ADHD prescribing: national findings of children and adolescents attending mental health services in Ireland

Introduction: Attention deficit hyperactivity disorder (ADHD) is a neurodevelopmental condition, which initially presents in childhood. While prescribing trends for treating ADHD have been previously examined in Ireland’s paediatric population, off-label prescribing of ADHD medication has yet to be studied. Aim: We aimed to describe ADHD medication prescribing and off-label prescribing of ADHD medication in Ireland. Method: This cross-sectional study used a sample drawn from the population of children and adolescents who were attending mental health services in Ireland as of 31st December 2021. Participants were included based on predefined inclusion and exclusion criteria; those who were aged 17 years or younger and had been prescribed at least one psychotropic medication (n = 3,193). We described the frequency and population of those prescribed an ADHD stimulant or non-stimulant medication and the target condition or target symptom cluster for prescription. We reported the starting and maintenance doses of each medication. Results: Fifty-three percentage (n = 1,687) of children and adolescents were prescribed an ADHD medication on 31st December 2021, with more boys being prescribed an ADHD medication compared to girls (n = 1,284 vs n = 395). The most common age category prescribed ADHD medication was 11–13 years of age. The most common indication for prescribing ADHD medication was the target condition ADHD (n = 1,661; 98.5%).Twenty-six patients (1.5%) were prescribed ADHD medication for target symptoms, most commonly depressive (n = 8) and behavioural disturbance symptoms (n = 8) (i.e., off-label prescribing of ADHD medication). Conclusion: More than half of young people attending specialist mental-health services in Ireland were receiving an ADHD-specific medicine, and almost all prescriptions were tied to a confirmed ADHD diagnosis. Off-label use for other symptom clusters was rare (< 2%), indicating strong adherence to licensed indications but also highlighting the importance of continued surveillance to detect emerging off-label trends and to ensure prescribing remains evidence-based and patient-centred.