Top

BMC Psychiatry

Published in:

Open Access 01-12-2021 | Hyperkinetic Disorder | Research article

Secular trends and regional variations in pharmacotherapy of attention-deficit/hyperactivity disorder (ADHD) among children and adolescents in Germany

Authors: Manas K. Akmatov, Jakob Holstiege, Jörg Bätzing

Published in: BMC Psychiatry | Issue 1/2021

Abstract

Background

The study aim was to examine the secular trends and regional variations in pharmacotherapy of children and adolescents with attention-deficit/hyperactivity disorder (ADHD) in Germany.

Methods

We used nationwide drug prescription data of outpatient care (2009 to 2016). The study population comprised patients aged between 5 and 14 years with the diagnoses “hyperkinetic disorders” (ICD-10 code F90) (e.g. n = 262,766 in 2016). The examined drugs were methylphenidate, amphetamines, atomoxetine and guanfacine.

Results

Overall, the proportion of patients received any prescription showed a decreasing trend over years (2010, 51%; 2016, 44%). The proportion of methylphenidate prescription was higher in Western than Eastern federal states. However, atomoxetine was more often prescribed in Eastern than Western federal states. The proportion of methylphenidate prescriptions issued by pediatric psychiatrists increased from 28% (2009) to 41% (2016).

Conclusion

A decreasing trend in use of pharmacotherapy may be explained by prescription restrictions issued by the Federal Joint Committee in recent years.

Akmatov MK, Steffen A, Holstiege J, Hering R, Schulz M, Batzing J. Trends and regional variations in the administrative prevalence of attention-deficit/hyperactivity disorder among children and adolescents in Germany. Sci Rep. 2018;8(1):17029. https://doi.org/10.1038/s41598-018-35048-5.CrossRefPubMedPubMedCentral

Banaschewski, T, Hohmann, S, Millenet, S, Döpfner, M, Grosse, K, and Rösler, M. Interdisciplinary evidence- and consensus-based (S3) guideline "attention-deficit/ hyperactivity disorder" in childhood and adulthood. 2020. https://www.awmf.org/leitlinien/detail/ll/028-045.html. Accessed 5 Dec 2020.

Bachmann CJ, Philipsen A, Hoffmann F. ADHD in Germany: trends in diagnosis and pharmacotherapy. Dtsch Arztebl Int. 2017;114(9):141–8. https://doi.org/10.3238/arztebl.2017.0141.CrossRefPubMed

Stubbe DE. Attention-deficit/hyperactivity disorder overview. Historical perspective, current controversies, and future directions. Child Adolesc Psychiatr Clin N Am. 2000;9(3):469–79. https://doi.org/10.1016/S1056-4993(18)30101-9.CrossRefPubMed

Clemow DB, Walker DJ. The potential for misuse and abuse of medications in ADHD: a review. Postgrad Med. 2014;126(5):64–81. https://doi.org/10.3810/pgm.2014.09.2801.CrossRefPubMed

Garbe E, Mikolajczyk RT, Banaschewski T, Petermann U, Petermann F, Kraut AA, 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;22(6):452–8. https://doi.org/10.1089/cap.2012.0022.CrossRefPubMedPubMedCentral

Schubert I, Koster I, Lehmkuhl G. The changing prevalence of attention-deficit/hyperactivity disorder and methylphenidate prescriptions: a study of data from a random sample of insurees of the AOK health insurance company in the German state of Hesse, 2000-2007. Dtsch Arztebl Int. 2010;107(36):615–21. https://doi.org/10.3238/arztebl.2010.0615.CrossRefPubMedPubMedCentral

Abbas S, Ihle P, Adler JB, Engel S, Gunster C, Linder R, et al. Psychopharmacological prescriptions in children and adolescents in Germany. Dtsch Arztebl Int. 2016;113(22–23):396–403. https://doi.org/10.3238/arztebl.2016.0396.CrossRefPubMedPubMedCentral

Federal Joint Committee. Directive on the prescription of pharmaceuticals in statutory health care. 2020. https://www.g-ba.de/english. Accessed 2 Oct 2020.

10.

DIMDI. ICD-10-GM. 2019. https://www.dimdi.de/dynamic/en/classifications/icd/icd-10-gm/index.html. Accessed 1 Nov 2019.

11.

Kim HJ, Fay MP, Feuer EJ, Midthune DN. Permutation tests for joinpoint regression with applications to cancer rates. Stat Med. 2000;19(3):335–51. https://doi.org/10.1002/(SICI)1097-0258(20000215)19:3<335::AID-SIM336>3.0.CO;2-Z.CrossRefPubMed

12.

Langner I, Haug U, Scholle O, Lindemann C, Schroder C, Riedel O. Potential explanations for increasing methylphenidate use in children and adolescents with attention-deficit/hyperactivity disorder in Germany from 2004 to 2013. J Clin Psychopharmacol. 2019;39(1):39–45. https://doi.org/10.1097/JCP.0000000000000980.CrossRefPubMed

13.

Bachmann CJ, Wijlaars LP, Kalverdijk LJ, Burcu M, Glaeske G, Schuiling-Veninga CCM, et al. Trends in ADHD medication use in children and adolescents in five western countries, 2005-2012. Eur Neuropsychopharmacol. 2017;27(5):484–93. https://doi.org/10.1016/j.euroneuro.2017.03.002.CrossRefPubMed

14.

Grimmsmann T, Himmel W. The 10-year trend in drug prescriptions for attention-deficit/hyperactivity disorder (ADHD) in Germany. Eur J Clin Pharmacol. 2021;77(1):107–15. https://doi.org/10.1007/s00228-020-02948-3.CrossRefPubMed

15.

Grobe TG. Regional differences of ADHD diagnosis rates in health insurance data from 2005 to 2015 : Methodological considerations and results. Bundesgesundheitsbl. 2017;60(12):1336–45. https://doi.org/10.1007/s00103-017-2640-8.CrossRef

16.

National Association of Statutory Health Insurance Physicians (KBV). [SHI-authorized physicians and psychotherapists per 100,000 inhabitants according to specialist group and region for the years 2014 to 2018]. 2020. https://www.versorgungsatlas.de/themen/alle-analysen-nach-datum-sortiert/?tab=6&uid=105. Accessed 1 Dec 2020.

17.

Schlack R, Holling H, Kurth BM, Huss M. The prevalence of attention-deficit/hyperactivity disorder (ADHD) among children and adolescents in Germany. Initial results from the German health interview and examination survey for children and adolescents (KiGGS). Bundesgesundheitsbl. 2007;50(5–6):827–35. https://doi.org/10.1007/s00103-007-0246-2.CrossRef

Title: Secular trends and regional variations in pharmacotherapy of attention-deficit/hyperactivity disorder (ADHD) among children and adolescents in Germany
Authors: Manas K. Akmatov
Jakob Holstiege
Jörg Bätzing
Publication date: 01-12-2021
Publisher: BioMed Central
Keyword: Hyperkinetic Disorder
Published in: BMC Psychiatry / Issue 1/2021
Electronic ISSN: 1471-244X
DOI: https://doi.org/10.1186/s12888-021-03409-6

Keynote webinar | Spotlight on medication adherence

Springer Medicine

Secular trends and regional variations in pharmacotherapy of attention-deficit/hyperactivity disorder (ADHD) among children and adolescents in Germany

Abstract

Background

Methods

Results

Conclusion

Keynote webinar | Spotlight on medication adherence

Springer Medicine

Abstract

Background

Methods

Results

Conclusion

Please log in to get access to this content

Other articles of this Issue 1/2021

Prevalence and associated factors of psychosocial distress among seafarers during COVID-19 pandemic

Parental bonding styles in schizophrenia, depressive and bipolar patients: a comparative study

Measuring diagnostic heterogeneity using text-mining of the lived experiences of patients

Working memory deficits in schizophrenia are associated with the rs34884856 variant and expression levels of the NR4A2 gene in a sample Mexican population: a case control study

A longitudinal study of changes in smart phone addiction and depressive symptoms and potential risk factors among Chinese college students

Escape and absconding among offenders with schizophrenia spectrum disorder – an explorative analysis of characteristics