ADHD in children and adolescents in Germany. Results of the cross-sectional KiGGS Wave 2 study and trends

Abstract

Attention deficit/hyperactivity disorder (ADHD) is one of the most common mental disorders in childhood and adolescence and is associated with functional, psychosocial and cognitive impairment. As part of the second wave of the German Health Interview and Examination Survey for Children and Adolescents (2014-2017), parents of children and adolescents aged between 3 and 17 years reported whether their child was diagnosed with ADHD by a physician or psychologist. Overall, 4.4% of children and adolescents have been diagnosed with ADHD in Germany. In comparison, the KiGGS baseline study (2003-2006) showed a reduction of lifetime ADHD diagnoses of almost one percentage point over a period of ten years. The reduction of parent-reported ADHD diagnoses primarily occurred among 3- to 8-year old children and boys. The results are discussed in terms of health promotion and the introduction of health care measures.

Prevalence and Epidemiological Characteristics of ADHD in Pre-School and School Age Children in the Province of Tarragona, Spain

“…The overall estimated prevalence of ADHD in our sample was 5.5%, which is in agreement with the 5.3% reported in the metaanalysis by Polanczyk et al (2007) and the 5.5% identified by the NSCH among US children (Song et al, 2019). Our estimate is higher than the latest meta-analyses by Polanczyk et al (2015) and Erskine et al (2013), which estimated rates of around 3%, and other European studies conducted in France, Italy, the UK, and Germany that reported ADHD prevalence rates of between 1.4% and 4.4% (Göbel et al, 2018;Lecendreux et al, 2011;Reale & Bonati, 2018;Russell et al, 2019). However, the high heterogeneity between prevalence estimates leads us to consult other studies that report even higher values, such as 6.3% in China (Liu et al, 2018;Wang et al, 2017), between 7.8% and 8.8% in Australia, Nigeria, and Korea (Kim et al, 2017;Sawyer et al, 2018;Umar et al, 2018), and 10.2% in the US (Xu et al, 2018).…”

“…As widely found by other researchers (Danielson et al, 2018;Ezpeleta et al, 2014, Göbel et al, 2018Umar et al, 2018;Vasiliadis et al, 2017;Xu et al, 2018), our results also indicated that regardless of age boys were more likely to have ADHD than girls, with a sex ratio in the range of 2-3:1, as reported in the review by Sayal et al (2018) and the administrative data by Pérez-Crespo et al (2020) in Spain. The prevalence in school-age boys was very high (11.9%), but not far from the 11.7% found by Danielson et al (2018) and Kim et al (2017) in 7-to 12-year-old children.…”

“…In this respect we found a prevalence of 7.7% in school children of 11 years, an age that has previously been established as a peak of diagnosis (Danielson et al, 2018;Göbel et al, 2018;Russell et al, 2019;Vasiliadis et al, 2017). Meanwhile the estimated prevalence in pre-schoolers was 3%, similar to the rate estimated by Ezpeleta et al (2014) for Spain, but higher than the 0.2% calculated by Göbel et al (2018) for Germany or the 1.5% to 2.1% calculated by Danielson et al (2017Danielson et al ( , 2018 for the US. In comparison with the prevalence reported in the Catalan public mental health system in pre-schoolers (0.28%; Pérez-Crespo et al, 2020), and the prevalence of prior diagnosis reported in the present sample (0.30%), our estimates (3%) are much higher.…”

“…Regarding the reasons for this apparent increase in diagnosis prevalence, Safer (2018) and Rydell et al (2018) have suggested that the rates of ADHD found in the last two decades might reflect changes in diagnostic and treatment practices, since the prevalence of ADHD symptoms based on parent ratings have not varied over time. In contrast, Göbel et al (2018) showed a reduction in lifetime ADHD diagnoses in Germany of almost one percentage point over the period between 2003 to 2006 (5.3%) and 2014 to 2017 (4.4%). Also in Europe, the weighted prevalence of ADHD from the Millennium Cohort Study was 3.9% (Russell et al, 2019), and the meta-analysis conducted in Italian children and adolescents reported a pooled prevalence of 2.9% (Reale & Bonati, 2018).…”

Physical activity and the development of general mental health problems or attention-deficit hyperactivity disorder (ADHD) symptoms in children and adolescents: A cross-lagged panel analysis of long-term follow-up epidemiological data

“…The global prevalence of ADHD is around 5% (Posner et al, 2020 ), and it has been reported in up to 7.2% among children and adolescents (Thomas et al, 2015 ). In Germany, the prevalence rate in children and adolescents was 5.3% (2003 – 2006) and 4.4% (2014 – 2017), respectively (Göbel et al, 2018 ). Age-inappropriate behaviors, including hyperactivity, impulsivity, and inattention, which persist for at least 6 months, are primary ADHD symptoms (American Psychiatric Association, 2016 ).…”