Department of Child and Adolescent Psychiatry,Kaohsiung Chang Gung Memorial Hospital and Chang Gung University College of Medicine,Kaohsiung,Taiwan.
Department of Psychiatry,Kaohsiung Veterans General Hospital,Kaohsiung,Taiwan.
Epidemiol Psychiatr Sci. 2017 Dec;26(6):624-634. doi: 10.1017/S2045796016000500. Epub 2016 Jul 20.
Public controversy regarding the potential overdiagnosis and overmedication of children with attention-deficit/hyperactivity disorder (ADHD) has continued for decades. This study used the National Health Insurance Research Database of Taiwan (NHIRD-TW) to explore trends in ADHD diagnosis in youths and the proportion of those receiving medication, with the aim of determining whether ADHD is overdiagnosed and overmedicated in Taiwan.
Youths (age ≤18 years) who had at least two NHIRD-TW claims records with ADHD diagnosis between January 2000 and December 2011 were selected as the subject cohort. In total, the study sample comprised 145 018 patients with ADHD (mean age at a diagnosis of ADHD: 7.7 ± 3.1 years; 21.4% females). The number of cases of ADHD were calculated annually for each year (from 2000 to 2011), and the number of cases per year who received medication was determined as those with at least one record of pharmacotherapy (immediate-release methylphenidate, osmotic controlled-release formulation of methylphenidate, and atomoxetine) in each year.
The prevalence rates of a diagnosis of ADHD in the youths ranged from 0.11% in 2000 to 1.24% in 2011. Compared with children under 6 years of age, the ADHD diagnosis rates in children aged between 7 and 12 years (ratio of prevalence rates = 4.36) and in those aged between 13 and 18 years (ratio of prevalence rates = 1.42) were significantly higher during the study period. The prevalence in males was higher than that in females (ratio of prevalence rates = 4.09). Among the youths with ADHD, 50.2% received medications in 2000 compared with 61.0% in 2011. The probability of receiving ADHD medication increased with age. More male ADHD patients received medications that females patients (ratio of prevalence rates = 1.16).
The rate of ADHD diagnosis was far lower than the prevalence rate (7.5%) identified in a previous community study using face-to-face interviews. Approximately 40-50% of the youths with ADHD did not receive any medications. These findings are not consistent with a systematic public opinion about overdiagnosis or overmedication of ADHD in Taiwan.
关于儿童注意缺陷多动障碍（ADHD）潜在过度诊断和过度用药的公众争议已经持续了几十年。本研究使用了台湾全民健康保险研究数据库（NHIRD-TW）来探讨青少年 ADHD 诊断的趋势和接受药物治疗的比例，旨在确定 ADHD 在台湾是否存在过度诊断和过度用药的情况。
选择 2000 年 1 月至 2011 年 12 月期间至少有两次 NHIRD-TW 记录的 ADHD 诊断的青少年（年龄≤18 岁）作为研究对象队列。该研究样本共包括 145018 例 ADHD 患者（ADHD 诊断时的平均年龄为 7.7±3.1 岁；21.4%为女性）。每年计算 ADHD 病例数，每年至少有一次药物治疗记录的病例数确定为每年接受药物治疗的病例数（速释哌甲酯、控释哌甲酯渗透制剂和托莫西汀）。
青少年 ADHD 的诊断率从 2000 年的 0.11%到 2011 年的 1.24%不等。与 6 岁以下儿童相比，7 至 12 岁儿童（患病率比=4.36）和 13 至 18 岁儿童（患病率比=1.42）的 ADHD 诊断率在研究期间明显较高。男性的患病率高于女性（患病率比=4.09）。在 ADHD 青少年中，2000 年有 50.2%接受了药物治疗，而 2011 年有 61.0%接受了药物治疗。随着年龄的增长，接受 ADHD 药物治疗的概率增加。接受 ADHD 药物治疗的男性患者多于女性患者（患病率比=1.16）。
ADHD 的诊断率远低于之前使用面对面访谈进行的社区研究确定的患病率（7.5%）。大约 40-50%的 ADHD 青少年没有接受任何药物治疗。这些发现与台湾关于 ADHD 过度诊断或过度用药的系统公众意见不一致。
