UK ADHD treatment rates – a regional variation model

UK ADHD treatment rates – a regional variation model | Research Square window.SnipcartSettings = { analytics: { enabled: false } }; (function() { var accessVector = localStorage.getItem('access_vector') || ''; window.dataLayer = window.dataLayer || []; if (accessVector) { window.dataLayer.push({ user: { profile: { profileInfo: { snid: accessVector } } } }); } })(); (function(w,d,s,l,i){w[l]=w[l]||[];w[l].push({'gtm.start':new Date().getTime(),event:'gtm.js'});var f=d.getElementsByTagName(s)[0],j=d.createElement(s),dl=l!='dataLayer'?'&l='+l:'';j.async=true;j.src='https://www.googletagmanager.com/gtm.js?id='+i+dl;f.parentNode.insertBefore(j,f);})(window,document,'script','dataLayer','GTM-K279D39R'); Browse Preprints In Review Journals COVID-19 Preprints AJE Video Bytes Research Tools Research Promotion AJE Professional Editing AJE Rubriq About Preprint Platform In Review Editorial Policies Our Team Advisory Board Help Center Sign In Submit a Preprint Cite Share Download PDF Research Article UK ADHD treatment rates – a regional variation model Blandine French, James Davies, Chris Williams, Amanda Kirby This is a preprint; it has not been peer reviewed by a journal. https://doi.org/ 10.21203/rs.3.rs-5956482/v1 This work is licensed under a CC BY 4.0 License Status: Posted Version 1 posted You are reading this latest preprint version Abstract Background – Attention deficit hyperactivity disorder (ADHD) is a common condition impacting approximately 5% of children and 3-4% of adults in the United Kingdom (UK). While it cannot be cured, treatment has shown to positively impact the difficulties associated with ADHD. However, ADHD is widely under-diagnosed and under-treated in the UK. This paper reports the results of a model developed to estimate pharmacological treatment rates by area across National Health Service (NHS) integrated care systems (ICSs) in England, health boards in Scotland and Wales, and health & social care trusts (HSCTs) in Northern Ireland. Methods - The model used UK general population and ADHD prevalence data to estimate the number of patients with ADHD in each area. Prescription data for medicines licensed for the treatment of ADHD were then used to estimate the number of patients that are untreated and treated, and percentage treatment rates by area. Results - Nationally, the estimated proportions of the children and young people (CYP; 5–17 years) and adult populations (18–65 years) treated were 26.6% and 15.6%, respectively, of the expected ADHD populations. Treatment rates by ICS or health board in England, Scotland and Wales ranged from 11.7% to 60.6% for the CYP population, and 8.6% to 24.8% in the adult population (data for Northern Ireland were not available by age group). Overall treatment rates (ages 5–65 years) in Northern Ireland ranged from 6.7% in the lowest ranking HSCT to 31.1% in the highest-ranking HSCT. Conclusions - In the UK, there is currently a high degree of geographic variation across all NHS systems and a generally low level of treatment of ADHD, especially in adults. Up to a 4.6-fold difference in pharmacological treatment rates was observed between NHS service provider areas. ADHD treatment treatment rates variation model healthcare services Figures Figure 1 Figure 2 Figure 3 Figure 4 Figure 5 Figure 6 Figure 7 Figure 8 Figure 9 Figure 10 Background In the UK, attention deficit hyperactivity disorder (ADHD) is estimated to affect approximately 5% of children ( 1 , 2 ) and 3–4% of adults ( 3 , 4 ) and is generally recognised as underdiagnosed and undertreated ( 2 , 5 ). ADHD can lead to considerable cognitive and behavioural impairment, affecting social behaviour, educational outcomes and day-to-day family interactions ( 6 ). In adulthood, these impairments, if untreated, are associated with higher rates of criminal behaviour, loss of work, addiction, suicidality and failed relationships ( 7 ). Services for ADHD, especially in adulthood, are scarce and underfunded ( 8 , 9 ) causing hundreds of thousands of children and adults to receive inadequate support or experiencing long delays in management ( 2 ). This leads to poorer outcomes for the individual and their families, with undiagnosed (and therefore unsupported) ADHD resulting in a range of consequences in the short and longer term. This includes significant academic underachievement and educational challenges, increased prevalence of depression and anxiety, higher rates of offending behaviour and imprisonment, driving accidents, substance abuse and unemployment ( 10 ). Diagnosis facilitates access to care or treatment ( 11 , 12 ), and in turn, appropriate interventions have been shown to positively impact the difficulties experienced by individuals, often preventing further struggles ( 13 , 14 ). Hence, early diagnosis and intervention are of utmost importance in targeting some of the long-term risks for individuals living with ADHD. However, as highlighted in Lord Darzi’s recent independent investigation of the National Health Service (NHS) in England, the growth in demand for ADHD assessments has been so significant that it risks overwhelming services, with many English trusts unable to clear the backlog in adult ADHD assessments for decades, if continued at current rates ( 15 ). In May 2024, NHS England announced the creation of an ADHD task force to tackle the many difficulties in access to care ( 16 ). A report from the Demos think-tank estimates that the hidden costs of undiagnosed ADHD to the economy could amount to billions of pounds yearly and calls for urgent action to uncover the true economic costs ( 17 ). While economic studies have assessed the costs of having ADHD ( 18 , 19 ), research has not yet focused on the costs of not diagnosing and treating people with ADHD on an individual or societal level. Previous health economic research has shown the significant cost of undiagnosed, and therefore untreated, mental health conditions in the general population and led to the creation of NHS Improving Access to Psychological Therapies (IAPT) policy ( 20 ). To establish the national cost of unsupported ADHD in the UK, it is first important to assess the level of national treatment rates. It is estimated that millions of adults and children with ADHD are currently undiagnosed in the UK ( 2 , 21 , 22 ) and this issue prevails around the world. In Denmark, as one example, over half of the children in a national birth cohort with probable ADHD based on parent-reported behaviour at age 7, were not diagnosed at follow-up many years later ( 23 ). Sayal and colleagues ( 2 ) reviewed the administrative prevalence in the UK, (i.e., the number of people with clinically diagnosed or recorded with ADHD as a proportion of the whole population) and found a wide range of prevalence from 0.19–0.76% in children and 0.29% in adults. A more recent cohort study ( 24 ) established that the prevalence of children receiving treatment in the UK by 2018 was 1.56% in boys and 0.36% in girls, but only 0.1% in adults. While diagnosis and treatment rates have increased over the years, it is still a long way from the reported community prevalence of approximately 5%. To date, no study has established individual treatment rates across different regions in the UK. This study aimed to assess the variability of ADHD treatment rates within children and young people (CYP) and adult ADHD services across the UK, establishing a national average and regional differences. Methods A model was developed in Microsoft Excel, and is the intellectual property of Takeda UK Ltd. The model estimates the number of patients with ADHD who are treated with prescription medicines licensed for ADHD, and calculates pharmacological treatment rates as a percentage of the community prevalence (i.e. the number people expected to have ADHD in a representative population sample). Estimates were calculated both on a national basis and by NHS service provider areas. Population Mid-year 2022 population data were used to calculate general population estimates for CYP (5–17 years) and adults (18–65 years) in the areas covered by English integrated care systems (ICSs ( 25 )), Scottish ( 26 ) and Welsh ( 25 ) health boards, and Northern Irish health & social care trusts (HSCTs) ( 27 ) (Table S 1). From the general population estimates, community ADHD prevalence rates of 5% for CYP (5–17 years) and 3.5% for adults (18–65 years) were used to calculate the number of prevalent ADHD patients in each area (Table S 2). These prevalence rates align with estimates published by the National Institute for Health and Care Excellence (5% for CYP and 3–4% for adults) ( 4 ). Prescription data Data on prescriptions for medicines licensed for the treatment of ADHD were used to calculate the number of patients treated with medication in each area. All medicines currently licensed for ADHD were included (Table S 3). UK prescription data for the 12 months to May 2023 were obtained from the IQVIA Longitudinal Prescription Data (LRx) and Regional Prescription Analysis (RxA) databases. This represents a period post-COVID-19 pandemic, and pre-dating the 2023–2024 national supply issues affecting mediations for the treatment of ADHD. LRx contains anonymous information about patients collecting prescriptions, including age, and is aggregated into areas. This data covers approximately half of all prescriptions and was used to provide an indication of the age of patients collecting ADHD prescriptions. The proportion of CYP (5–17 years) and adults (18–65 years) prescribed ADHD medications was obtained from LRx, and applied to prescription data from the RxA dataset, which covers the whole UK market, including NHS Business Services Authority data, along with private prescription and hospital sales data. Procedure and analysis To calculate the number of treated patients in each area (Table S 4), the percentage of CYP and adults (from LRx) was multiplied by the average number of monthly ADHD prescriptions (from RXa). It was assumed that one prescription per month represented one patient, as most patients are treated by a single daily dose of extended-release stimulant medication (included medications are listed in Table S 3). However, as some patients receive an immediate release top-up to extend the duration of treatment, and others receive multiple ADHD medications to help manage symptoms, the model may over-estimate the number of individuals treated. The estimated number of prevalent and treated patients was used to calculate the percentage of treated patients by area, and service providers were ranked according to the proportion of CYP or adults who were prescribed treatment. Spearman’s rank correlation was used to investigate the relationship between CYP and adult treatment rates within ICSs, health boards and HSCTs. Results 1. National pharmacological treatment rates The estimated prevalent ADHD population and the number of patients treated with licensed ADHD medications in the UK are presented in Table 1 . Table 1 Estimated ADHD population and number of patients treated with licenced ADHD medicines in the UK Country ADHD population, n Treated, n (%) CYP (5–17 years) Adults (18–65 years) All ages (5–65 years) CYP (5–17 years) Adults (18–65 years) All ages (5–65 years) England 441,021 1,232,004 1,673,024 114,867 (26.0%) 191,227 (15.5%) 306,094 (18.3%) Scotland 37,927 119,394 157,321 13,476 (35.5%) 18,633 (15.6%) 32,110 (20.4%) Wales 23,344 65,710 89,054 5,244 (22.5%) 10,722 (16.3%) 15,966 (17.9%) Northern Ireland 16,239 40,574 56,812 N/A* N/A* 9,155 (16.1%) Great Britain 502,291 1,417,108 1,919,399 133,587 (26.6%) 220,582 (15.6%) 354,170 (18.5%) UK 518,530 1,457,682 1,976,211 N/A† N/A† 363,325 (18.4%) Abbreviations: ADHD = attention deficit hyperactivity disorder; CYP = children and young people; UK = United Kingdom * Data not available by age group † Number of treated patients by age group could not be calculated for the UK as a whole due to the lack of data by age group for Northern Ireland ADHD pharmacological treatment rates in England were 26.0% for CYP (aged 5–17 years), 15.5% for adults (aged 18–65 years) and 18.3% for all ages combined (Fig. 2 ). Treatment rates in Scotland were higher than England for CYP (35.5%) and similar to England for adults (15.6%), with an overall treatment rate of 20.4%. In Wales, treatment rates were similar to those in England (22.5% for CYP, 16.6% for adults, and 17.9% for all ages combined). Data for Northern Ireland were not available by age group, however the estimated pharmacological treatment rate for patients of all ages (18–65 years) in Northern Ireland was 16.1%. In Great Britain (England, Scotland and Wales), the estimated proportions of the CYP (5–17 years) and adult populations treated were 26.6% and 15.6%, respectively. Across the UK as a whole, the treatment rate for patients of all ages was 18.4%. 2. Pharmacological treatment rates by area The distribution of pharmacological treatment rates across English, Scottish and Welsh service providers is shown in Figure 2. The median proportion of patients treated was 26.2% (mean 28.7%) for CYP services, and 15.4% (mean 15.3%) for adult services. In England, pharmacological treatment rates ranged from 11.7% in the lowest ranked ICS to 48.7% in the highest ranked ICS for the CYP population (Figure 3 and Table S 4), and 9.3% to 24.8%, respectively, in the adult population (Figure 4 and Table S 4). This represents a 4.2-fold variation in treatment rates for CYP, and a 2.7-fold variation in adults. In Scotland, pharmacological treatment rates were 14.3–60.6% for the CYP population (Figure 5 and Table S 4), and 8.6–22.3%, respectively, in the adult population (Figure 6 and Table S 4). This represents similar variation to that observed in England (4.2-fold variation in CYP, and 2.6-fold variation in adults). Compared with both England and Scotland, maximum pharmacological treatment rates in Wales were lower (30.8% of CYP [Figure 7 and Table S 4]; 19.7% of adults [Figure 8 and Table S 4]), while the minimum treatment rates were similar to those in England and Scotland (12.8% of CYP; 9.8% of adults); as such there was less variation than either England or Scotland (2.4-fold variation for CYP, and 2.0-fold variation for adults). Data for Northern Ireland were not available by age group. Overall pharmacological treatment rates (ages 5–65 years) ranged from 6.7% in the lowest ranking health board to 31.1% in the highest-ranking board (Figure 9 and Table S 4), representing a 4.6-fold difference in treatment rates. 3. Relationship between CYP and adult treatment rates The relationship between pharmacological treatment rates in CYP and adults by service provider in England, Scotland & Wales is shown in Figure 10. For both England and Wales, there was no statistically significant correlation between treatment rates in CYP services and adult services (England: R=0.21, p=0.18; Wales: R=0.28, p=0.56). However, in Scotland, a positive correlation was observed between CYP and adult treatment rates (R=0.58, p=0.03). Discussion This study highlights the differences of rates of pharmacological treatment for ADHD in CYP and adults across the UK reporting a high degree of geographic variation across all NHS systems and a low level of treatment of ADHD, especially in adults. The model used UK population data and prevalence estimates to estimate the number of patients with ADHD in each area of the UK. Prescription data for medicines licensed for the treatment of ADHD were then used to calculate the number and percentage of patients treated per area. Regionally, up to a 4.6-fold difference in treatment rates was observed between NHS providers. Nationally, the estimated proportions of the CYP (5–17 years) and adult populations treated were 26.6% and 15.6% , respectively (excluding Northern Ireland). National treatment rates in England were 26.0% for CYP and 15.5% for adults, ranging from 11.7% in the lowest ranked ICS to 48.7% in the highest ranked ICS for CYP, and 9.3% to 24.8%, respectively, for adults. In Scotland, both the national treatment rate and the highest health board treatment rate for CYP was higher than in England (35.5% compared with 26.0%, and 60.6% compared with 48.7%, respectively), while the adult treatment rates were similar to those in England (15.6% nationally and up to 22.3% among health boards). In Wales, national treatment rates were 22.5% (CYP) and 16.3% (adults). Compared with England and Scotland, maximum treatment rates among Welsh health boards were lower (30.8% of CYP; 19.7% of adults) and the minimum rates were similar to those in England (12.8% of CYP; 9.8% of adults). Although data for Northern Ireland were not available by age group, treatment rates for all ages (5–65 years) ranged from 6.7% in the lowest ranking HSCT to 31.1% in the highest-ranking HSCT. It has been well established that ADHD treatment is highly beneficial for service-users and can prevent negative outcomes (12,28). Our findings show concerningly low treatment rates in a number of areas across the UK; however, it is difficult to establish the reasons for this as many factors could be at play. Firstly, low rates of pharmacological treatment could reflect low rates of diagnosis and low recognition of ADHD in healthcare practices, especially in primary care. Healthcare professionals seldomly receive training on ADHD in the UK (8,9) and this often leads to lack of recognition and understanding (29). Additionally, a lack of trained and skilled workforce healthcare professionals, able to meet the increasing demands on services is also problematic. Secondly, a lack of funding and service provision around ADHD, especially in adult services as also led to increasing waiting lists with some areas reporting 5 years or more delays before being assessed for ADHD (30–32). This issue has been exacerbated by the COVID-19 pandemic and is only getting worse (31). Routes into services for those higher risk groups may mean those with the highest needs are missed all together including children excluded from school, care experienced children and adults and those in the criminal justice system. This has potential importance economically as it is these latter groups that cost society and the individuals and their families greatly. While this study demonstrates the national issue in low pharmacological treatment rates, it is important to explore the variation across different regions. What are different areas doing differently that might explain some of the variation? If we can learn from areas where there are higher rates of treatment, we may be able to learn about effective triage methods that could be replicated. For example, do lower pharmacological treatment rates in fact mean there are efforts being made in non-healthcare settings, such as schools, to support some children, thereby reducing presentation in ADHD services? Are lower rates a reflection of local social deprivation? Do some areas have good transition services from CYP to adult services? It is beyond the scope of this study to explore the individual factors across regions that would explain the variation, however from exploring different case studies (publication by same team in preparation) we can see that we may be able to start to answer some of these questions and build some clinical models that can have a lasting impact. Many strengths and limitations arise from this study. To our knowledge, this is the only model that has been developed that shows treatment rates in the UK at a national and local level. A recent Spanish retrospective cohort analysis using regional prescription data (33) has demonstrated a similar 3.3-fold difference in medication usage between the lowest to highest regions; however, this analysis was limited to methylphenidate treatment only, and as the study measured pharmacy sales in number of packages, some of this variation could be accounted for by differences in dosage. This study captures ADHD care at a very specific but pivotal time point in the UK. It was conducted following the COVID-19 pandemic which has significantly impacted demands on services, highlighting a significant need at a time where demands are higher than ever known. While it is not possible to conclude direct diagnosis rates from this data, these numbers can be an indication of relative issues throughout the care pathway, from recognition and diagnosis to treatment. This is both a strength and limitation of this report. While we can infer a lack of diagnosis from this data and implications throughout the care pathway, these figures do not tell us how many people are diagnosed and also do not account for service users who receive non-pharmacological forms of treatment. Approximately one-third of the diagnosed population may be expected to have no history of stimulant treatment (34); however, the model did not adjust for this as the same pharmacological treatment rate would apply across all areas, and would therefore have no effect on the variation observed. Another limitation of this study is in the timeframe coinciding with a national medication supply crisis. (35) While more up-to-date treatment rates could be calculated, the model uses prescription data that pre-date autumn 2023 (36). From this time, the UK experienced a national ADHD medication shortage and any data reported after this time would have been impacted, and would therefore not be a true representation of pharmacological treatment rates. This report was not able to determine the effect of the NHS ‘Right to Choose’(37). Following the increase in waiting times, many families and adults have received care privately through the NHS ‘Right to Choose Act’ which allows service-users to seek alternate provisions if services provided by the NHS are not adequate (38). This led to a significant increase in private providers diagnosing and treating ADHD but no studies to date have been able to untangle the specific effects (positive and negative) this had on service-provision. We do not know yet what the quality of after-care or ongoing treatment rates for this group compared for those going to their local NHS services. We also do not know if those going to alternative routes are coming from a specific sector of society with higher rates of knowledge and skills to navigate clinical systems. Additionally, the effect of private healthcare on treatment patterns is not known; private providers may issue all prescriptions through a single pharmacy, which could have a distorting effect on the treatment rates for the ICS/health board/HSCT areas where these pharmacies are located. The data presented in this publication can be very useful for future research and practice. Future studies could examine the need to investigate in more detail regional differences and why some regions are ‘better’ than others. Additionally, understanding the implications higher treatment rates has on social factors (education, employment, crime) would highlight further the potential benefits of treatment. The model could also be used to understand further the impact of the national medication shortage. Finally, potential patterns in treatment across the last few years could be picked up by this model and further highlight trends in ADHD care nationally and regionally, informing decision making for commissioners. Conclusions This study, the first of its kind, has shown the geographic variations in medication treatments for children, young people and adults with ADHD. This is not about ‘calling out’ the good and the bad across the UK but rather to begin to understand why, if ADHD is diagnosed in a standardised way (based on national guidelines), is there such a discrepancy? Are some services more accessible for people to access the processes which is important given that many people with ADHD have dyslexia, developmental language disorder and autism spectrum conditions. With increasing demand on services and increasing waiting lists answering some of these questions becomes an urgent question to answer. What is also fundamentally important is how do we prioritise access to care based on patient needs. A triage system that supports those who ‘shout loudest’ means those with the greatest need may never be seen as waiting lists become longer. This paper does not explore this, but we know from past research there are higher rates of ADHD in certain groups who also have increased lasting and costly implications for them and society. How can we embed more straight forward ADHD diagnoses with general practitioners (GPs) so that people with more complex challenges can be seen by specialised teams? More GP training is certainly important in this mix. Abbreviations ADHD, attention deficit hyperactivity disorder CYP, children and young people GP, general practitioner HSCT, health & social care trust IAPT, Improving Access to Psychological Therapies NHS, National Health Service ICS, integrated care systems UK, United Kingdom LRx, Longitudinal Prescription Data RxA, Regional Prescription Analysis COVID-19, coronavirus disease 2019 Declarations Ethics approval and consent Not applicable. Consent for publication Not applicable Availability of data and materials The data that support the findings of this study are available from IQVIA Inc. but restrictions apply to the availability of these data, which were used under license for the current study, and so are not publicly available. Data are however available from the authors upon reasonable request and with permission of IQVIA Inc. Competing interests BF reports personal fees and nonfinancial support from Takeda and Medice. JD and CW are employees of Takeda UK Ltd and JD owns stock in Takeda Pharm Sp ADS. AK is currently Chair of the ADHD Foundation. Funding The model was developed and funded by Takeda UK Ltd. Authors’ contributions The authors confirm contribution as follows: study conception and design: BF, JD, CW, AK; data collection and model development: JD, CW; analysis and interpretation of results: BF, JD, CW, AK; manuscript preparation: BF, JD. All authors reviewed the results and approved the final version of the manuscript. Acknowledgments The authors would like to thank Peter Cain (Takeda UK) for statistical support and analysis. References Polanczyk G, Rohde LA. Epidemiology of attention-deficit/hyperactivity disorder across the lifespan. Curr Opin Psychiatry. 2007 Jul;20(4):386. Sayal K, Prasad V, Daley D, Ford T, Coghill D. ADHD in children and young people: prevalence, care pathways, and service provision. Lancet Psychiatry. 2018 Feb 1;5(2):175–86. 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Available from: https://www.england.nhs.uk/personalisedcare/choice/ Gudka R, Becker K, Ward J, Smith JR, Mughal F, Melendez-Torres GJ, et al. Primary care provision for young people with ADHD: a multi-perspective qualitative study. Br J Gen Pract. 2024 Jun 1;74(743):e408–16. Additional Declarations Competing interest reported. BF reports personal fees and nonfinancial support from Takeda and Medice. JD and CW are employees of Takeda UK Ltd and JD owns stock in Takeda Pharm Sp ADS. AK is currently Chair of the ADHD Foundation. Supplementary Files Supplementaryappendix.docx Cite Share Download PDF Status: Posted Version 1 posted You are reading this latest preprint version Research Square lets you share your work early, gain feedback from the community, and start making changes to your manuscript prior to peer review in a journal. As a division of Research Square Company, we’re committed to making research communication faster, fairer, and more useful. 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Also discoverable on Platform About Our Team In Review Editorial Policies Advisory Board Help Center Resources Author Services Accessibility API Access RSS feed Manage Cookie Preferences © Research Square 2026 | ISSN 2693-5015 (online) Privacy Policy Terms of Service Do Not Sell My Personal Information {"props":{"pageProps":{"initialData":{"identity":"rs-5956482","acceptedTermsAndConditions":true,"allowDirectSubmit":true,"archivedVersions":[],"articleType":"Research Article","associatedPublications":[],"authors":[{"id":411249264,"identity":"2601d77c-6503-44af-80c0-0c869fc344d4","order_by":0,"name":"Blandine French","email":"data:image/png;base64,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","orcid":"","institution":"University of Nottingham, Institute of Mental Health","correspondingAuthor":true,"prefix":"","firstName":"Blandine","middleName":"","lastName":"French","suffix":""},{"id":411249269,"identity":"5319686b-74a9-47df-9b73-5c0f89b7429c","order_by":1,"name":"James Davies","email":"","orcid":"","institution":"","correspondingAuthor":false,"prefix":"","firstName":"James","middleName":"","lastName":"Davies","suffix":""},{"id":411249271,"identity":"b02ceefa-6ec3-49fd-a2db-eae9a8d5171d","order_by":2,"name":"Chris Williams","email":"","orcid":"","institution":"","correspondingAuthor":false,"prefix":"","firstName":"Chris","middleName":"","lastName":"Williams","suffix":""},{"id":411249272,"identity":"7bd8d745-c8c2-4734-9fce-b784f2e7ede2","order_by":3,"name":"Amanda Kirby","email":"","orcid":"","institution":"","correspondingAuthor":false,"prefix":"","firstName":"Amanda","middleName":"","lastName":"Kirby","suffix":""}],"badges":[],"createdAt":"2025-02-04 08:53:30","currentVersionCode":1,"declarations":"","doi":"10.21203/rs.3.rs-5956482/v1","doiUrl":"https://doi.org/10.21203/rs.3.rs-5956482/v1","draftVersion":[],"editorialEvents":[],"editorialNote":"","failedWorkflow":false,"files":[{"id":75520292,"identity":"8d7fef3f-9ef5-4cfd-9f92-703167edd3b9","added_by":"auto","created_at":"2025-02-05 12:02:58","extension":"png","order_by":1,"title":"Figure 1","display":"","copyAsset":false,"role":"figure","size":64960,"visible":true,"origin":"","legend":"\u003cp\u003eEstimated percentage of patients treated with licenced ADHD medicines in the UK\u003c/p\u003e\n\u003cp\u003eAbbreviations: ADHD = attention deficit hyperactivity disorder; CYP = children and young people; UK = United Kingdom\u003c/p\u003e","description":"","filename":"1.png","url":"https://assets-eu.researchsquare.com/files/rs-5956482/v1/ba27c82634d376a2a35e156e.png"},{"id":75521560,"identity":"c0b88ad0-f515-420c-b4e3-30d990e8db4e","added_by":"auto","created_at":"2025-02-05 12:18:58","extension":"png","order_by":2,"title":"Figure 2","display":"","copyAsset":false,"role":"figure","size":85815,"visible":true,"origin":"","legend":"\u003cp\u003eDistribution of ADHD pharmacological treatment rates (Great Britain*)\u003c/p\u003e\n\u003cp\u003eAbbreviations: ADHD = attention deficit hyperactivity disorder; CYP = children and young people; ICS = integrated care system\u003c/p\u003e\n\u003cp\u003e* Northern Ireland is excluded as data were not available by age group\u003c/p\u003e\n\u003cp\u003eDashed lines indicate medians.\u003c/p\u003e","description":"","filename":"2.png","url":"https://assets-eu.researchsquare.com/files/rs-5956482/v1/583eaec5b371aa643d1bc173.png"},{"id":75519832,"identity":"6bc99952-c118-4a76-9d14-3c44bcae86a9","added_by":"auto","created_at":"2025-02-05 11:54:58","extension":"png","order_by":3,"title":"Figure 3","display":"","copyAsset":false,"role":"figure","size":44017,"visible":true,"origin":"","legend":"\u003cp\u003eEstimated percentage of CYP (aged 5 to17 years) treated with licenced ADHD medicines in England, ranked from lowest to highest by ICS\u003c/p\u003e\n\u003cp\u003eAbbreviations: ADHD = attention deficit hyperactivity disorder; CYP = children and young people; ICS = integrated care system\u003c/p\u003e\n\u003cp\u003eSee supplementary appendix for ICS reference numbers\u003c/p\u003e","description":"","filename":"3.png","url":"https://assets-eu.researchsquare.com/files/rs-5956482/v1/0e04860125b406b4f436fcca.png"},{"id":75520293,"identity":"68815918-3ba1-41eb-b30f-8ece8d95dda7","added_by":"auto","created_at":"2025-02-05 12:02:58","extension":"png","order_by":4,"title":"Figure 4","display":"","copyAsset":false,"role":"figure","size":44732,"visible":true,"origin":"","legend":"\u003cp\u003eEstimated percentage of adults (aged 18 to 65 years) treated with licensed ADHD medicines in England, ranked from lowest to highest by ICS\u003c/p\u003e\n\u003cp\u003eAbbreviations: ADHD = attention deficit hyperactivity disorder; ICS = integrated care system\u003c/p\u003e\n\u003cp\u003eSee supplementary appendix for ICS reference numbers\u003c/p\u003e","description":"","filename":"4.png","url":"https://assets-eu.researchsquare.com/files/rs-5956482/v1/bc3630318e799909f4b0952c.png"},{"id":75521364,"identity":"efd2ab4b-4ffe-4741-b779-c7709bdb913c","added_by":"auto","created_at":"2025-02-05 12:10:58","extension":"png","order_by":5,"title":"Figure 5","display":"","copyAsset":false,"role":"figure","size":34138,"visible":true,"origin":"","legend":"\u003cp\u003eEstimated percentage of CYP (aged 5–17 years) treated with licenced ADHD medicines in Scotland, ranked from lowest to highest by health board\u003c/p\u003e\n\u003cp\u003eAbbreviations: ADHD = attention deficit hyperactivity disorder; CYP = children and young people\u003c/p\u003e\n\u003cp\u003eSee supplementary appendix for health board reference numbers\u003c/p\u003e","description":"","filename":"5.png","url":"https://assets-eu.researchsquare.com/files/rs-5956482/v1/ae4c92d912161659dbc656b0.png"},{"id":75522426,"identity":"faec082c-2626-444e-b112-b6315fe7c812","added_by":"auto","created_at":"2025-02-05 12:26:58","extension":"png","order_by":6,"title":"Figure 6","display":"","copyAsset":false,"role":"figure","size":31917,"visible":true,"origin":"","legend":"\u003cp\u003eEstimated percentage of adults (aged 18–65 years) treated with licenced ADHD medicines in Scotland, ranked from lowest to highest by health board\u003c/p\u003e\n\u003cp\u003eAbbreviations: ADHD = attention deficit hyperactivity disorder\u003c/p\u003e\n\u003cp\u003eSee supplementary appendix for health board reference numbers\u003c/p\u003e","description":"","filename":"6.png","url":"https://assets-eu.researchsquare.com/files/rs-5956482/v1/6d487aeb45a7a4e06f963f4e.png"},{"id":75520299,"identity":"88e7732b-3929-4d78-a67e-2f729b42efcb","added_by":"auto","created_at":"2025-02-05 12:02:58","extension":"png","order_by":7,"title":"Figure 7","display":"","copyAsset":false,"role":"figure","size":28305,"visible":true,"origin":"","legend":"\u003cp\u003eEstimated percentage of CYP (aged 5–17 years) treated with licenced ADHD medicines in Wales, ranked from lowest to highest by health board\u003c/p\u003e\n\u003cp\u003eAbbreviations: ADHD = attention deficit hyperactivity disorder; CYP = children and young people\u003c/p\u003e\n\u003cp\u003eSee supplementary appendix for health board reference numbers\u003c/p\u003e","description":"","filename":"7.png","url":"https://assets-eu.researchsquare.com/files/rs-5956482/v1/aa44a5029cdd605b8f385748.png"},{"id":75519847,"identity":"6c187a88-9c0a-4aa3-aafe-df50bd65b7c7","added_by":"auto","created_at":"2025-02-05 11:54:59","extension":"png","order_by":8,"title":"Figure 8","display":"","copyAsset":false,"role":"figure","size":27834,"visible":true,"origin":"","legend":"\u003cp\u003eEstimated percentage of adults (aged 18–65 years) treated with licenced ADHD medicines in Wales, ranked from lowest to highest by health board\u003c/p\u003e\n\u003cp\u003eAbbreviations: ADHD = attention deficit hyperactivity disorder\u003c/p\u003e\n\u003cp\u003eSee supplementary appendix for health board reference numbers\u003c/p\u003e","description":"","filename":"8.png","url":"https://assets-eu.researchsquare.com/files/rs-5956482/v1/adf6b44e437ee780ebc9b121.png"},{"id":75520303,"identity":"e80fb948-ff83-4511-ad96-3cc5038e5d37","added_by":"auto","created_at":"2025-02-05 12:02:58","extension":"png","order_by":9,"title":"Figure 9","display":"","copyAsset":false,"role":"figure","size":26664,"visible":true,"origin":"","legend":"\u003cp\u003eEstimated percentage of patients (aged 5–65 years) treated with licenced ADHD medicines in Northern Ireland, ranked from lowest to highest by HSCT\u003c/p\u003e\n\u003cp\u003eAbbreviations: ADHD = attention deficit hyperactivity disorder; HSCT = health \u0026amp; social care trust\u003c/p\u003e\n\u003cp\u003eSee supplementary appendix for HSCT reference numbers\u003c/p\u003e","description":"","filename":"9.png","url":"https://assets-eu.researchsquare.com/files/rs-5956482/v1/099a7ad98b60a86fdd52c8e9.png"},{"id":75521369,"identity":"47ccefb4-96d5-4025-82f5-06af73e6d820","added_by":"auto","created_at":"2025-02-05 12:10:58","extension":"png","order_by":10,"title":"Figure 10","display":"","copyAsset":false,"role":"figure","size":106095,"visible":true,"origin":"","legend":"\u003cp\u003eEstimated percentage of CYP (aged 5–17 years) and adults (aged 18-65 years) treated with licensed ADHD medicines in Great Britain*, by ICS or health board\u003c/p\u003e\n\u003cp\u003eAbbreviations: ADHD = attention deficit hyperactivity disorder; CYP = children and young people; ICS = integrated care system\u003c/p\u003e\n\u003cp\u003e* Northern Ireland is excluded as data were not available by age group\u003c/p\u003e","description":"","filename":"10.png","url":"https://assets-eu.researchsquare.com/files/rs-5956482/v1/8fcbf8cefdaafe04165b06cb.png"},{"id":75925258,"identity":"17b1d2b2-ccd7-4037-bc81-b469f4b9318f","added_by":"auto","created_at":"2025-02-10 15:11:12","extension":"pdf","order_by":0,"title":"","display":"","copyAsset":false,"role":"manuscript-pdf","size":1039948,"visible":true,"origin":"","legend":"","description":"","filename":"manuscript.pdf","url":"https://assets-eu.researchsquare.com/files/rs-5956482/v1/8648d714-6b8f-4f2e-a1a6-453cd4c23544.pdf"},{"id":75519822,"identity":"ae94b47c-a098-48f3-a0d9-70328a970d8b","added_by":"auto","created_at":"2025-02-05 11:54:58","extension":"docx","order_by":1,"title":"","display":"","copyAsset":false,"role":"supplement","size":46511,"visible":true,"origin":"","legend":"","description":"","filename":"Supplementaryappendix.docx","url":"https://assets-eu.researchsquare.com/files/rs-5956482/v1/6282af6aa544f4e6fab1b908.docx"}],"financialInterests":"Competing interest reported. BF reports personal fees and nonfinancial support from Takeda and Medice. JD and CW are employees of Takeda UK Ltd and JD owns stock in Takeda Pharm Sp ADS. AK is currently Chair of the ADHD Foundation.","formattedTitle":"UK ADHD treatment rates – a regional variation model","fulltext":[{"header":"Background","content":"\u003cp\u003eIn the UK, attention deficit hyperactivity disorder (ADHD) is estimated to affect approximately 5% of children (\u003cspan citationid=\"CR1\" class=\"CitationRef\"\u003e1\u003c/span\u003e, \u003cspan citationid=\"CR2\" class=\"CitationRef\"\u003e2\u003c/span\u003e) and 3\u0026ndash;4% of adults (\u003cspan citationid=\"CR3\" class=\"CitationRef\"\u003e3\u003c/span\u003e, \u003cspan citationid=\"CR4\" class=\"CitationRef\"\u003e4\u003c/span\u003e) and is generally recognised as underdiagnosed and undertreated (\u003cspan citationid=\"CR2\" class=\"CitationRef\"\u003e2\u003c/span\u003e, \u003cspan citationid=\"CR5\" class=\"CitationRef\"\u003e5\u003c/span\u003e). ADHD can lead to considerable cognitive and behavioural impairment, affecting social behaviour, educational outcomes and day-to-day family interactions (\u003cspan citationid=\"CR6\" class=\"CitationRef\"\u003e6\u003c/span\u003e).\u003c/p\u003e \u003cp\u003eIn adulthood, these impairments, if untreated, are associated with higher rates of criminal behaviour, loss of work, addiction, suicidality and failed relationships (\u003cspan citationid=\"CR7\" class=\"CitationRef\"\u003e7\u003c/span\u003e). Services for ADHD, especially in adulthood, are scarce and underfunded (\u003cspan citationid=\"CR8\" class=\"CitationRef\"\u003e8\u003c/span\u003e, \u003cspan citationid=\"CR9\" class=\"CitationRef\"\u003e9\u003c/span\u003e) causing hundreds of thousands of children and adults to receive inadequate support or experiencing long delays in management (\u003cspan citationid=\"CR2\" class=\"CitationRef\"\u003e2\u003c/span\u003e). This leads to poorer outcomes for the individual and their families, with undiagnosed (and therefore unsupported) ADHD resulting in a range of consequences in the short and longer term. This includes significant academic underachievement and educational challenges, increased prevalence of depression and anxiety, higher rates of offending behaviour and imprisonment, driving accidents, substance abuse and unemployment (\u003cspan citationid=\"CR10\" class=\"CitationRef\"\u003e10\u003c/span\u003e). Diagnosis facilitates access to care or treatment (\u003cspan citationid=\"CR11\" class=\"CitationRef\"\u003e11\u003c/span\u003e, \u003cspan citationid=\"CR12\" class=\"CitationRef\"\u003e12\u003c/span\u003e), and in turn, appropriate interventions have been shown to positively impact the difficulties experienced by individuals, often preventing further struggles (\u003cspan citationid=\"CR13\" class=\"CitationRef\"\u003e13\u003c/span\u003e, \u003cspan citationid=\"CR14\" class=\"CitationRef\"\u003e14\u003c/span\u003e). Hence, early diagnosis and intervention are of utmost importance in targeting some of the long-term risks for individuals living with ADHD. However, as highlighted in Lord Darzi\u0026rsquo;s recent independent investigation of the National Health Service (NHS) in England, the growth in demand for ADHD assessments has been so significant that it risks overwhelming services, with many English trusts unable to clear the backlog in adult ADHD assessments for decades, if continued at current rates (\u003cspan citationid=\"CR15\" class=\"CitationRef\"\u003e15\u003c/span\u003e).\u003c/p\u003e \u003cp\u003eIn May 2024, NHS England announced the creation of an ADHD task force to tackle the many difficulties in access to care (\u003cspan citationid=\"CR16\" class=\"CitationRef\"\u003e16\u003c/span\u003e). A report from the Demos think-tank estimates that the hidden costs of undiagnosed ADHD to the economy could amount to billions of pounds yearly and calls for urgent action to uncover the true economic costs (\u003cspan citationid=\"CR17\" class=\"CitationRef\"\u003e17\u003c/span\u003e). While economic studies have assessed the costs of having ADHD (\u003cspan citationid=\"CR18\" class=\"CitationRef\"\u003e18\u003c/span\u003e, \u003cspan citationid=\"CR19\" class=\"CitationRef\"\u003e19\u003c/span\u003e), research has not yet focused on the costs of not diagnosing and treating people with ADHD on an individual or societal level. Previous health economic research has shown the significant cost of undiagnosed, and therefore untreated, mental health conditions in the general population and led to the creation of NHS Improving Access to Psychological Therapies (IAPT) policy (\u003cspan citationid=\"CR20\" class=\"CitationRef\"\u003e20\u003c/span\u003e).\u003c/p\u003e \u003cp\u003eTo establish the national cost of unsupported ADHD in the UK, it is first important to assess the level of national treatment rates. It is estimated that millions of adults and children with ADHD are currently undiagnosed in the UK (\u003cspan citationid=\"CR2\" class=\"CitationRef\"\u003e2\u003c/span\u003e, \u003cspan citationid=\"CR21\" class=\"CitationRef\"\u003e21\u003c/span\u003e, \u003cspan citationid=\"CR22\" class=\"CitationRef\"\u003e22\u003c/span\u003e) and this issue prevails around the world. In Denmark, as one example, over half of the children in a national birth cohort with probable ADHD based on parent-reported behaviour at age 7, were not diagnosed at follow-up many years later (\u003cspan citationid=\"CR23\" class=\"CitationRef\"\u003e23\u003c/span\u003e). Sayal and colleagues (\u003cspan citationid=\"CR2\" class=\"CitationRef\"\u003e2\u003c/span\u003e) reviewed the administrative prevalence in the UK, (i.e., the number of people with clinically diagnosed or recorded with ADHD as a proportion of the whole population) and found a wide range of prevalence from 0.19\u0026ndash;0.76% in children and 0.29% in adults. A more recent cohort study (\u003cspan citationid=\"CR24\" class=\"CitationRef\"\u003e24\u003c/span\u003e) established that the prevalence of children receiving treatment in the UK by 2018 was 1.56% in boys and 0.36% in girls, but only 0.1% in adults. While diagnosis and treatment rates have increased over the years, it is still a long way from the reported community prevalence of approximately 5%.\u003c/p\u003e \u003cp\u003eTo date, no study has established individual treatment rates across different regions in the UK. This study aimed to assess the variability of ADHD treatment rates within children and young people (CYP) and adult ADHD services across the UK, establishing a national average and regional differences.\u003c/p\u003e"},{"header":"Methods","content":"\u003cp\u003eA model was developed in Microsoft Excel, and is the intellectual property of Takeda UK Ltd. The model estimates the number of patients with ADHD who are treated with prescription medicines licensed for ADHD, and calculates pharmacological treatment rates as a percentage of the community prevalence (i.e. the number people expected to have ADHD in a representative population sample). Estimates were calculated both on a national basis and by NHS service provider areas.\u003c/p\u003e \u003cdiv id=\"Sec3\" class=\"Section2\"\u003e \u003ch2\u003ePopulation\u003c/h2\u003e \u003cp\u003eMid-year 2022 population data were used to calculate general population estimates for CYP (5\u0026ndash;17 years) and adults (18\u0026ndash;65 years) in the areas covered by English integrated care systems (ICSs (\u003cspan citationid=\"CR25\" class=\"CitationRef\"\u003e25\u003c/span\u003e)), Scottish (\u003cspan citationid=\"CR26\" class=\"CitationRef\"\u003e26\u003c/span\u003e) and Welsh (\u003cspan citationid=\"CR25\" class=\"CitationRef\"\u003e25\u003c/span\u003e) health boards, and Northern Irish health \u0026amp; social care trusts (HSCTs) (\u003cspan citationid=\"CR27\" class=\"CitationRef\"\u003e27\u003c/span\u003e) (Table S 1).\u003c/p\u003e \u003cp\u003eFrom the general population estimates, community ADHD prevalence rates of 5% for CYP (5\u0026ndash;17 years) and 3.5% for adults (18\u0026ndash;65 years) were used to calculate the number of prevalent ADHD patients in each area (Table S 2). These prevalence rates align with estimates published by the National Institute for Health and Care Excellence (5% for CYP and 3\u0026ndash;4% for adults) (\u003cspan citationid=\"CR4\" class=\"CitationRef\"\u003e4\u003c/span\u003e).\u003c/p\u003e \u003c/div\u003e\n\u003ch3\u003ePrescription data\u003c/h3\u003e\n\u003cp\u003eData on prescriptions for medicines licensed for the treatment of ADHD were used to calculate the number of patients treated with medication in each area. All medicines currently licensed for ADHD were included (Table S 3).\u003c/p\u003e \u003cp\u003eUK prescription data for the 12 months to May 2023 were obtained from the IQVIA Longitudinal Prescription Data (LRx) and Regional Prescription Analysis (RxA) databases. This represents a period post-COVID-19 pandemic, and pre-dating the 2023\u0026ndash;2024 national supply issues affecting mediations for the treatment of ADHD.\u003c/p\u003e \u003cp\u003eLRx contains anonymous information about patients collecting prescriptions, including age, and is aggregated into areas. This data covers approximately half of all prescriptions and was used to provide an indication of the age of patients collecting ADHD prescriptions. The proportion of CYP (5\u0026ndash;17 years) and adults (18\u0026ndash;65 years) prescribed ADHD medications was obtained from LRx, and applied to prescription data from the RxA dataset, which covers the whole UK market, including NHS Business Services Authority data, along with private prescription and hospital sales data.\u003c/p\u003e\n\u003ch3\u003eProcedure and analysis\u003c/h3\u003e\n\u003cp\u003eTo calculate the number of treated patients in each area (Table S 4), the percentage of CYP and adults (from LRx) was multiplied by the average number of monthly ADHD prescriptions (from RXa). It was assumed that one prescription per month represented one patient, as most patients are treated by a single daily dose of extended-release stimulant medication (included medications are listed in Table S 3). However, as some patients receive an immediate release top-up to extend the duration of treatment, and others receive multiple ADHD medications to help manage symptoms, the model may over-estimate the number of individuals treated.\u003c/p\u003e \u003cp\u003eThe estimated number of prevalent and treated patients was used to calculate the percentage of treated patients by area, and service providers were ranked according to the proportion of CYP or adults who were prescribed treatment. Spearman\u0026rsquo;s rank correlation was used to investigate the relationship between CYP and adult treatment rates within ICSs, health boards and HSCTs.\u003c/p\u003e"},{"header":"Results","content":"\u003cdiv id=\"Sec7\" class=\"Section2\"\u003e\n \u003ch2\u003e1. National pharmacological treatment rates\u003c/h2\u003e\n \u003cp\u003eThe estimated prevalent ADHD population and the number of patients treated with licensed ADHD medications in the UK are presented in Table\u0026nbsp;\u003cspan class=\"InternalRef\"\u003e1\u003c/span\u003e.\u003c/p\u003e\n \u003cdiv class=\"gridtable\"\u003e\u0026nbsp;\u003ctable id=\"Tab1\" border=\"1\"\u003e\n \u003ccaption language=\"En\"\u003e\n \u003cdiv class=\"CaptionNumber\"\u003eTable 1\u003c/div\u003e\n \u003cdiv class=\"CaptionContent\"\u003e\n \u003cp\u003eEstimated ADHD population and number of patients treated with licenced ADHD medicines in the UK\u003c/p\u003e\n \u003c/div\u003e\n \u003c/caption\u003e\n \u003ccolgroup cols=\"7\"\u003e\u003c/colgroup\u003e\n \u003cthead\u003e\n \u003ctr\u003e\n \u003cth align=\"left\" rowspan=\"2\"\u003e\n \u003cp\u003eCountry\u003c/p\u003e\n \u003c/th\u003e\n \u003cth align=\"left\" colspan=\"3\"\u003e\n \u003cp\u003eADHD population, n\u003c/p\u003e\n \u003c/th\u003e\n \u003cth align=\"left\" colspan=\"3\"\u003e\n \u003cp\u003eTreated, n (%)\u003c/p\u003e\n \u003c/th\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003cth align=\"left\"\u003e\n \u003cp\u003eCYP\u003c/p\u003e\n \u003cp\u003e(5\u0026ndash;17 years)\u003c/p\u003e\n \u003c/th\u003e\n \u003cth align=\"left\"\u003e\n \u003cp\u003eAdults\u003c/p\u003e\n \u003cp\u003e(18\u0026ndash;65 years)\u003c/p\u003e\n \u003c/th\u003e\n \u003cth align=\"left\"\u003e\n \u003cp\u003eAll ages\u003c/p\u003e\n \u003cp\u003e(5\u0026ndash;65 years)\u003c/p\u003e\n \u003c/th\u003e\n \u003cth align=\"left\"\u003e\n \u003cp\u003eCYP\u003c/p\u003e\n \u003cp\u003e(5\u0026ndash;17 years)\u003c/p\u003e\n \u003c/th\u003e\n \u003cth align=\"left\"\u003e\n \u003cp\u003eAdults\u003c/p\u003e\n \u003cp\u003e(18\u0026ndash;65 years)\u003c/p\u003e\n \u003c/th\u003e\n \u003cth align=\"left\"\u003e\n \u003cp\u003eAll ages\u003c/p\u003e\n \u003cp\u003e(5\u0026ndash;65 years)\u003c/p\u003e\n \u003c/th\u003e\n \u003c/tr\u003e\n \u003c/thead\u003e\n \u003ctbody\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eEngland\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e441,021\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e1,232,004\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e1,673,024\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e114,867 (26.0%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e191,227 (15.5%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e306,094 (18.3%)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eScotland\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e37,927\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e119,394\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e157,321\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e13,476 (35.5%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e18,633 (15.6%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e32,110 (20.4%)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eWales\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e23,344\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e65,710\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e89,054\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e5,244 (22.5%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e10,722 (16.3%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e15,966 (17.9%)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eNorthern Ireland\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e16,239\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e40,574\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e56,812\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eN/A*\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eN/A*\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e9,155 (16.1%)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e\u003cstrong\u003eGreat Britain\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e\u003cstrong\u003e502,291\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e\u003cstrong\u003e1,417,108\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e\u003cstrong\u003e1,919,399\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e\u003cstrong\u003e133,587 (26.6%)\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e\u003cstrong\u003e220,582 (15.6%)\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e\u003cstrong\u003e354,170 (18.5%)\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e\u003cstrong\u003eUK\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e\u003cstrong\u003e518,530\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e\u003cstrong\u003e1,457,682\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e\u003cstrong\u003e1,976,211\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e\u003cstrong\u003eN/A\u0026dagger;\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e\u003cstrong\u003eN/A\u0026dagger;\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e\u003cstrong\u003e363,325 (18.4%)\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\" colspan=\"7\"\u003e\n \u003cp\u003eAbbreviations: ADHD\u0026thinsp;=\u0026thinsp;attention deficit hyperactivity disorder; CYP\u0026thinsp;=\u0026thinsp;children and young people; UK\u0026thinsp;=\u0026thinsp;United Kingdom\u003c/p\u003e\n \u003cp\u003e* Data not available by age group\u003c/p\u003e\n \u003cp\u003e\u0026dagger; Number of treated patients by age group could not be calculated for the UK as a whole due to the lack of data by age group for Northern Ireland\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003c/tbody\u003e\n \u003c/table\u003e\n \u003c/div\u003e\n \u003cp\u003eADHD pharmacological treatment rates in England were 26.0% for CYP (aged 5\u0026ndash;17 years), 15.5% for adults (aged 18\u0026ndash;65 years) and 18.3% for all ages combined (Fig. \u003cspan class=\"InternalRef\"\u003e2\u003c/span\u003e). Treatment rates in Scotland were higher than England for CYP (35.5%) and similar to England for adults (15.6%), with an overall treatment rate of 20.4%. In Wales, treatment rates were similar to those in England (22.5% for CYP, 16.6% for adults, and 17.9% for all ages combined).\u003c/p\u003e\n \u003cp\u003eData for Northern Ireland were not available by age group, however the estimated pharmacological treatment rate for patients of all ages (18\u0026ndash;65 years) in Northern Ireland was 16.1%.\u003c/p\u003e\n \u003cp\u003eIn Great Britain (England, Scotland and Wales), the estimated proportions of the CYP (5\u0026ndash;17 years) and adult populations treated were 26.6% and 15.6%, respectively. Across the UK as a whole, the treatment rate for patients of all ages was 18.4%.\u003c/p\u003e\n \u003cp\u003e\u003cstrong\u003e\u003cem\u003e2. Pharmacological treatment rates by area\u003c/em\u003e\u003c/strong\u003e\u003c/p\u003e\n \u003cp\u003eThe distribution of pharmacological treatment rates across English, Scottish and Welsh service providers is shown in Figure 2. The median proportion of patients treated was 26.2% (mean 28.7%) for CYP services, and 15.4% (mean 15.3%) for adult services.\u003c/p\u003e\n \u003cp\u003eIn England, pharmacological treatment rates ranged from 11.7% in the lowest ranked ICS to 48.7% in the highest ranked ICS for the CYP population (Figure 3 and Table S 4), and 9.3% to 24.8%, respectively, in the adult population (Figure 4 and Table S 4). This represents a 4.2-fold variation in treatment rates for CYP, and a 2.7-fold variation in adults.\u0026nbsp;\u003c/p\u003e\n \u003cp\u003eIn Scotland, pharmacological treatment rates were 14.3\u0026ndash;60.6% for the CYP population (Figure 5 and Table S 4), and 8.6\u0026ndash;22.3%, respectively, in the adult population (Figure 6 and Table S 4). This represents similar variation to that observed in England (4.2-fold variation in CYP, and 2.6-fold variation in adults).\u003c/p\u003e\n \u003cp\u003eCompared with both England and Scotland, maximum pharmacological treatment rates in Wales were lower (30.8% of CYP [Figure 7 and Table S 4]; 19.7% of adults [Figure 8 and Table S 4]), while the minimum treatment rates were similar to those in England and Scotland (12.8% of CYP; 9.8% of adults); as such there was less variation than either England or Scotland (2.4-fold variation for CYP, and 2.0-fold variation for adults).\u003c/p\u003e\n \u003cp\u003eData for Northern Ireland were not available by age group. Overall pharmacological treatment rates (ages 5\u0026ndash;65 years) ranged from 6.7% in the lowest ranking health board to 31.1% in the highest-ranking board (Figure 9 and Table S 4), representing a 4.6-fold difference in treatment rates.\u003c/p\u003e\n \u003cp\u003e\u003cstrong\u003e\u003cem\u003e3. Relationship between CYP and adult treatment rates\u003c/em\u003e\u003c/strong\u003e\u003c/p\u003e\n \u003cp\u003eThe relationship between pharmacological treatment rates in CYP and adults by service provider in England, Scotland \u0026amp; Wales is shown in Figure 10. For both England and Wales, there was no statistically significant correlation between treatment rates in CYP services and adult services (England: R=0.21, p=0.18; Wales: R=0.28, p=0.56). However, in Scotland, a positive correlation was observed between CYP and adult treatment rates (R=0.58, p=0.03).\u003c/p\u003e\n\u003c/div\u003e"},{"header":"Discussion","content":"\u003cp\u003eThis study highlights the differences of rates of pharmacological treatment for ADHD in\u0026nbsp;CYP\u0026nbsp;and adults across the UK\u0026nbsp;reporting a high degree of geographic variation across all NHS systems and a low level of treatment of ADHD, especially in adults. The model used UK population data and prevalence estimates to estimate the number of patients with ADHD in each area of the UK. Prescription data for medicines licensed for the treatment of ADHD were then used to calculate the number and percentage of patients treated per area.\u0026nbsp;Regionally, up to a 4.6-fold difference in treatment rates was observed between NHS providers.\u0026nbsp;Nationally, the estimated proportions of the CYP (5\u0026ndash;17 years) and adult populations treated were 26.6% and 15.6%\u003cem\u003e,\u0026nbsp;\u003c/em\u003erespectively (excluding Northern Ireland).\u003cem\u003e\u0026nbsp;\u003c/em\u003eNational treatment rates in England were 26.0% for CYP and 15.5% for adults, ranging from 11.7% in the lowest ranked ICS to 48.7% in the highest ranked ICS for CYP, and 9.3% to 24.8%, respectively, for adults. In Scotland, both the national treatment rate and the highest health board treatment rate for CYP was higher than in England (35.5% compared with 26.0%, and 60.6% compared with 48.7%, respectively), while the adult treatment rates were similar to those in England (15.6% nationally and up to 22.3% among health boards). In Wales, national treatment rates were 22.5% (CYP) and 16.3% (adults). Compared with England and Scotland, maximum treatment rates among Welsh health boards were lower (30.8% of CYP; 19.7% of adults) and the minimum rates were similar to those in England (12.8% of CYP; 9.8% of adults). Although data for Northern Ireland were not available by age group, treatment rates for all ages (5\u0026ndash;65 years) ranged from 6.7% in the lowest ranking HSCT to 31.1% in the highest-ranking HSCT.\u003c/p\u003e\n\u003cp\u003eIt has been well established that ADHD treatment is highly beneficial for service-users and can prevent negative outcomes\u0026nbsp;(12,28).\u0026nbsp;Our findings show concerningly low treatment rates in a number of areas across the UK; however, it is difficult to establish the reasons for this as many factors could be at play. Firstly, low rates of pharmacological treatment could reflect low rates of diagnosis and low recognition of ADHD in healthcare practices, especially in primary care. Healthcare professionals seldomly receive training on ADHD in the UK\u0026nbsp;(8,9)\u0026nbsp;and this often leads to lack of recognition and understanding\u0026nbsp;(29). Additionally, a lack of trained and skilled workforce healthcare professionals, able to meet the increasing demands on services is also problematic. Secondly, a lack of funding and service provision around ADHD, especially in adult services as also led to increasing waiting lists with some areas reporting 5 years or more delays before being assessed for ADHD\u0026nbsp;(30\u0026ndash;32). This issue has been exacerbated by the\u0026nbsp;COVID-19 pandemic and is only getting worse\u0026nbsp;(31). Routes into services for those higher risk groups may mean those with the highest needs are missed all together including children excluded from school, care experienced children and adults and those in the criminal justice system. This has potential importance economically as it is these latter groups that cost society and the individuals and their families greatly.\u003c/p\u003e\n\u003cp\u003eWhile this study demonstrates the national issue in low pharmacological treatment rates, it is important to explore the variation across different regions. What are different areas doing differently that might explain some of the variation? If we can learn from areas where there are higher rates of treatment, we may be able to learn about effective triage methods that could be replicated. For example, do lower pharmacological treatment rates in fact mean there are efforts being made in non-healthcare settings, such as schools, to support some children, thereby reducing presentation in ADHD services? Are lower rates a reflection of local social deprivation? Do some areas have good transition services from CYP to adult services? It is beyond the scope of this study to explore the individual factors across regions that would explain the variation, however from exploring different case studies (publication by same team in preparation) we can see that we may be able to start to answer some of these questions and build some clinical models that can have a lasting impact.\u003c/p\u003e\n\u003cp\u003eMany strengths and limitations arise from this study. To our knowledge, this is the only model that has been developed that shows treatment rates in the UK at a national and local level. \u0026nbsp;A recent Spanish retrospective cohort analysis using regional prescription data\u0026nbsp;(33)\u0026nbsp;has demonstrated a similar 3.3-fold difference in medication usage between the lowest to highest regions; however, this analysis was limited to methylphenidate treatment only, and as the study measured pharmacy sales in number of packages, some of this variation could be accounted for by differences in dosage.\u003c/p\u003e\n\u003cp\u003eThis study captures ADHD care at a very specific but pivotal time point in the UK. It was conducted following the\u0026nbsp;COVID-19\u0026nbsp;pandemic which has significantly impacted demands on services, highlighting a significant need at a time where demands are higher than ever known. While it is not possible to conclude direct diagnosis rates from this data, these numbers can be an indication of relative issues throughout the care pathway, from recognition and diagnosis to treatment. This is both a strength and limitation of this report. While we can infer a lack of diagnosis from this data and implications throughout the care pathway, these figures do not tell us how many people are diagnosed and also do not account for service users who receive non-pharmacological forms of treatment. Approximately one-third of the diagnosed population may be expected to have no history of stimulant treatment\u0026nbsp;(34); however, the model did not adjust for this as the same pharmacological treatment rate would apply across all areas, and would therefore have no effect on the variation observed.\u0026nbsp;\u003c/p\u003e\n\u003cp\u003eAnother limitation of this study is in the timeframe coinciding with a national medication supply crisis.\u0026nbsp;(35)\u0026nbsp;While more up-to-date treatment rates could be calculated, the model uses prescription data that pre-date autumn 2023\u0026nbsp;(36). From this time, the UK experienced a national ADHD medication shortage and any data reported after this time would have been impacted, and would therefore not be a true representation of pharmacological treatment rates.\u003c/p\u003e\n\u003cp\u003eThis report was not able to determine the effect of the NHS \u0026lsquo;Right to Choose\u0026rsquo;(37). Following the increase in waiting times, many families and adults have received care privately through the NHS \u0026lsquo;Right to Choose Act\u0026rsquo; which allows service-users to seek alternate provisions if services provided by the NHS are not adequate\u0026nbsp;(38). This led to a significant increase in private providers diagnosing and treating ADHD but no studies to date have been able to untangle the specific effects (positive and negative) this had on service-provision. We do not know yet what the quality of after-care or ongoing treatment rates for this group compared for those going to their local NHS services. We also do not know if those going to alternative routes are coming from a specific sector of society with higher rates of knowledge and skills to navigate clinical systems. Additionally, the effect of private healthcare on treatment patterns is not known; private providers may issue all prescriptions through a single pharmacy, which could have a distorting effect on the treatment rates for the ICS/health board/HSCT areas where these pharmacies are located.\u003c/p\u003e\n\u003cp\u003eThe data presented in this publication can be very useful for future research and practice. Future studies could examine the need to investigate in more detail regional differences and why some regions are \u0026lsquo;better\u0026rsquo; than others. Additionally, understanding the implications higher treatment rates has on social factors (education, employment, crime) would highlight further the potential benefits of treatment. The model could also be used to understand further the impact of the national medication shortage. Finally, potential patterns in treatment across the last few years could be picked up by this model and further highlight trends in ADHD care nationally and regionally, informing decision making for commissioners.\u003c/p\u003e"},{"header":"Conclusions","content":"\u003cp\u003eThis study, the first of its kind, has shown the geographic variations in medication treatments for children, young people and adults with ADHD. This is not about ‘calling out’ the good and the bad across the UK but rather to begin to understand why, if ADHD is diagnosed in a standardised way (based on national guidelines), is there such a discrepancy? Are some services more accessible for people to access the processes which is important given that many people with ADHD have dyslexia, developmental language disorder and autism spectrum conditions. With increasing demand on services and increasing waiting lists answering some of these questions becomes an urgent question to answer.\u0026nbsp;\u003c/p\u003e\n\u003cp\u003eWhat is also fundamentally important is how do we prioritise access to care based on patient needs. A triage system that supports those who ‘shout loudest’ means those with the greatest need may never be seen as waiting lists become longer. This paper does not explore this, but we know from past research there are higher rates of ADHD in certain groups who also have increased lasting and costly implications for them and society.\u003c/p\u003e\n\u003cp\u003eHow can we embed more straight forward ADHD diagnoses with general practitioners (GPs) so that people with more complex challenges can be seen by specialised teams? More GP training is certainly important in this mix.\u003c/p\u003e"},{"header":"Abbreviations","content":"\u003cp\u003eADHD,\u0026nbsp;attention deficit hyperactivity disorder\u003c/p\u003e\n\u003cp\u003eCYP, children and young people\u003c/p\u003e\n\u003cp\u003eGP, general practitioner\u003c/p\u003e\n\u003cp\u003eHSCT, health \u0026amp; social care trust\u003c/p\u003e\n\u003cp\u003eIAPT, Improving Access to Psychological Therapies\u003c/p\u003e\n\u003cp\u003eNHS, National Health Service\u003c/p\u003e\n\u003cp\u003eICS, integrated care systems\u003c/p\u003e\n\u003cp\u003eUK, United Kingdom\u003c/p\u003e\n\u003cp\u003eLRx, Longitudinal Prescription Data\u003c/p\u003e\n\u003cp\u003eRxA, Regional Prescription Analysis\u0026nbsp;\u003c/p\u003e\n\u003cp\u003eCOVID-19, coronavirus disease 2019\u003c/p\u003e"},{"header":"Declarations","content":"\u003cp\u003e\u003cem\u003eEthics approval and consent\u003c/em\u003e\u003c/p\u003e\n\u003cp\u003eNot applicable.\u003c/p\u003e\n\u003cp\u003e\u003cem\u003eConsent for publication\u003c/em\u003e\u003c/p\u003e\n\u003cp\u003eNot applicable\u003c/p\u003e\n\u003cp\u003e\u003cem\u003eAvailability of data and materials\u003c/em\u003e\u003c/p\u003e\n\u003cp\u003eThe data that support the findings of this study are available from\u0026nbsp;IQVIA Inc.\u0026nbsp;but restrictions apply to the availability of these data, which were used under license for the current study, and so are not publicly available. Data are however available from the authors upon reasonable request and with permission of\u0026nbsp;IQVIA Inc.\u003c/p\u003e\n\u003cp\u003e\u003cem\u003eCompeting interests\u003c/em\u003e\u003c/p\u003e\n\u003cp\u003eBF reports personal fees and nonfinancial support from Takeda and Medice.\u0026nbsp;JD and CW are employees of Takeda UK Ltd and JD owns stock in Takeda Pharm Sp ADS. AK is currently Chair of the ADHD Foundation.\u003c/p\u003e\n\u003cp\u003e\u003cem\u003eFunding\u003c/em\u003e\u003c/p\u003e\n\u003cp\u003eThe model was developed and funded by Takeda UK Ltd.\u003c/p\u003e\n\u003cp\u003e\u003cem\u003eAuthors’ contributions\u003c/em\u003e\u003c/p\u003e\n\u003cp\u003eThe authors confirm contribution as follows: study conception and design: BF, JD, CW, AK; data collection and model development: JD, CW; analysis and interpretation of results: BF, JD, CW, AK; manuscript preparation: BF, JD. All authors reviewed the results and approved the final version of the manuscript.\u003c/p\u003e\n\u003cp\u003e\u003cem\u003eAcknowledgments\u003c/em\u003e\u003c/p\u003e\n\u003cp\u003eThe authors would like to thank Peter Cain (Takeda UK) for statistical support and analysis.\u003c/p\u003e"},{"header":"References","content":"\u003col\u003e\n \u003cli\u003ePolanczyk G, Rohde LA. Epidemiology of attention-deficit/hyperactivity disorder across the lifespan. Curr Opin Psychiatry. 2007 Jul;20(4):386.\u003c/li\u003e\n \u003cli\u003eSayal K, Prasad V, Daley D, Ford T, Coghill D. ADHD in children and young people: prevalence, care pathways, and service provision. Lancet Psychiatry. 2018 Feb 1;5(2):175\u0026ndash;86.\u003c/li\u003e\n \u003cli\u003eSong P, Zha M, Yang Q, Zhang Y, Li X, Rudan I. The prevalence of adult attention-deficit hyperactivity disorder: A global systematic review and meta-analysis. 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BJPsych Open. 2023 Jul;9(4):e121.\u003c/li\u003e\n \u003cli\u003eHealth geographies population estimates (Accredited official statistics) - Office for National Statistics [Internet]. [cited 2025 Feb 3]. Available from: https://www.ons.gov.uk/peoplepopulationandcommunity/populationandmigration/\u003cbr\u003epopulationestimates/datasets/clinicalcommissioninggroupmidyearpopulationestimates\u003c/li\u003e\n \u003cli\u003ePopulation Estimates - Health Board (2019) Population Estimates - Scottish Health and Social Care Open Data [Internet]. [cited 2025 Feb 3]. Available from: https://www.opendata.nhs.scot/dataset/population-estimates/resource/27a72cc8-d6d8-430c-8b4f-3109a9ceadb1\u003c/li\u003e\n \u003cli\u003eNorthern Ireland Statistics and Research Agency [Internet]. 2024 [cited 2025 Feb 3]. 2022 Mid-Year Population Estimates for Small Geographical Areas within Northern Ireland. 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Quantifying the Protective Effects of Stimulants on Functional Outcomes in Attention-Deficit/Hyperactivity Disorder: A Focus on Number Needed to Treat Statistic and Sex Effects. J Adolesc Health. 2019 Dec 1;65(6):784\u0026ndash;9.\u003c/li\u003e\n \u003cli\u003eThompson T. NHS Cheshire and Merseyside. [cited 2024 Sep 9]. Update on ADHD Medication Shortage. Available from: https://www.cheshireandmerseyside.nhs.uk//your-health/prescribing/update-on-adhd-medication-shortage/\u003c/li\u003e\n \u003cli\u003ewww.rcpsych.ac.uk [Internet]. [cited 2024 Jun 26]. Statement on shortage of ADHD medication. Available from: https://www.rcpsych.ac.uk/news-and-features/latest-news/detail/2023/10/19/statement-on-shortage-of-adhd-medication\u003c/li\u003e\n \u003cli\u003eNHS England \u0026raquo; Choice [Internet]. [cited 2024 Jun 26]. 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Br J Gen Pract. 2024 Jun 1;74(743):e408\u0026ndash;16.\u003c/li\u003e\n\u003c/ol\u003e"}],"fulltextSource":"","fullText":"","funders":[],"hasAdminPriorityOnWorkflow":false,"hasManuscriptDocX":true,"hasOptedInToPreprint":true,"hasPassedJournalQc":"","hasAnyPriority":true,"hideJournal":true,"highlight":"","institution":"","isAcceptedByJournal":false,"isAuthorSuppliedPdf":false,"isDeskRejected":"","isHiddenFromSearch":false,"isInQc":false,"isInWorkflow":false,"isPdf":false,"isPdfUpToDate":true,"isWithdrawnOrRetracted":false,"journal":{"display":true,"email":"[email protected]","identity":"researchsquare","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":true,"externalIdentity":"","sideBox":"","snPcode":"","submissionUrl":"/submission","title":"Research Square","twitterHandle":"researchsquare","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"","reportingPortfolio":"","inReviewEnabled":false,"inReviewRevisionsEnabled":true},"keywords":"ADHD, treatment, treatment rates, variation model, healthcare services","lastPublishedDoi":"10.21203/rs.3.rs-5956482/v1","lastPublishedDoiUrl":"https://doi.org/10.21203/rs.3.rs-5956482/v1","license":{"name":"CC BY 4.0","url":"https://creativecommons.org/licenses/by/4.0/"},"manuscriptAbstract":"\u003cp\u003eBackground – Attention deficit hyperactivity disorder (ADHD) is a common condition impacting approximately 5% of children and 3-4% of adults in the United Kingdom (UK). While it cannot be cured, treatment has shown to positively impact the difficulties associated with ADHD. However, ADHD is widely under-diagnosed and under-treated in the UK. This paper reports the results of a model developed to estimate pharmacological treatment rates by area across National Health Service (NHS) integrated care systems (ICSs) in England, health boards in Scotland and Wales, and health \u0026amp; social care trusts (HSCTs) in Northern Ireland.\u003c/p\u003e\n\u003cp\u003eMethods - The model used UK general population and ADHD prevalence data to estimate the number of patients with ADHD in each area. Prescription data for medicines licensed for the treatment of ADHD were then used to estimate the number of patients that are untreated and treated, and percentage treatment rates by area.\u003c/p\u003e\n\u003cp\u003eResults - Nationally, the estimated proportions of the children and young people (CYP; 5–17 years) and adult populations (18–65 years) treated were 26.6% and 15.6%, respectively, of the expected ADHD populations. Treatment rates by ICS or health board in England, Scotland and Wales ranged from 11.7% to 60.6% for the CYP population, and 8.6% to 24.8% in the adult population (data for Northern Ireland were not available by age group). Overall treatment rates (ages 5–65 years) in Northern Ireland ranged from 6.7% in the lowest ranking HSCT to 31.1% in the highest-ranking HSCT.\u003c/p\u003e\n\u003cp\u003eConclusions - In the UK, there is currently a high degree of geographic variation across all NHS systems and a generally low level of treatment of ADHD, especially in adults. Up to a 4.6-fold difference in pharmacological treatment rates was observed between NHS service provider areas.\u003c/p\u003e","manuscriptTitle":"UK ADHD treatment rates – a regional variation model","msid":"","msnumber":"","nonDraftVersions":[{"code":1,"date":"2025-02-05 11:54:53","doi":"10.21203/rs.3.rs-5956482/v1","editorialEvents":[{"type":"communityComments","content":0}],"status":"published","journal":{"display":true,"email":"[email protected]","identity":"researchsquare","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":true,"externalIdentity":"","sideBox":"","snPcode":"","submissionUrl":"/submission","title":"Research Square","twitterHandle":"researchsquare","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"","reportingPortfolio":"","inReviewEnabled":false,"inReviewRevisionsEnabled":true}}],"origin":"","ownerIdentity":"2c8454e2-3ec6-4fc3-91d2-be7368e4c41c","owner":[],"postedDate":"February 5th, 2025","published":true,"recentEditorialEvents":[],"rejectedJournal":[],"revision":"","amendment":"","status":"posted","subjectAreas":[],"tags":[],"updatedAt":"2025-02-13T12:53:37+00:00","versionOfRecord":[],"versionCreatedAt":"2025-02-05 11:54:53","video":"","vorDoi":"","vorDoiUrl":"","workflowStages":[]},"version":"v1","identity":"rs-5956482","journalConfig":"researchsquare"},"__N_SSP":true},"page":"/article/[identity]/[[...version]]","query":{"redirect":"/article/rs-5956482","identity":"rs-5956482","version":["v1"]},"buildId":"8U1c8b4HqxoKbykW_rLl7","isFallback":false,"isExperimentalCompile":false,"dynamicIds":[84888],"gssp":true,"scriptLoader":[]}