REPORT: Turning Attention to ADHD

Mar 12, 2014
Express Scripts' new report, Turning Attention to ADHD, investigates medication utilization trends for Attention Deficit Hyperactivity Disorder.
  • Attention Disorders
  • Female
  • Children
  • Teenagers

Today we released the report, Turning Attention to ADHD: U.S. Medication Trends for Attention Deficit Hyperactivity Disorder, the most current and comprehensive analysis of ADHD medication use. According to our pharmacy claims data, between 2008 and 2012, the number of Americans who use medication to treat ADHD rose 36%, totaling more than 4.8 million privately insured individuals in 2012.

Most surprisingly, we saw the greatest increase in use during the five-year study period was among adults, with the largest gains seen in women ages 26 to 34, climbing 85%.

No Longer Just a Childhood Condition

While children are still the primary users of ADHD medications, the number of adults on these medications has been increasing at a much faster pace, up 53.4% vs. 18.9% from 2008 to 2012.

Among adults, women far outnumber men in their use of ADHD treatments, the reverse of childhood trends where only half as many girls as boys take ADHD medications. The number of males using ADHD drugs plummets after age 18, while women ages 19 to 25 surpass younger girls’ use of these medications, 4.4% vs. 3.5% respectively in 2012.

ADHD bar chart

Other notable trends include:

  • The percentage of boys ages 12 to 18 using ADHD medications reached 9% in 2012, an 18% increase from 2008.
  • The southern region of the U.S. has the highest concentration of ADHD medication use, with South Carolina showing the greatest prevalence overall: 14% of 12 to 18 year olds are on an ADHD medication treatment.
  • The prescribing of antipsychotic treatments is exceptionally high among those treated for ADHD (12% vs. 4% of non-ADHD medication users); however, the number has been declining in recent years.

What’s Driving This Dramatic Shift?

The rapid increase in adult use of these medications is striking, especially because there is little research on how these treatments affect an older population.

Since females tend to present the inattentive form of ADHD and do not display disruptive behavior in school, their symptoms may be overlooked in childhood. As they age, they may become more aware of their symptoms and consult their physician.

There are, however, concerns that less appropriate uses of the medication may be behind the increase in use among women. Stimulant medications are known to decrease a person’s appetite and are sometimes used as a weight-loss aid. Also, some women may turn to these medications, or experience symptoms of attention disorders, as a result of keeping up with the multiple demands on their time.

While generally safe for the majority of the population of patients, stimulants prescribed for ADHD come with several serious safety concerns and have an addictive nature. Use of these medications can be dangerous for patients with heart problems and may cause serious interactions with other medications and conditions, like bipolar disorder.

The trends here signal a need to look more closely at how and why physicians prescribe these medications for adults and the need for prescribers to fully assess the entire psychosocial landscape of an individual patient prior to reaching for the prescription pad.

Protecting Patient Safety

Our clinical programs and model of specialized pharmacy practice, which includes neuroscience and behavioral health, provide an important safety net for patients who may be struggling with side effects from ADHD medications, as well as additional mental disorders that can complicate their care.

The Express Scripts programs – Advanced Utilization Management and RationalMed® Patient Safety – identify medication risks and alert pharmacists and physicians to potential problems so prescription changes can be made.

Patients with ADHD also benefit from the expertise and experience provided through the Express Scripts Neuroscience Therapeutic Resource Center®, where specialist pharmacists with advanced training in behavioral treatments oversee their care. With ADHD medication abuse a growing problem, specialist pharmacists also are on the lookout for any suspicious use of these medications that could indicate potential abuse. If abuse is suspected, the Express Scripts Fraud, Waste &  Abuse program can investigate, and when necessary, will refer to the proper legal authorities.

About the Report

From an annual sample size of approximately 15 million privately insured individuals under age 65, the research examined the de-identified pharmacy claims of more than 400,000 individuals who filled at least one prescription for a medication indicated for the treatment of ADHD during the five-year study period. The analysis includes trends in utilization, cost and the use of concurrent treatments including antidepressants, antipsychotics and behavioral therapy.

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