Trends in ADHD medication use in children and adolescents in five western countries, 2005–2012

https://doi.org/10.1016/j.euroneuro.2017.03.002Get rights and content

Abstract

Over the last two decades, the use of ADHD medication in US youth has markedly increased. However, less is known about ADHD medication use among European children and adolescents. A repeated cross-sectional design was applied to national or regional data extracts from Denmark, Germany, the Netherlands, the United Kingdom (UK) and the United States (US) for calendar years 2005/2006–2012. The prevalence of ADHD medication use was assessed, stratified by age and sex. Furthermore, the most commonly prescribed ADHD medications were assessed. ADHD medication use prevalence increased from 1.8% to 3.9% in the Netherlands cohort (relative increase: +111.9%), from 3.3% to 3.7% in the US cohort (+10.7%), from 1.3% to 2.2% in the German cohort (+62.4%), from 0.4% to 1.5% in the Danish cohort (+302.7%), and from 0.3% to 0.5% in the UK cohort (+56.6%). ADHD medication use was highest in 10–14-year olds, peaking in the Netherlands (7.1%) and the US (8.8%). Methylphenidate use predominated in Europe, whereas in the US amphetamines were nearly as common as methylphenidate. Although there was a substantially greater use of ADHD medications in the US cohort, there was a relatively greater increase in ADHD medication use in youth in the four European countries. ADHD medication use patterns in the US differed markedly from those in western European countries.

Introduction

Attention-deficit/hyperactivity disorder (ADHD) is a psychiatric disorder with a male preponderance and a worldwide prevalence estimate of 3.4% in childhood and adolescence (Polanczyk et al., 2015), with European studies reporting lower prevalences (Döpfner et al., 2008, Green et al., 2005, Kvist et al., 2013, Meltzer et al., 2000, Russell et al., 2014) and US studies reporting higher prevalences (8.7%–10.6% (Visser et al., 2014; Wolraich et al., 2014)). Generally, studies employing DSM-IV ADHD criteria yield higher prevalences than those based on ICD-10 criteria (Döpfner et al., 2008, Ford et al., 2003). This is due to the fact that the ICD-10 equivalent of ADHD, the so-called “hyperkinetic disorder”, is a narrower and more severe subtype of the DSM-IV “attention-deficit/hyperactivity disorder”. For the sake of brevity, in the following text both disorders will be subsumised under the term “ADHD”.

In school-age children, most international clinical guidelines on the management of ADHD recommend a stepwise approach to treatment, starting with non-pharmacological interventions (Thapar and Cooper, 2016) and, if this is not successful, pharmacological treatment should be initiated. In contrast, US guidelines recommend an individual treatment plan that can include pharmacotherapy, behavioral therapy and/or psychosocial interventions, but which is not designed in a stepwise fashion (Pliszka, 2007). In preschool children with ADHD, parent training should be given priority, and – with the exception of the US (Pliszka, 2007) – prescription of ADHD medication is not encouraged (National Institute for Health and Care Excellence, 2008).

In recent years, the prevalence of ADHD medication use has increased in several countries (Burcu et al., 2016, Dalsgaard et al., 2013, Visser et al., 2014). These increases have been seen across all age groups, from young children to adolescents, and the use is increasingly continued into adulthood (Dalsgaard et al., 2013, Johansen et al., 2015).

For decades, methylphenidate has been the most commonly prescribed drug for treatment of ADHD symptoms, however, use of other drugs for the treatment of ADHD (e.g. atomoxetine, lisdexamfetamine) is increasing (Health and Social Care Information Centre, 2015). According to international treatment guidelines, methylphenidate or dexamfetamine are recommended as first-line pharmacological treatment and atomoxetine as second line in both children and adolescents (Thapar and Cooper, 2016). Long-term effectiveness and safety data are lacking, and there are concerns about safety aspects of prescribing ADHD medication in the pediatric population (Zito and Burcu, 2016). Despite largely similar treatment guidelines, the use of medication and psychosocial treatment for ADHD varies significantly between countries (Hinshaw et al., 2011, Setyawan et al., 2015). Therefore, an international comparison of medication trends is useful in order to compare medication use patterns.

In this study, we aimed to compare trends in prevalence of ADHD medication use in children and adolescents (0–19 year-olds) in Denmark, Germany, the Netherlands, the United Kingdom (UK), and the United States (US), stratified by sex and age. Additionally, we aimed to assess the most commonly prescribed ADHD medications.

Section snippets

Denmark

This study was performed using data from the Danish Registry of Medicinal Products Statistics (RMPS). The RMPS constitutes a national prescription database of all outpatient pharmacy-dispensed prescription medications for the 5.5 million Danish inhabitants. Each prescription record contains detailed information on the drug dispensed (including ATC code). The prevalence of ADHD medication use was calculated using an estimation of the underlying population of 0- to 19-year olds as denominator.

Germany

We

Results

In 2012, the number of children and adolescents who received ADHD medication among eligible youth were as follows: Germany: 30,747/1,414,623; Denmark: 18,585/1,203,817; the Netherlands: 5157/131,954; the United Kingdom: 4489/827,906; and the United States: 3869/105,188. From 2005/6 to 2012, there was an increase in the annual prevalence of ADHD medication use in all included cohorts (Figure 1): Netherlands cohort: 1.8%–3.9%; Germany cohort: 1.3%–2.2%; Denmark cohort: 0.4%–1.5%; UK cohort:

Discussion

The main results of this study are as follows:

1. From 2005/6 to 2012, the prevalence of ADHD medication use grew markedly in children and adolescents in European countries in contrast to a more modest change in US youth. 2. There were substantial differences between countries regarding ADHD medication use. In 2012, while the US youth had nearly seven-fold more extensive use of ADHD medications than in the UK, youth in other European countries, particularly the Netherlands and Denmark, were

Role of funding source

No funding was secured for this study.

Contributors

Dr. Bachmann conceptualized and designed the study, drafted the initial manuscript, and approved the final manuscript as submitted. Dr. Burcu acquired, analyzed and interpreted data, revised the manuscript critically, and approved the final manuscript as submitted. Prof. Glaeske acquired, analyzed and interpreted data, revised the manuscript critically, and approved the final manuscript as submitted. Dr. Kalverdijk acquired, analyzed and interpreted data, revised the manuscript critically, and

Conflict of interest

Dr. Bachmann has received lecture fees from Actelion, Novartis, and Ferring as well as payment from BARMER GEK and from AOK for writing book chapters. He has served as a study physician in clinical trials for Shire and Novartis. Prof. Glaeske and Prof. Hoffmann are active on behalf of a number of statutory health-insurance companies (BARMER GEK, DAK, TK, and various corporate health-insurance funds) in the setting of contracts for third-party payment. Prof. Aagaard has received traveling grants

Acknowledgments

The authors are grateful to the insurance funds, databases and government agencies that provided the data on ADHD use.

References (56)

  • M. Burcu et al.

    Trends in stimulant medication use in commercially insured youths and adults, 2010–2014

    JAMA Psychiatry

    (2016)
  • G.R. Byck

    A comparison of the socioeconomic and health status characteristics of uninsured, state children׳s health insurance program-eligible children in the United States with those of other groups of insured children: implications for policy

    Pediatrics

    (2000)
  • J. Calver et al.

    Stimulant prescribing for the treatment of adhd in western Australia: socioeconomic and remoteness differences

    Med. J. Aust.

    (2007)
  • C.Y. Chen et al.

    Stimulant use following the publicity of cardiovascular safety and the introduction of patient medication guides

    Pharmacoepidemiol. Drug Saf.

    (2015)
  • P. Conrad

    The Medicalization of Society

    (2007)
  • S. Dalsgaard et al.

    Cardiovascular safety of stimulants in children with attention-deficit/hyperactivity disorder: a nationwide prospective cohort study

    J. Child Adolesc. Psychopharmacol.

    (2014)
  • S. Dalsgaard et al.

    Five-fold increase in national prevalence rates of attention-deficit/hyperactivity disorder medications for children and adolescents with autism spectrum disorder, attention-deficit/hyperactivity disorder, and other psychiatric disorders: a danish register-based study

    J. Child Adolesc. Psychopharmacol.

    (2013)
  • M. Döpfner et al.

    How often do children meet ICD-10/DSM-IV criteria of attention deficit-/hyperactivity disorder and hyperkinetic disorder? parent-based prevalence rates in a national sample--results of the Bella study

    Eur. Child Adolesc. Psychiatry

    (2008)
  • E. Garbe et al.

    Drug treatment patterns of attention-deficit/hyperactivity disorder in children and adolescents in Germany: results from a large population-based cohort study

    J. Child Adolesc. Psychopharmacol.

    (2012)
  • Gemeinsamer Bundesausschuss (G-BA)

    Beschluss des gemeinsamen Bundesausschusses über eine Änderung der Arzneimittel-Richtlinie: Anlage III Nummer 44

    Stimulantien. Vom 16. September 2010.

    (2010)
  • H. Green et al.

    Mental Health of Children and Young People in Great Britain, 2004

    (2005)
  • Health and Social Care Information Centre. 2015. Prescriptions Dispensed in the Community. Statistics for England,...
  • S.P. Hinshaw et al.

    International variation in treatment procedures for ADHD: social context and recent trends

    Psychiatr. Serv.

    (2011)
  • F. Hoffmann et al.

    Differences in sociodemographic characteristics, health, and health service use of children and adolescents according to their health insurance funds

    Bundesgesundheitsblatt-Gesundheitsforschung-Gesundheitsschutz

    (2014)
  • L. Horsfall et al.

    Identifying periods of acceptable computer usage in primary care research databases

    Pharmacoepidemiol. Drug Saf.

    (2013)
  • R. Kornfield et al.

    Effects of FDA advisories on the pharmacologic treatment of ADHD, 2004–2008

    Psychiatr. Serv.

    (2013)
  • I. Larkin et al.

    Restrictions on pharmaceutical detailing reduced off-label prescribing of antidepressants and antipsychotics in children

    Health Aff.

    (2014)
  • A. Maguire et al.

    The importance of defining periods of complete mortality reporting for research using automated data from primary care

    Pharmacoepidemiol. Drug Saf.

    (2009)
  • Cited by (100)

    • Treatments for child and adolescent attention deficit hyperactivity disorder in low and middle-income countries: A narrative review

      2022, Asian Journal of Psychiatry
      Citation Excerpt :

      Furthermore, poor and delayed access to mental health services compound the problem (Caqueo-Urizar et al., 2020; Healy et al., 2018). Although a range of beneficial treatments for ADHD exist, including both pharmacological and psychological modalities (Bachmann et al., 2017; Fullen et al., 2020), clear consensus and information on their use across LMICs is lacking (Vrba et al., 2016). Thus, there is an opportunity to encourage healthcare professionals in LMICs to evaluate and develop culturally and linguistically adapted, sensitive, and effective interventions which are cost effective (Ali et al., 2016; Cork et al., 2019).

    View all citing articles on Scopus
    1

    Both authors contributed equally.

    View full text