Current use of attention-deficit hyperactivity disorder (ADHD) medications and clinical characteristics of child and adolescent psychiatric outpatients prescribed multiple ADHD medications in Japan

Abstract

Background/aim Patients with attention-deficit hyperactivity disorder (ADHD) manifest symptoms of hyperactivity, impulsivity, and/or inattention. ADHD medications available in Japan are limited compared with those in Western countries. Prescribing status has not been sufficiently evaluated in clinical settings in Japan. This study investigated the current use of ADHD medications and characteristics of patients who received multiple ADHD medications in a clinical setting in Japan. Methods Study participants were those who visited the Department of Child and Adolescent Psychiatry, Kohnodai Hospital between April 2015 and March 2020. We investigated patients who received osmotic-controlled release oral delivery system methylphenidate, atomoxetine, or guanfacine. A retrospective case–control design was used to evaluate the characteristics of patients who received multiple ADHD medications. Patients who were given three ADHD medications were defined as the case group. Randomly sampled sex- and age-matched patients diagnosed with ADHD were defined as the control group. We compared data for child-to-parent violence, antisocial behavior, suicide attempt or self-harm, abuse history, refusal to attend school, and two psychological rating scales (the ADHD-Rating Scale and Tokyo Autistic Behavior Scale). Results Among the 878 patients who were prescribed any ADHD medications, 43 (4.9%) received three ADHD medications. Logistic regression revealed that children with severe ADHD symptoms, autistic characteristics, or tendency of child-to-parent violence were more likely to have been prescribed three medications during their treatment. Conclusions Our findings suggest the approach to prevent the use of multiple ADHD medications. A prospective study to investigate the causality between prescribing status and clinical characteristics is warranted.

Practical clinical guidelines and pharmacological treatment for attention‐deficit hyperactivity disorder in Asia

“…23 Despite concerns about overdiagnosis and inappropriate prescription for ADHD worldwide, many children diagnosed with ADHD may receive insufficient pharmacological treatment in Japan because of caution against the risks compared with the benefits. 24,25 Raman et al indicated that differences in regional clinical guidelines for ADHD treatment recommendations are related to the differences in prescription prevalence across the world. 26 The Japanese guidelines for ADHD are peculiar compared with that of other Asian countries and regions as LDX and GXR can be prescribed while MPH-IR is unavailable.…”

“…The prevalence of ADHD in school‐aged children varies considerably between countries; for example, white individuals have higher rates of ADHD than Asian individuals 23 . Despite concerns about overdiagnosis and inappropriate prescription for ADHD worldwide, many children diagnosed with ADHD may receive insufficient pharmacological treatment in Japan because of caution against the risks compared with the benefits 24,25 . Raman et al.…”

Psychodynamic therapy for adverse childhood experience in a hospitalized girl with attention deficit hyperactivity disorder

“…Close attention should be paid to environmental factors (e.g., bullying, teacher reprimands, parental abuse) that may influence the symptoms of ADHD. For example, of the 878 patients prescribed the three anti-ADHD medications Methylphenidate, Atomoxetine, and Ganfacine, 43 (4.9%) had used all three medications, indicating that children with severe ADHD symptoms, autistic features and child-parent violence are more likely to experience all three during their treatment have been found to be more likely to experience three medications during treatment (4). Therefore, it is crucial to assess the background of ADHD symptoms and, in doing so, consider interventions for these background factors.…”