European Child & Adolescent Psychiatry

, Volume 16, Issue 7, pp 430–438 | Cite as

Who cares for patients with attention-deficit/hyperactivity disorder (ADHD)?

Insights from Nordbaden (Germany) on administrative prevalence and physician involvement in health care provision
  • Michael Schlander
  • Oliver Schwarz
  • Goetz-Erik Trott
  • Michael Viapiano
  • Norbert Bonauer



To determine age and gender specific administrative prevalence of ADHD (hyperkinetic disorder, HKD, and hyperkinetic conduct disorder, HKCD, according to ICD-10-based coding) in Germany in 2003, and to assess physician involvement in medical care.


Retrospective claims database analysis covering the insured population of Nordbaden, Germany (n = 2.238 million).


A total of 11,875 subjects with a diagnosis of HKD/HKCD were identified (overall 12-month prevalence rate 0.53%). Prevalence was highest among children age 7–12 years (5.0%; boys, 7.2%; girls, 2.7%). Among adults age 20 years and higher, prevalence was 0.04% (males, 0.04%; females, 0.03%). 36.0% (13.0%) of children and adolescents and 33.5% (12.5%) of adults with a diagnosis of ADHD were seen by a specialized physician at least once (four times) during the year. Physician involvement by discipline was highly skewed.


Diagnosis rates in children and adolescents exceeded those expected according to ICD-10 criteria, but matched DSM-IV-based estimates. In the adult population, ADHD was rarely detected. Most patients were not seen by a mental health specialist, and physician involvement was highly concentrated. Potential policy implications include a high need for expertise among pediatricians and general practitioners. The data indicate an urgent need for further research into health care utilization and quality.


attention deficit-hyperactivity disorder (ADHD) hyperkinetic disorder (HKD) Prevalence physician involvement health care utilization 


  1. 1.
    Adler LA, Spencer T, Faraone SV, Reimherr FW, Kelsey D, Michelson D, Biederman J (2005) Training raters to assess adult ADHD: reliability of ratings. J Atten Disord 8:121–126PubMedCrossRefGoogle Scholar
  2. 2.
    American Psychiatric Association (1994) Diagnostic and statistical manual of mental disorders (DSM-IV), 4th edn. American Psychiatric Association, Washington, DCGoogle Scholar
  3. 3.
    Biederman J (2004) Impact of comorbidity in adults with attention-deficit/hyperactivity disorder. J Clin Psychiatr 65(Suppl 3):3–7Google Scholar
  4. 4.
    Biederman J, Mick E, Faraone SV (2000) Age-dependent decline of symptoms of attention deficit hyperactivity disorder: impact of remission definition and symptom type. Am J Psychiat 157:816–818PubMedCrossRefGoogle Scholar
  5. 5.
    Biederman J, Faraone SV, Spencer T, Wilens T, Mick E, Lapey KA (1994) Gender differences in a sample of adults with attention deficit hyperactivity disorder. Psychiatry Res 53:13–29PubMedCrossRefGoogle Scholar
  6. 6.
    Brownell MD, Yogendran MS (2001) Attention-deficit hyperactivity disorder in Manitoba children: medical diagnosis and psychostimulant treatment rates. Can J Psychiatr 46:264–272Google Scholar
  7. 7.
    Bruehl B, Doepfner M, Lehmkuhl G (2000) Der Fremdbeurteilungsbogen fuer hyperkinetische Stoerungen (FBB-HKS)—Praevalenz hyperkinetischer Stoerungen im Elternurteil und psychometrische Kriterien. Kindheit und Entwicklung 9:115–125Google Scholar
  8. 8.
    Buitelaar JK, Rothenberger A (2004) Foreword—ADHD in the scientific and political context. Eur Child Adolesc Psychiatry 13(Suppl 1):1–6Google Scholar
  9. 9.
    Busch B, Biederman J, Cohen LG, Sayer JM, Monuteaux MC, Mick E, Zallen B, Faraone SV (2002) Correlates of ADHD among children in pediatric and psychiatric clinics. Psychiatr Serv 53:1103–1111PubMedCrossRefGoogle Scholar
  10. 10.
    DeGrandpre R (2000) Ritalin nation: rapid-fire-culture and the transformation of human consciousness. Norton, New YorkGoogle Scholar
  11. 11.
    Epstein MA, Shaywitz SE, Shaywitz BA, Woolston JL (1991) The boundaries of attention deficit disorder. J Learn Disabil 24:78–86PubMedCrossRefGoogle Scholar
  12. 12.
    Faraone SV, Sergeant J, Gillberg C, Biederman J (2003) The worldwide prevalence of ADHD: is it an American condition? World Psychiatry 2:104–113PubMedGoogle Scholar
  13. 13.
    Federal Ministry for Health and Social Affairs (Bundesministerium fuer Gesundheit und Soziales, BMGS). Statistik ueber Versicherte, gegliedert nach Status, Alter, Wohnort, Kassenart: GKV Statistik KM6. Available online at
  14. 14.
    Gillberg C, Gillberg IC, Rasmussen P, Kadesjo B, Soderstrom H, Rastam M, Johnson M, Rothenberger A, Niklasson L (2004) Co-existing conditions in ADHD—implications for diagnosis and intervention. Eur Child Adolesc Psychiatry 13(Suppl 1):80–92Google Scholar
  15. 15.
    Green M, Wong M, Atkins D, et al (1999) Diagnosis and treatment of attention-deficit/hyperactivity disorder in children and adolescents. Technical Review No 3. Agency for Health Care Policy and Research, AHCPR Publication No 99–0050, Rockville, MDGoogle Scholar
  16. 16.
    Hoeger C, Rothenberger A (1998) Provision of child and adolescent psychiatric services in the Federal Republic of Germany. Eur Child Adolesc Psychiatry 7(3):176–180CrossRefGoogle Scholar
  17. 17.
    Kelleher KJ, McInerny TK, Gardner WP, Childs GE, Wasserman RC (2001) Increasing identification of psychosocial problems: 1979–1996. Pediatrics 105:1313–1321CrossRefGoogle Scholar
  18. 18.
    Kessler RC, Adler L, Ames M, Barkley RA, Birnbaum H, Greenberg P, Johnston JA, Spencer T, Ustun TB (2005) The prevalence and effects of attention deficit/hyperactivity disorder on work performance in a nationally representative sample of workers. J Occup Environ Med 47:565–572PubMedCrossRefGoogle Scholar
  19. 19.
    Koester I, Schubert I, Doepfner M, Adam C, Ihle P, Lehmkuhl G (2004) Hyperkinetische Stoerungen bei Kindern und Jugendlichen: Zur Haeufigkeit des Behandlungsanlasses in der ambulanten Versorgung nach den Daten der Versichertenstichprobe AOK Hessen/KV Hessen. Zeitschrift fuer Kinder- und Jugendpsychiatrie und Psychotherapie 32:157–166CrossRefGoogle Scholar
  20. 20.
    Kooij JJ, Buitelaar JK, van den Oord EJ, Furer JW, Rijnders CA, Hodiamont PP (2005) Internal and external validity of attention-deficit hyperactivity disorder in a population-based sample of adults. Psychol Med 35:817–827PubMedCrossRefGoogle Scholar
  21. 21.
    Mannuza S, Klein RG, Moulton JL III (2003) Persistence of attention-deficit/hyperactivity disorder into adulthood: what have we learned from the prospective follow-up studies? J Atten Disord 7:93–100CrossRefGoogle Scholar
  22. 22.
    Meier A (2003) Der rechtliche Schutz patientenbezogener Gesundheitsdaten. Verlag Versicherungswirtschaft, Karlsruhe, pp 263–311Google Scholar
  23. 23.
    Motheral B, Brooks J, Clark MA, Crown WH, Davey P, Hutchins D, Martin BC, Stang P (2003) A checklist for retrospective database studies—report of the ISPOR Task Force on retrospective databases. Value Health 6:90–97PubMedCrossRefGoogle Scholar
  24. 24.
    Rappley MD (2005) Attention deficit-hyperactivity disorder. New Engl J Med 352:165–173PubMedCrossRefGoogle Scholar
  25. 25.
    Scahill L, Schwab-Stone M (2000) Epidemiology of ADHD in school-age children. Child Adolesc Psychiatr Clin N Am 9:541–555PubMedGoogle Scholar
  26. 26.
    Schneeweiss S, Avorn J (2005) A review of uses of health care utilization databases for epidemiologic research on therapeutics. J Clin Epidemiol 58:323–337PubMedCrossRefGoogle Scholar
  27. 27.
    Schubert I, Selke GW, Osswald-Huang P-H, Schroeder H, Nink K (2002) Methylphenidat-Verordnungsanalyse auf der Basis von GKV-Daten, Wissenschaftliches Institut der AOK (WidO), BonnGoogle Scholar
  28. 28.
    Shatin D, Levin R, Ireys HT, Haller V (1998) Health care utilization by children with chronic illnesses: a comparison of Medicaid and employer-insured managed care. Pediatrics 102:e44PubMedCrossRefGoogle Scholar
  29. 29.
    Statistical Office of the European Communites. Population by age in Germany. Available online at
  30. 30.
    Statistisches Landesamt Baden-Wuerttemberg. Bevoelkerung am 31.12.2004 nach Altersjahren, Nationalitaet und Geschlecht; Regierungsbezirk Karlsruhe. Available online at
  31. 31.
    Taylor E, Doepfner M, Sergeant J, Asherson P, Banaschewski T, Buitelaar J, Coghill D, Danckaerts M, Rothenberger A, Sonuga-Barke E, Steinhausen HC, Zuddas A (2004) European clinical guidelines for hyperkinetic disorder—first upgrade. Eur Child Adolesc Psychiatry 13(Suppl 1):7–30Google Scholar
  32. 32.
    Tripp G, Luk SL, Schaughency EA, Singh R (1999) DSM-IV and ICD-10: a comparison of the correlates of ADHD and hyperkinetic disorder. J Am Acad Child Adolesc Psychiatry 38:156–164PubMedCrossRefGoogle Scholar
  33. 33.
    Wasserman RC, Kelleher KJ, Bocian A, Baker A, Childs GE, Indacochea F, Stulp C, Gardner WP (1999) Identification of attentional and hyperactivity problems in primary care: a report from pediatric research in office settings and the ambulatory sentinel practice network. Pediatrics 103:e38PubMedCrossRefGoogle Scholar
  34. 34.
    Wasserstein J (2005) Diagnostic issues for adolescents and adults with ADHD. J Clin Psychol 61:535–547PubMedCrossRefGoogle Scholar
  35. 35.
    Weiss M, Murray C, Weiss G (2002) Adults with attention-deficit/hyperactivity disorder: current concepts. J Psychiatr Pract 8:99–111PubMedCrossRefGoogle Scholar
  36. 36.
    Wender PH, Wolf LE, Wasserstein J (2001) Adults with ADHD. An overview. Ann N Y Acad Sci 931:1–16PubMedCrossRefGoogle Scholar
  37. 37.
    Wenwei Y (1996) An investigation of adult outcome of hyperactive children in Shanghai. Chin Med J 109:877–880Google Scholar
  38. 38.
    Wichmann HE, Raspe HH, Joeckel KH [Deutsche Arbeitsgemeinschaft fuer Epidemiologie, DAE], and Hamm R, Wellbrock R [Arbeitskreis Wissenschaft der Konferenz der Datenschutzbeauftragten des Bundes und der Laender] (1998) Epidemiologie und DatenschutzGoogle Scholar
  39. 39.
    Wolraich M (1998) Current assessment and treatment practices: Consensus Development Conference Statement: Diagnosis and Treatment of Attention Deficit Hyperactivity Disorder (ADHD). National Institutes of Health, Bethesda, MDGoogle Scholar
  40. 40.
    Wolraich M, Hannah J, Pinnock TY, Baumgaertel A, Brown J (1999) Comparison of diagnostic criteria for attention-deficit hyperactivity disorder in a county-wide sample. J Am Acad Child Adolesc Psychiatry 35:319–324CrossRefGoogle Scholar
  41. 41.
    Wolraich ML, Hannah JN, Baumgaertel A, Feurer ID (1998) Examination of DSM-IV criteria for attention deficit/hyperactivity disorder in a county-wide sample. J Dev Behav Pediatr 19:162–168PubMedCrossRefGoogle Scholar
  42. 42.
    World Health Organization (1992) International statistical classification of diseases and related health problems (ICD-10), 10th edn. The World Health Organization; 1992, Geneva, SwitzerlandGoogle Scholar

Copyright information

© Steinkopff Verlag 2007

Authors and Affiliations

  • Michael Schlander
    • 1
    • 3
    • 4
  • Oliver Schwarz
    • 1
    • 2
  • Goetz-Erik Trott
    • 5
  • Michael Viapiano
    • 6
  • Norbert Bonauer
    • 6
  1. 1.Institute for Innovation and Valuation in Health Care (INNOVALHC)EschbornGermany
  2. 2.Heilbronn UniversityHeilbronnGermany
  3. 3.Dept. of Public Health, Social and Preventive Medicine, Mannheim Medical FacultyUniversity of HeidelbergHeidelbergGermany
  4. 4.University of Applied Economic SciencesLudwigshafenGermany
  5. 5.AschaffenburgGermany
  6. 6.Kassenaerztliche Vereinigung Baden-WuerttembergRegionaldirektion KarlsruheKarlsruheGermany

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