Starting, stopping and restarting. Patterns of Methylphenidate Use over 14 years in a large public health system

The study analyzed patterns of methylphenidate use in children and adolescents with ADHD in South Africa over 14 years (2011-2024) using pharmacy database records. The study included 23,243 children aged 5-18 years who generated 65,885 treatment episodes. The median age at first prescription was 10 years, with 77.6% of patients being male. Only 28.2% of patients continued treatment for 12 months at first initiation and only 15.4% at re-initiation, substantially lower than in high-income countries. Approximately one quarter of patients never visited a pharmacy to collect their first prescription, and nearly 40% of patients had three or more treatment episodes. The strongest predictor of treatment continuation was high visit frequency at the beginning of treatment and use of sustained-release formulations. The study demonstrated that early clinical engagement and reducing barriers to treatment access are modifiable factors that improve persistence.