ADHD in Germany: Trends in Diagnosis and Pharmacotherapy

Bachmann, Christian; Philipsen, Alexandra; Hoffmann, Falk

doi:10.3238/arztebl.2017.0141

Cited by 55 publications

(51 citation statements)

References 49 publications

(42 reference statements)

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“…A few studies reported about rising trends of disease frequency (reviewed in 6 ). In Germany, an increase in prevalence was reported by two studies 3,7 ; e.g . from 2.5% in 2005 to 4.2% in 2015 3 and from 5.0% in 2009 to 6.1% in 2014 7 , although some studies showed no increase in recent years.…”

Section: Introductionmentioning

confidence: 89%

“…In Germany, an increase in prevalence was reported by two studies 3,7 ; e.g . from 2.5% in 2005 to 4.2% in 2015 3 and from 5.0% in 2009 to 6.1% in 2014 7 , although some studies showed no increase in recent years. The question arising in this context is whether the prevalence increase over the last years is true or whether it is just the result of the heightened attention from the public, media and scientific community.…”

Section: Introductionmentioning

confidence: 89%

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Trends and regional variations in the administrative prevalence of attention-deficit/hyperactivity disorder among children and adolescents in Germany

Akmatov

Steffen

Holstiege

et al. 2018

Sci Rep

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There is a controversy regarding temporal trends in prevalence of attention-deficit/hyperactivity disorder (ADHD). Using nationwide claims data containing data for approximately six million statutory health insured children we aimed to examine a) trends of ADHD administrative prevalence during 2009–2016; b) regional variations in prevalence, and c) factors associated with an increased chance of ADHD diagnosis. The ICD-10 code ‘F90-hyperkinetic disorder’ was used to define an ADHD case. Global and Local Moran’s I tests were used to examine the spatial autocorrelation and k-means-cluster analysis to examine the course of ADHD prevalence in administrative districts over years. Two-level logistic regression was applied to examine individual- and district-level factors associated with ADHD diagnosis. The administrative prevalence of ADHD was 4.33% (95% CI: 4.31–4.34%). We observed pronounced small-area differences on the district level with prevalences ranging between 1.6% and 9.7%. There was evidence of strong spatial autocorrelation (Global Moran’s I: 0.46, p < 0.0001). The k-means-method identified six clusters of different size; all with a stagnating trend in the prevalence over the observation period of eight years. On the district level, a lower proportion of foreign citizens, and a higher density of paediatric psychiatrists and paediatricians were positively associated with ADHD with a more pronounced effect in urban districts.

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Section: Introductionmentioning

confidence: 89%

Section: Introductionmentioning

confidence: 89%

Trends and regional variations in the administrative prevalence of attention-deficit/hyperactivity disorder among children and adolescents in Germany

Akmatov

Steffen

Holstiege

et al. 2018

Sci Rep

View full text Add to dashboard Cite

show abstract

“…Prevalence rates in children and adolescents represent averaged values across the full age range, but peak prevalence may be much higher in certain age groups, for example, 13% in 9-year-old boys. 35 Universal ADHD prevalence in adults is estimated to lie at 2.8%, with higher rates in high-income (3.6%) than in low-income (1.4%) countries. 36 True prevalence rates (also called community prevalence, e.g., Sayal et al 37 ) should be based on population-based representative health surveys, that is, the actual base rate of ADHD in the population, in contrast to the administrative base rate, which is related to clinical data collection (Taylor 38 ).…”

Section: Definitions and Phenomenologymentioning

confidence: 99%

ADHD: Current Concepts and Treatments in Children and Adolescents

et al. 2020

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Attention deficit hyperactivity disorder (ADHD) is among the most frequent disorders within child and adolescent psychiatry, with a prevalence of over 5%. Nosological systems, such as the Diagnostic and Statistical Manual of Mental Disorders, 5th edition (DSM-5) and the International Classification of Diseases, editions 10 and 11 (ICD-10/11) continue to define ADHD according to behavioral criteria, based on observation and on informant reports. Despite an overwhelming body of research on ADHD over the last 10 to 20 years, valid neurobiological markers or other objective criteria that may lead to unequivocal diagnostic classification are still lacking. On the contrary, the concept of ADHD seems to have become broader and more heterogeneous. Thus, the diagnosis and treatment of ADHD are still challenging for clinicians, necessitating increased reliance on their expertise and experience. The first part of this review presents an overview of the current definitions of the disorder (DSM-5, ICD-10/11). Furthermore, it discusses more controversial aspects of the construct of ADHD, including the dimensional versus categorical approach, alternative ADHD constructs, and aspects pertaining to epidemiology and prevalence. The second part focuses on comorbidities, on the difficulty of distinguishing between “primary” and “secondary” ADHD for purposes of differential diagnosis, and on clinical diagnostic procedures. In the third and most prominent part, an overview of current neurobiological concepts of ADHD is given, including neuropsychological and neurophysiological researches and summaries of current neuroimaging and genetic studies. Finally, treatment options are reviewed, including a discussion of multimodal, pharmacological, and nonpharmacological interventions and their evidence base.

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“…ADHD diagnoses were identified by the ICD-10 codes F90.0, F90.1, F90.8, F90.9, or F98.8 from the baseline period. These ICD-10 codes were used in a recent study to identify ADHD patients in German health insurance data (Bachmann et al 2017). Individuals with an atomoxetine (ATX) prescription prior to the initial MPH prescription or with prescriptions of lisdexamfetamine (LIS) or dexamfetamine (DEX) at any time were excluded since these drugs played a minor role in clinical practice during the study period.…”

Section: Cohort Definitionmentioning

confidence: 99%