ADHD Medication Errors in Children Sharply Increased

ADHD medication errors have increased nearly 300% in the United States (U.S.) in the last two decades. In 2021, such errors harmed one child every 100 minutes, a study finds.

Attention-deficit/hyperactivity disorder (ADHD) is one of the most common pediatric neurodevelopmental disorders, affecting nearly 10% of children in the United States (U.S.), according to the 2019 data. About 3.3 million children, or roughly 5 out of every 100 children in the U.S., are currently prescribed medication for ADHD.

A new study published in Pediatrics by the researchers at the Center for Injury Research and Policy and Central Ohio Poison Center at Nationwide Children’s Hospital found that the annual number of ADHD-related medication errors increased 299% from 2000 to 2021.

In 2021 alone, 5,235 medication errors were reported, with children in the 6-12-year-old age group accounting for 67% of cases. Nearly all (93%) of exposures occurred in the home.

The most common ADHD medication errors were:

• 54% – “Inadvertently taken/given medication twice”
• 13% – “Inadvertently taken/given someone else’s medication”
• 13% – “Wrong medication taken/given”

The overall trend was driven by males, accounting for 76% of the medication errors. Gary Smith, MD, DrPH, senior author of the study and director of the Center for Injury Research and Policy at Nationwide Children’s Hospital, says that males are more affected by medication errors because ADHD diagnosis rates are higher among boys than girls.

“We are unaware of data showing that health care providers became more likely to prescribe medications to a child with the diagnosis of ADHD during the past 2 decades. Therefore, we are unable to comment on whether changes in prescribing practices may have contributed to the observed increase in ADHD medication errors,” he told Healthnews.

Although in 83% of cases, the individual did not receive treatment in a health care facility, 2.3% of medication errors resulted in admission to a health care facility, including 0.8% to a critical care unit. Additionally, 4.2% of cases were associated with a serious medical outcome, such as agitation, tremors, seizures, and changes in mental status.

Children younger than 6 years old were twice as likely to experience a serious medical outcome and were more than three times as likely to be admitted to a healthcare facility than 6-19-year-olds.

The study authors say that ADHD medication errors could be prevented by educating parents and caregivers and developing improved child-resistant medication dispensing and tracking systems.

“Another strategy may be a transition from pill bottles to unit-dose packaging, like blister packs, which may aid in remembering whether a medication has already been taken or given,” Smith says.

Researchers say that while prevention efforts should focus on the home setting, it is important to give additional attention to settings where children and adolescents spend time and receive medication, such as schools.

What is ADHD?

ADHD usually is first diagnosed in childhood and often lasts into adulthood. Children with the condition may have trouble paying attention or be overly active.

While it is normal for children to have trouble with focus or behavior, a child with ADHD might:

• Daydream a lot
• Forget or lose things a lot
• Squirm or fidget
• Talk too much
• Make careless mistakes or take unnecessary risks
• Have a hard time resisting temptation
• Have trouble taking turns
• Have difficulty getting along with others

The causes of ADHD remain unclear; however, research suggests that genetics may play an important role. Scientists are also looking at possible risk factors, such as brain injury, exposure to environmental risks during pregnancy, premature delivery, low birth weight, and alcohol and tobacco use during pregnancy.

Behavioral therapy is a first-line treatment for ADHD and can be combined with medications. The U.S. Food and Drug Administration (FDA) has approved two types of ADHD drugs — stimulants and nonstimulants.