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Covid-19: an opportunity to reduce unnecessary healthcare

BMJ 2020; 370 doi: https://doi.org/10.1136/bmj.m2752 (Published 14 July 2020) Cite this as: BMJ 2020;370:m2752

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Overdiagnosis and -treatment of ADHD is more a North American problem

Dear Editor,
Moynihan et al. make an important point about analysing the impact of missed medical appointments during the COVID-19 lockdown as an opportunity for evidence-based reduction of unnecessary healthcare.[1]

We were not happy to see ADHD on the list of over-diagnosed conditions in the BMJ, which is read primarily by members of the British Medical Association. There is good evidence from pharmaco-epidemiological studies that prescribing of ADHD medication in the US is 5-8 times higher in children and adolescents, and 10-20 times higher in adults with ADHD compared to countries with much lower prescribing rates in Europe (France, UK and Spain) and worldwide (Japan, Australia).[2] Prescribing of ADHD medication in the UK has increased considerably in the last 20 years, especially for 10-14 year-old boys, but 2014 data indicate that less than 0.1% of adults in UK were prescribed ADHD medication,[2] this is by a factor 10-40 lower than the global prevalence of ADHD in adults (1.4-3.6 %).[3] The prevalence of ADHD was stable from 1985-2012 when controlling for study methods.[4] However, in the UK and elsewhere in Europe, ADHD is an under-diagnosed condition and ADHD medication is widely under-prescribed.

Most NHS services have waiting lists of 1-2 years for an adult ADHD assessment and this situation has just got worse with the closing down of many ADHD services that were considered non-essential during the pandemic lockdown. We need more funding and more efficient NHS services (including video-consultations, electronic prescribing and trained doctors & nurse prescribers) to tackle this problem.

References
1. Moynihan et al., BMJ 2020; 370:m2752
2. Raman et al., Lancet Psychiatry 2018; 5: 824-35
3. Fayyad et al., Atten Def Hyp Disord 201; 9: 47-65
4. Polanczyk et al., Int J Epidemiol 2014; 43: 434-42

Competing interests: UM-S is joint president and JS-M executive committee member of UKAAN (www.ukaan.org), which has received educational funding from Flynn/Medice, Janssen & Shire/Takeda

25 July 2020
Ulrich Müller-Sedgwick
Consultant Psychiatrist
Jane A. Sedgwick-Müller
Adult ADHD Service, BEH Mental Health NHS Trust, North London & Department of Psychiatry, University of Cambridge & UK Adult ADHD Network (UKAAN)
London & Cambridge, UK