Paving the way for cheaper medicines for children with ADHD
Campaign expected to help lower costs for families following research
For families with children diagnosed with ADHD, the first question usually is how and where they can get help if their loved one needs it. The number of Irish children presenting with Attention Deficit Hyperactivity Disorder is on the increase, but not due to a rise in the prevalence of the condition.
Associated stigma with ADHD down through the years and a failure by clinicians to properly diagnose it mean many children, some at this stage young adults, are only presenting with symptoms now.
Treating children early with medication can help any long term effects, contend clinicians. Nonetheless, a new study involving Professor Fiona McNicholas, Professor of Child and Adolescent Psychiatry at UCD School of Medicine and consultant at Our Lady’s Hospital for Sick Children in Crumlin, throws light on the surprising fact that only a small amount of children are availing of free medication under a state-funded scheme. A public campaign is now needed to ensure there is a greater take up of the free ADHD medication to ensure better outcomes for children, especially as they approach adolescence. But changes must minimise cost implications for the state.
Outlining the background to the study entitled ADHD in children: a path to free medicines, published in a recent edition of the Irish Journal of Medical Science, Professor McNicholas, explained:
“We have reasonable data in that long term, effective treatment of ADHD has benefits in terms of a child not engaging in criminality or a child having a better educational outcome, having a better record of going to a job and maintaining a job, having fewer interpersonal difficulties, these are all the long term negative sequela of ADHD. “The sense is that those who have a treatment have a better outcome than those who have not been treated. The argument would be that you are swapping one cost for another”. The research looked at the discrepancies in entitlements of Irish children to free ADHD medication and how, after a decision by the Ombudsman, all children with ADHD can now avail of free medication. The study looked at the cost implications for the state and the implications of universal coverage under the long term illness (LTI) scheme for under 16s.
Professor McNicholas explained how, while it was internationally accepted that 5% of children had ADHD, that there was no concrete data on the numbers of children in Ireland who have the condition and are taking the medication. There was also a period of confusion in 2013 after negative public discussion around ADHD and a perception that some children were only entitled to such medication outside of the LTI scheme.
“That created a disparity and an inequity amongst families with a member who had the condition,” explained Professor McNicholas. The confusion was clarified by the Ombudsman who wrote to the Government and declared it was unsatisfactory that there was such inequity around the issue. The research group accessed data on those drawing down medication under the scheme. It discovered that the number of children with ADHD taking medication on the LTI scheme was “very small”.
In fact, €107,894 (4.4%) of the €2.4m the state spent on ADHD medicines was under the LTI scheme in 2011. But this study concludes that, given demand and applications for free ADHD medicines, this is likely to rise significantly now under the LTI scheme. There could now be a €8.4m bill for ADHD medicines, based on current prescribing patterns.
But why has there been such a limited take up by families under the scheme to date? “Given there was confusion and a wish to remove ADHD, it is understandable how clinicians filling in forms may have been influenced by what their old managers on health boards were saying,” added Professor McNicholas. Professor McNicholas, has said that a campaign is needed to ensure the take up of ADHD medication increases. “In addition, there’s certainly stigma around mental health problems and even pursuing free medication. For some families, they already feel blamed for their children’s misbehaviour and feel unentitled to free medication,” she explained
“The reality going forward is medication costs shouldn’t be a barrier to effective treatment.”
GPs will help destigmatise ADHD and will be trained to do so while campaign groups have also been contacted. Clinicians are sufficiently aware of the costs of drugs and should be encouraged to consider prescribing less expensive drugs if equal efficacy is established. “The NHS [in Britain] have started to do on a larger scale where they are recommending and in some cases restricting stocking of medications to ones that are less expensive.” ADHD medication here on average now costs €100 a month per family for each child.
Professor McNicholas has also received EU funding for research into the transition between child and adult mental healthcare, including young people with ADHD.
The MILESTONE project gave €6m to eight countries, including €350,000 to Ireland. Professor McNicholas and Dr Lesley O’Hara of UCD School of Medicine are leading the research. This separate project aims to map the gap in child to adult services across Europe.
“There’s a huge gap of young people at the age of 18 needing mental health services but not actually going from one service to another. Children with ADHD and eating disorders are less likely to be referred,” concluded Professor McNicholas.
This story first appeared in the summer 2016 edition of UCD Today, the university magazine.
