Utilization of Stimulants and Atomoxetine for Attention‐Deficit/Hyperactivity Disorder among 5.4 Million Children Using Population‐Based Longitudinal Data

Abstract

Use of stimulants to treat attention-deficit/hyperactivity disorder (ADHD) has increased over the past two decades and varies substantially between countries. The objective of this multinational population-based study was to examine utilization of ADHD drugs (stimulants and atomoxetine) including comedication with other psychotropic drugs in the entire child population in the five Nordic countries. We included longitudinal data on dispensed ADHD drugs from five Nordic prescription registers during 2008-2012, which in 2012 comprised 48,296 individuals among 5.42 million inhabitants aged 0-17 years. Prevalence of filling ≥1 prescriptions of ADHD drugs among children aged 6-17 years increased during 2008-2012 from 5.9 to 11.2 and 19.4 to 31.0 per 1000 girls and boys, respectively. Prevalence by country showed that Iceland, Finland and Sweden had a steady increase during the study period, while in Norway the prevalence was quite stable and in Denmark it levelled off from 2010. Use in preschoolers (aged 0-5 years) was rare. Iceland had much higher prevalence and incidence than the other Nordic countries. The incidence of ADHD drug use increased during the study period, from 4.0 to 4.9 and from 1.5 to 2.3 per 1000 boys and girls, respectively. The increasing number of new users levelled off somewhat after 2010. Comedication with other psychotropic drugs was more common among girls (33.9%) than boys (27.0%) and was mainly melatonin, followed by antidepressants and antipsychotics. Overall prevalence of ADHD drug use increased among Nordic girls and boys aged 6-17 years, whereas the incidence increased slightly during 2008-2010 but levelled off through 2012. The substantial differences in ADHD drug use across the Nordic countries and high degree of comedication with other psychotropic drugs underscore the importance of close monitoring of treatment for ADHD among children.

Prevalence, incidence and persistence of ADHD drug use in Japan

“…This is the first study to establish the representative prescribing practices of ADHD drugs in Japan. The prevalence of ADHD drug use in children and adolescents in Japan (0.4%) is much lower than that in the USA (5.3%) (Burcu et al 2016) and Norway (1.4%) (Furu et al 2017), while it is similar to that in Italy (0.2%) (Piovani et al 2016), France (0.2%) (Kovess et al 2015) and the UK (0.5%) (Beau-Lejdstrom et al 2016). As in Japan, the countries with a similar prevalence have some restriction policies for prescribing ADHD drugs.…”

Children’s Relative Age and ADHD Medication Use: A Finnish Population-Based Study

“…17 There is also notable variation between countries in prescribing rates for ADHD, and studies also differ by the years studied. 6,24 For example, prevalence rates of ADHD medication use among the child population in Finland have been relatively low, particularly among girls, 24,25 but the rates of ADHD diagnoses and medication use are increasing relatively rapidly. 26 Sex differences are also important to consider because the rates of ADHD vary by sex in middle childhood.…”

Diagnosis of hyperkinetic disorder among children in Norway

“…Data fra Norsk pasientregister for årene 2008-11 viste at 3,4 % av norske barn hadde fått diagnosen i spesialisthelsetjenesten ved 12 års alder (4). I aldersgruppen 6-17 år ble 3 % av guttene og 1 % av jentene medisinert mot tilstanden (5). Disse andelene har vaert stabile siden 2010 (5).…”

“…I aldersgruppen 6-17 år ble 3 % av guttene og 1 % av jentene medisinert mot tilstanden (5). Disse andelene har vaert stabile siden 2010 (5). I befolkningsundersøkelser hvor representative utvalg av barn er undersøkt med spørreskjemaer og kliniske intervjuer, er forekomsten av hyperkinetisk forstyrrelse 1,7 % hos 7-9-åringer (6) og 2,1 % hos 13-15-åringer (7).…”

“…12, men er på linje med estimatet på 3,4 % i en metaanalyse av 41 studier fra 27 land (13). Andelene som får medisiner er på nivå med de i Sverige og Danmark, men over Finland (5).…”