Medication Errors in ADHD Treatment Among Youth Under 20 Surged Nearly 300%

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Medication Errors in ADHD Treatment Among Youth Under 20 Surged Nearly 300%

A recent study reveals a startling increase in medication errors related to Attention Deficit Hyperactivity Disorder (ADHD) in American adolescents under the age of 20 over the past 22 years, with most errors occurring in homes.

Researchers emphasize the urgent need for enhanced education for patients and caregivers to prevent these preventable mistakes.

Attention Deficit Hyperactivity Disorder (ADHD) is one of the most common neurodevelopmental disorders in pediatrics.

It is estimated that in 2019, 9.4% of children in the United States were diagnosed with ADHD, with 5 out of every 100 children receiving prescription medication as part of their treatment.

Medication Errors in ADHD Treatment Among Youth Under 20 Surged Nearly 300%

Stimulants such as methylphenidate (e.g., Ritalin, Concerta), amphetamine (Adderall), lisdexamfetamine (Vyvanse, Elvanse), and modafinil (Provigil) are commonly prescribed for ADHD treatment. Non-stimulant medications like atomoxetine (Strattera), guanfacine (Tenex, Intuniv), and clonidine (Kapvay) are also prescribed. However, like any medication, there is a potential for errors when administering these drugs to children and adolescents, resulting in adverse effects.

Researchers from Nationwide Children’s Hospital examined the rates of outpatient ADHD medication errors in adolescents under 20 reported to the American Association of Poison Control Centers from 2000 to 2021 and uncovered concerning statistics.

The National Poison Data System (NPDS) defines medication errors as “unintentional deviations from the correct treatment regimen leading to dosage errors, route errors, patient errors, or substance errors,” with reports coming through the national poison hotline.

In the current study, researchers retrospectively analyzed NPDS data from 2000 to 2021. Participants were categorized by age: under 6, 6 to 12, and 13 to 19 years old. Locations of exposure were classified as residence (own or others’), school, other (public places, workplaces, restaurants), or unknown. ADHD medications were divided into amphetamines and related compounds, methylphenidate, guanfacine, clonidine, modafinil, or atomoxetine.

The researchers found that between 2000 and 2021, the American Association of Poison Control Centers received a total of 124,383 reports related to ADHD medication errors, representing a 299% annual increase in frequency. During the study period, there were 87,691 cases of medication errors primarily involving ADHD medications in youth under 20, averaging 3,985 cases per year.

In 2021 alone, 5,235 medication errors were reported, equivalent to one child experiencing a medication error every 100 minutes. These errors were predominantly male (76%) and involved children aged 6 to 12 (67%). The majority of exposures (93%) occurred in homes. Amphetamine and related compounds ranked first among the medications involved (50.5%), followed by guanfacine (23.1%) and methylphenidate (14.7%). The most common error scenarios were “accidental double dosing/administration” (53.9%), “accidental dosing/administration to others” (13.4%), and “administration of the wrong medication” (12.9%).

While 83% of cases did not require treatment, 2.3% required hospitalization, with 0.8% needing intensive care unit admission. Furthermore, 4.2% of cases experienced severe medical outcomes, with some children exhibiting agitation, tremors, seizures, and altered mental status. Children under 6 were twice as likely to experience severe medical outcomes and more than three times as likely to be hospitalized compared to those aged 13 to 19.

One of the co-authors of the study, Natalie Rine, remarked, “The increase in reported medication errors aligns with findings from other studies, suggesting an increase in the diagnosis of ADHD in American children over the past two decades, likely related to increased use of ADHD medications.”

The researchers stress that their findings underscore the need for improved education on ADHD medication, possibly necessitating changes in medication practices.

The corresponding author of the study, Gary Smith, stated, “Since ADHD medication errors are preventable, there should be a greater focus on educating patients and caregivers, as well as developing improved systems for distributing and tracking pediatric-resistant medications. Another strategy might involve transitioning from medication bottles to unit-dose packaging, such as blister packs, which could help in remembering whether the medication has been taken or administered.”

The study has been published in the journal Pediatrics.