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A new study published in the journal Pediatrics, of the American Academy of Pediatrics, reveals that the frequency of cases reported to United States poison centers of out-of-hospital Attention-Deficit/Hyperactivity Disorder (ADHD) pediatric medication-related therapeutic errors increased by nearly 300% during the study period, which spanned 22 years.

Although part of this increase can be attributed to increased prescribing of these medications, the study warns of the need for more prevention strategies, given that these errors are preventable.

Attention-deficit/hyperactivity disorder (ADHD) is among the most common pediatric neurodevelopmental disorders. In 2019, an estimated 9.4% of US children had a diagnosis of ADHD. Around 3.3 million children, or approximately 5 out of every 100, are prescribed medications for this disorder. Worldwide estimates of ADHD prevalence range from 8% to 10% in children and adolescents, and from 2.5% to 4% in adults. Approximately one third of childhood ADHD persists into adulthood, making this disorder a critical mental health problem.

The US National Poison Data System (NPDS) defines a therapeutic error as an “an unintentional deviation from a proper therapeutic regimen that results in the wrong dose, incorrect route of administration, administration to the wrong person, or administration of the wrong substance.”

From 2000 to 2021, 87,691 therapeutic error exposures involving ADHD medications as the first-ranked substance among youth younger than 20 years old were reported. In 2021, 5,235 therapeutic errors were reported. The 6 to 12-year-old age group accounted for two-thirds (66.6%) of the exposures, and approximately three-quarters (76.4%) of the exposures were to males.

Most exposures (92.9%) occurred in residences, while 5.5% occurred at school and 1.6% occurred at another location (public area, workplace, or restaurant).

4.2% (3,561) of exposures were associated with a serious medical outcome. However, most exposures were moderate effect cases (3479, 4.1%) and only 82 (0.1%) were major effect cases; no deaths were reported.

In this study, most therapeutic errors were attributable to “inadvertently taken or given medication twice,” followed by “inadvertently taken or given someone else’s medication.”

The strategies proposed by the study to prevent and reduce the incidence of these errors include:

• Patient and caregiver education about how to maintain a record of when medications are taken or the use of child-resistant pill organizers.
• A transition from pill bottles to unit-dose packaging, such as blister packs, which may aid in remembering whether a medication has already been taken or given.
• The development of improved child-resistant medication tracking and dispensing systems.
  

Although prevention efforts should focus on the home (where approximately 93% of exposures occurred), the study concludes that additional attention should be given to schools and other settings where children and adolescents spend time and receive medications. Continued efforts to raise awareness among health professionals about the prevention of these therapeutic errors also seem warranted.

This story was produced using content from original studies or reports and from other medical research, as well as health and public health sources, highlighted in related links throughout the article.