 of age.

“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, study co-author and director of the Central Ohio Poison Center at Nationwide Children's Hospital in Columbus.

The researchers identified 124,383 such errors that were reported to U.S. poison control centers in the course of the study period. The frequency thus increased by 299 percent.

Two-thirds (66.6%) of exposures involved children ages 6 to 12, three-quarters (76.4%) involved boys, and half (50.5%) involved stimulants and related substances. Most (79.7%) treatment errors were on account of exposure to a single substance. Nearly 83% of patients weren’t treated in a health care facility. But 2.3% were hospitalized and 4.2% had “serious medical consequences,” the researchers found.

According to the researchers, essentially the most common scenarios were “accidental ingestion or double administration of medication” (53.9%), followed by “accidental ingestion or administration of another person's medication” (13.4%) and “incorrect ingestion or administration of medication” (12.9%). Two percent of cases involved errors by a pharmacist or nurse.

Easily avoidable

Rine said the errors were on account of easy mistakes likely attributable to busy households and inattentive caregivers. She said the errors could easily be avoided by storing medications properly, keeping a sheet with medications to document what was taken and when, and using a pill box or one among the numerous apps that may also help document medication administration.

“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 subsequent prescription of medicines are reasons for the nearly 300% increase in calls to poison control centers. A 2018 study showed that the estimated prevalence of ADHD diagnoses amongst children and adolescents within the United States increased from 6.1% in 1997-1998 to 10.2% in 2015-2016. The CDC states that 6 million children and adolescents ages 3 to 17 have been diagnosed with ADHD and 62% have received ADHD medications.

Colleen Kraft, 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 20 years, the growing number of ADHD medications is a reason for more errors, Kraft said.

“Because there are 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 ADHD can also have a genetic component, and that’s the reason some parents whose ADHD has not been diagnosed or treated are chargeable for their child's medication – a scenario during which many errors can arise.

Possible dangers

Not all ADHD medication overdoses are the identical, Kraft stressed. Double-dosing on a stimulant resembling methylphenidate, higher generally known as Ritalin, or the mixture of amphetamine and dextroamphetamine or Adderall may cause headaches, lack of appetite and upset stomach, although these symptoms normally go away after a number of hours.

However, she noted that using alpha-1 adrenoceptor blockers is more concerning. Drugs resembling guanfacine and clonidine, also used to treat hypertension, have a sedative effect. A double dose can lower blood pressure to dangerous levels.

The study's biggest limitation was self-reporting bias, which researchers say can have led to underreporting of cases. Not every case where an error occurs and a toddler is taking medication for ADHD is reported to poison control, as some people take a wait-and-see approach and will not call if their child isn’t experiencing symptoms.

“Our data is only as good as what the callers tell us,” Rine said.