Every year, increasing numbers of Swedish children are being medicated with ADHD drugs. In some areas and age groups this amounts to one pupil in every school class. At the same time, the regional variations are huge.
The numbers of children prescribed ADHD medications can vary between 2 and 14 percent in different municipalities, for the same age and gender group. According to Peter Salmi, investigator at The National Board of Health and Welfare (Socialstyrelsen), the causes behind the regional differences remain unknown. The authority is investigating the subject and Salmi says they “are hoping to know more soon”.
In contrast to other common psychiatric diagnoses “there are not yet any national guidelines for ADHD”, he adds.
Still, the Pharmaceutical Agency (Läkemedelsverket) have recommendations for medicating ADHD and the Children and Youth Psychiatry (BUP) has created their own guidelines.
Peter Salmi says that the regional variations might to some extent be explained by the lack of awareness and research on neuro psychiatric diagnoses, such as ADHD and Autism.
“You can speculate about the causes. ADHD might actually be more prevalent in some regions than in others and socioeconomic factors may be of importance,” he argues.
Ingemar Engström, professor of child psychiatry, doesn’t agree, “There is no reason to believe that the numbers of children in need of CNS-stimulants varies in different parts of the country”. He adds that the differences more probably are a result of varying local clinical traditions and sometimes affected by influential profiles in the regional child psychiatry.
In recent years, Gävleborg, Halland and Gotland counties top the list of prescribed ADHD medications for children and teenagers. And in some municipalities in Norbotten, Västerbotten and Örebro county, as many as 14 percent of the boys aged 10-17 take ADHD medications.
While in all of Sweden, boys use CNS-stimulants more than twice as often as girls, this difference don’t stand true for all counties. On Gotland, girls aged 15-19 are prescribed more than boys in the same age group. The teenage girls on Gotland stand out from the country average and use five times as much ADHD drugs as the corresponding population in Jönköping county.
Methylphenidate, a CNS-stimulant classified as a narcotic, is the first choice medication for ADHD. It is sold under various names, such as Ritalin and Concerta, and is given to around 80 percent of diagnosed children. According to The Swedish Agency for health technology assessment (SBU), there are no long term studies on the effects on children, but the medication is generally considered safe and efficient. However, an extensive South Korean study from 2016 showed an increased risk of heart arrhythmias in children and young adults using CNS-stimulants and previous research indicates that the medications may stunt children’s growth.
According to Peter Salmi, the huge regional variations for ADHD medications are unusual and not observed for other common psychiatric drugs, such as antidepressants or anxiolytics.
“There is something particular with the ADHD diagnosis and this patient group that makes these differences more pronounced”, he says.
Prescription of CNS-stimulants to children in Sweden
Source for numbers mentioned and data visualisations: The National Board of Health and Welfare (Socialstyrelsen)
BY SOPHIA TIBBLIN AND LILIIA MAKASHOVA