Skip to main page content
U.S. flag

An official website of the United States government

Dot gov

The .gov means it’s official.
Federal government websites often end in .gov or .mil. Before sharing sensitive information, make sure you’re on a federal government site.

Https

The site is secure.
The https:// ensures that you are connecting to the official website and that any information you provide is encrypted and transmitted securely.

Access keys NCBI Homepage MyNCBI Homepage Main Content Main Navigation
. 2017 Mar 3;114(9):141-148.
doi: 10.3238/arztebl.2017.0141.

ADHD in Germany: Trends in Diagnosis and Pharmacotherapy

Christian J Bachmann  1 , Alexandra Philipsen, Falk Hoffmann
Affiliations

ADHD in Germany: Trends in Diagnosis and Pharmacotherapy

Christian J Bachmann et al. Dtsch Arztebl Int. .

Abstract

Background: Attention-deficit/hyperactivity disorder (ADHD) sometimes persists into adulthood. There have been no studies from Germany until the present time on the diagnosis and treatment of ADHD over the course of patients' lives, in particular during the transition from adolescence to early adulthood.

Methods: We used nationwide routine data of the AOK statutory healthinsurance fund to determine the frequency of ADHD diagnoses and prescriptions of medication for ADHD. We additionally analyzed the care of a transition cohort of initially 15-year-old ADHD patients over a period of six years.

Results: From 2009 to 2014, the prevalence of a diagnosis of ADHD rose from 5.0% to 6.1% in persons aged 0 to 17 years (with a maximum of 13.9% in 9-year-old boys) and from 0.2% to 0.4% in persons aged 18 to 69 years. The amount of ADHD medication prescribed to adults with ADHD increased over time, while the amount prescribed to children and adolescents fell. Methylphenidate was the most commonly prescribed drug, followed by atomoxetine and lisdexamfetamine. Only 31.2% of the patients in the transition cohort still carried the diagnosis of ADHD at the end of the six-year period, at age 21. The percentage of patients taking ADHD medication in this group fell from 51.8% at age 15 to 6.6% at age 21.

Conclusion: The administrative prevalence of a diagnosis of ADHD among adults and the degree of medication use for ADHD by adults have risen in recent years. This can be interpreted as an indication of the sensitization of physicians and patients to the possibility of adult ADHD. Nonetheless, the prevalence of diagnosed ADHD remains less than the prevalence revealed by epidemiologic studies. This may indicate that adults with ADHD are currently underdiagnosed and undertreated. The low rate of use of ADHD medications among adolescents with ADHD who are on the verge of adulthood leads us to the question of whether specific transitional concepts need to be developed for this age group.

PubMed Disclaimer

Figures

FIGURE 1
FIGURE 1
ADHD diagnoses in AOK insurants for 2009 and 2014 by age and sex, based on routine data (administrative prevalence) ADHD: Attention-deficit/hyperactivity disorder; AOK: Allgemeine Ortskrankenkassen
FIGURE 2
FIGURE 2
ADHD medication rates in 2009 and 2014 (a) and overview of prescribed substances in 2014 (b, c) a) AOK insurants prescribed medication to treat ADHD as a percentage of all AOK insurants with a diagnosis of ADHD, by age (2009 versus 2014) b) Percentage of prescriptions of substances to treat ADHD in 2014 among female AOK insurants with a diagnosis of ADHD, by age c) Percentage of prescription of substances to treat ADHD in 2014 among male AOK insurants with a diagnosis of ADHD, by age ADHD: Attention-deficit/hyperactivity disorder; AOK: Allgemeine Ortskrankenkassen (Germany’s largest statutory health insurance company); ATX: Atomoxetine; DEX: Dexamfetamine; LDX: Lisdexamfetamine; MPH: Methylphenidate
FIGURE 3
FIGURE 3
Percentage of AOK insurants in the transition cohort with a diagnosis of ADHD or receiving ADHD medication over time, 2008 to 2014 ADHD: Attention-deficit/hyperactivity disorder
eFigure
eFigure
Contact between transition cohort members and physicians: percentage distribution between specialties, 2009 to 2014 ADHD: Attention-deficit/hyperactivity disorder
See this image and copyright information in PMC

Comment in

  • Unanswered Questions.
    Schlander M, Schwarz O, Trott GE. Schlander M, et al. Dtsch Arztebl Int. 2017 Jun 23;114(25):428. doi: 10.3238/arztebl.2017.0428a. Dtsch Arztebl Int. 2017. PMID: 28683857 Free PMC article. No abstract available.

References

    1. Erskine HE, Ferrari AJ, Polanczyk GV, et al. The global burden of conduct disorder and attention-deficit/hyperactivity disorder in 2010. J Child Psychol Psychiatry. 2014;55:328–336. - PubMed
    1. Braun S, Zeidler J, Linder R, Engel S, Verheyen F, Greiner W. Treatment costs of attention deficit hyperactivity disorder in Germany. Eur J Health Econ. 2013;14:939–945. - PubMed
    1. Thapar A, Cooper M. Attention deficit hyperactivity disorder. Lancet. 2016;387:1240–1250. - PubMed
    1. Döpfner M, Breuer D, Wille N, Erhart M, Ravens-Sieberer U. 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;17(1):59–70. - PubMed
    1. Visser SN, Danielson ML, Bitsko RH, et al. Trends in the parent-report of health care provider-diagnosed and medicated attention-deficit/hyperactivity disorder: United States, 2003-2011. J Am Acad Child Adolesc Psychiatry. 2014;53:34–46. e2. - PMC - PubMed

Substances