“ADHD is among the most common pediatric neurodevelopmental disorders,” Gary A. Smith, MD, DrPH, notes. “In 2019, nearly 10% of US children had a diagnosis of ADHD. Approximately 3.3 million children, or roughly 5 out of every 100 children in the US, are currently prescribed medication for ADHD.”
Most prior research on medication errors that occur outside of the hospital included all pharmaceutical classes and did not focus on ADHD medications. Further, studies that have specifically examined ADHD medication exposures in children have not focused on therapeutic errors. A new study by Dr. Smith and colleagues published in Pediatrics fills this gap by investigating medication errors involving ADHD medication among US youth.
The researchers conducted a retrospective analysis of data from the National Poison Data System (NPDS) from 2000-2021. America’s Poison Centers—formerly the American Association of Poison Control Centers—maintains this database, which includes information from calls to US poison centers.
“This study’s objective was to investigate the characteristics of, and trends in, out-of hospital ADHD medication errors among people younger than 20,” says Dr. Smith. “This study was limited to exposures designated by the NPDS as ‘unintentional therapeutic errors’ involving ADHD medications. Population based rates of therapeutic errors were calculated using US census data.”
Most Errors Occurred Among Boys & At Home
The researchers identified 124,383 ADHD medication related errors reported from 2000 to 2021. “The annual number of ADHD-related medication errors increased almost 300% from 2000 to 2021,”
Dr. Smith notes. “Nearly 93% of the exposures occurred in the home, and 66.6% of cases involved children aged 6-12.”
Errors related to ADHD medications occurred most often in boys (76.4%), and half (50.5%) involved amphetamines and related compounds. Most errors (79.7%) were single substance exposures.
“About half of medication errors involving ADHD medications as the primary substance occurred when someone inadvertently took or was given a medication twice,” Dr. Smith says. “In about 13% of cases, someone inadvertently took or was given someone else’s medication. In another 13% of cases, the wrong medication was taken or given.”
The increase in ADHD medication-related errors parallels the increase in ADHD diagnoses (Figure). “We are unaware of data showing that healthcare providers became more likely to prescribe medications to a child with the diagnosis of ADHD during the past two decades,” notes Dr. Smith. “Therefore, we are unable to comment on whether changes in prescribing practices may have contributed to the observed increase in ADHD medication errors.”
Focus on Educating Patients & Caregivers
While most errors related to ADHD medications did not require treatment at a healthcare facility (82.7%), 2.3% of cases did involve a hospital admission, including to a critical care unit in 0.8% of cases. Further, 4.2% of cases were associated with a serious medical outcome, according to Dr. Smith.
“Some children experienced agitation, tremors, seizures, and changes in mental status,” he says. “Children younger than 6 were twice as likely to experience a serious medical outcome and were more than three times as likely to be admitted to a healthcare facility than individuals aged 6-19.”
These findings point to a need to dedicate more attention to the education of patients and caregivers about preventing medication errors. Improving child-resistant medication dispensing systems and tracking tools are also important. “Pediatricians should continue to provide clear instructions to patients and child caregivers about dosing and timing of medications,” Dr. Smith notes. “They may wish to consider using teach-back and other techniques to ensure understanding.”