Editorials

Prescribing methylphenidate for moderate ADHD

BMJ 2013; 347 doi: https://doi.org/10.1136/bmj.f6216 (Published 16 October 2013) Cite this as: BMJ 2013;347:f6216
  1. Iain McClure, consultant child and adolescent psychiatrist
  1. 1Royal Hospital for Sick Children, Edinburgh EH9 1LF, UK
  1. iain.mcclure{at}ed.ac.uk

Has NICE guidance unwittingly exposed a new challenge for assessing this condition?

Why has the National Institute for Health and Care Excellence (NICE) issued a reminder that first line treatment for moderate attention-deficit/hyperactivity disorder (ADHD), which affects about 8% of school aged children and young people in the United Kingdom,1 should not include methylphenidate?2 This recent bulletin follows the annual report by the Care Quality Commission, which showed that methylphenidate prescriptions for ADHD in primary care in England rose by 56% between 2007 and 2013.3

The 2006 NICE technology appraisal guidance for the use of methylphenidate in ADHD in children stated that “it is not anticipated that this guidance will result in a major increase over current trends in the rate of prescribing for ADHD.”4 Although the Care Quality Commission report didn’t clarify what proportion of methylphenidate prescriptions are for moderate ADHD, NICE’s bulletin suggests that the institute is worried that it has underestimated prescription trends and that clinicians may not be heeding its guidance. What could be causing this increase in methylphenidate use?

The commission’s report explains that between 2011 and 2012 the prescription of methylphenidate in primary care continued to rise steadily, …

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