Clinical Drug Investigation

, Volume 26, Issue 3, pp 161–167

Prevalence of Methylphenidate Use among Israeli Children 1998–2004

Original Research Article


Background: Use of methylphenidate for the treatment of attention-deficit hyperactivity disorder (ADHD) has increased throughout the world in the past decade. In Israel, as elsewhere, there is much debate regarding the diagnosis of ADHD and methylphenidate use. The aim of this study was to examine methylphenidate use rates for the treatment of ADHD among children in Israel during the years 1998–2004 with a special focus on prescriptions among girls.

Study design and methods: This was a longitudinal population-based prevalence study wherein we reviewed the computerised database of a major health maintenance organisation (HMO). Subjects studied included all children living in the central district of Clalit HMO in Israel who were prescribed methylphenidate in the 7-year period from 1998–2004.

Main outcome measures and results: The overall 1-year prevalence rate of methylphenidate use in children aged 0–18 years increased from 0.7% in 1998 to 2.5% in 2004, an increase by a factor of 3.54 (95% CI 3.31, 3.79). In 1998, the rate of methylphenidate prescription ranged from 0.20% among schoolgirls to 1.2% among boys, a 6-fold difference. In 2004, the rate of methylphenidate prescription ranged from 1.1% among schoolgirls to 3.8% among boys; the sex difference had narrowed to only 3.45. Except for kindergarten girls, methylphenidate utilisation increased for all ages from kindergarten to high school, both among boys and among girls.

Conclusion: The continuous increasing rate of methylphenidate use in Israel, especially among girls, represents a significant public health issue. There is a need for future research into the relationship between sex and ADHD diagnosis and treatment.


  1. 1.
    Goldman LS, Genel M, Bezman RJ, et al. Diagnosis and treatment of attention-deficit/hyperactivity disorder in children and adolescents. Council on Scientific Affairs, American Medical Association. JAMA 1998; 279: 1100–7PubMedCrossRefGoogle Scholar
  2. 2.
    Jensen PS, Hinshaw SP, Swanson JM, et al. Findings from the NIMH Multimodal Treatment Study of ADHD (MTA): implications and applications for primary care providers. J Dev Behav Pediatr 2001; 22: 60–73PubMedCrossRefGoogle Scholar
  3. 3.
    Shatin D, Drinkard CR. Ambulatory use of psychotropics by employer-insured children and adolescents in a national managed care organization. Ambul Pediatr 2002; 2: 111–9PubMedCrossRefGoogle Scholar
  4. 4.
    Zito JM, Safer DJ, DosReis S, et al. Psychotropic practice patterns for youth: a 10-year perspective. Arch Pediatr Adolesc Med 2003; 157: 17–25PubMedCrossRefGoogle Scholar
  5. 5.
    Martin A, Van Hoof T, Stubbe D, et al. Multiple psychotropic pharmacotherapy among child and adolescent enrollees in Connecticut Medicaid managed care. Psychiatr Serv 2003; 54: 72–7PubMedCrossRefGoogle Scholar
  6. 6.
    Cox ER, Motheral BR, Henderson RR, et al. Geographic variation in the prevalence of stimulant medication use among children 5 to 14 years old: results from a commercially insured US sample. Pediatrics 2003; 111: 237–43PubMedCrossRefGoogle Scholar
  7. 7.
    Robison LM, Skaer TL, Sclar DA, et al. Is attention deficit hyperactivity disorder increasing among girls in the US? Trends in diagnosis and the prescribing of stimulants. CNS Drugs 2002; 16: 129–37PubMedCrossRefGoogle Scholar
  8. 8.
    Safer DJ, Krager JM. A survey of medication treatment for hyperactive/inattentive students. JAMA 1988; 260: 2256–8PubMedCrossRefGoogle Scholar
  9. 9.
    Olfson M, Marcus SC, Weissman MM, et al. National trends in the use of psychotropic medications by children. J Am Acad Child Adolesc Psychiatry 2002; 41: 514–21PubMedCrossRefGoogle Scholar
  10. 10.
    Rushton JL, Whitmire JT. Pediatric stimulant and selective serotonin reuptake inhibitor prescription trends: 1992 to 1998. Arch Pediatr Adolesc Med 2001; 155: 560–5PubMedGoogle Scholar
  11. 11.
    Romano E, Baillargeon RH, Wu HX, et al. Prevalence of methylphenidate use and change over a two-year period: a nationwide study of 2- to 11-year-old Canadian children. J Pediatr 2002; 141:71–5PubMedCrossRefGoogle Scholar
  12. 12.
    Berbatis CG, Sunderland VB, Bulsara M. Licit psychostimulant consumption in Australia, 1984-2000: international and jurisdictional comparison. Med J Aust 2002; 177: 539–43PubMedGoogle Scholar
  13. 13.
    Zwi M, Ramchandani P, Joughin C. Evidence and belief in ADHD. BMJ 2000; 321: 975–6PubMedCrossRefGoogle Scholar
  14. 14.
    Schirm E, Tobi H, Zito JM, et al. Psychotropic medication in children: a study from The Netherlands. Pediatrics 2001; 108(2): E25PubMedCrossRefGoogle Scholar
  15. 15.
    Madsen H, Andersen M, Hallas J. Drug prescribing among Danish children: a population-based study. Eur J Clin Pharmacol 2001; 57: 159–65PubMedCrossRefGoogle Scholar
  16. 16.
    Hugtenburg JG, Heerdink ER, Egberts AC. Increased psychotropic drug consumption by children in The Netherlands during 1995–2001 is caused by increased use of methylphenidate by boys. Eur J Clin Pharmacol 2004; 60: 377–9PubMedCrossRefGoogle Scholar
  17. 17.
    Fogelman Y, Vinker S, Guy N, et al. Prevalence of and change in the prescription of methylphenidate in Israel over a 2-year period. CNS Drugs 2003; 17: 915–9PubMedCrossRefGoogle Scholar
  18. 18.
    Robison LM, Sclar DA, Skaer TL, et al. National trends in the prevalence of attention-deficit/hyperactivity disorder and the prescribing of methylphenidate among school-age children: 1990-1995. Clin Pediatr (Phila) 1999; 38: 209–17CrossRefGoogle Scholar
  19. 19.
    Safer DJ, Krager JM. The increased rate of stimulant treatment for hyperactive/inattentive students in secondary schools. Pediatrics 1994; 94(4 Pt 1): 462–4PubMedGoogle Scholar
  20. 20.
    Zito JM, Safer DJ, dosReis S, et al. Trends in the prescribing of psychotropic medications to preschoolers. JAMA 2000; 283: 1025–30PubMedCrossRefGoogle Scholar
  21. 21.
    Tripp G, Luk SL, Schaughency EA, et al. DSM-IV and ICD-10: a comparison of the correlates of ADHD and hyperkinetic disorder. J Am Acad Child Adolesc Psychiatry 1999; 38: 156–64PubMedCrossRefGoogle Scholar
  22. 22.
    Gingerich KJ, Turnock P, Litfin JK, et al. Diversity and attention deficit hyperactivity disorder. J Clin Psychol 1998; 54: 415–26PubMedCrossRefGoogle Scholar
  23. 23.
    Cantwell DP. Attention deficit disorder: a review of the past 10 years. J Am Acad Child Adolesc Psychiatry 1996; 35: 978–87PubMedCrossRefGoogle Scholar
  24. 24.
    Gershon J. A meta-analytic review of gender differences in ADHD. J Atten Disord 2002; 5: 143–54PubMedCrossRefGoogle Scholar
  25. 25.
    Biederman J, Mick E, Faraone SV, et al. Influence of gender on attention deficit hyperactivity disorder in children referred to a psychiatric clinic. Am J Psychiatry 2002; 159: 36–42PubMedCrossRefGoogle Scholar
  26. 26.
    Biederman J, Kwon A, Aleardi M, et al. Absence of gender effects on attention deficit hyperactivity disorder: findings in nonreferred subjects. Am J Psychiatry. 2005; 162: 1083–9PubMedCrossRefGoogle Scholar
  27. 27.
    Swanson JM, Sergeant JA, Taylor E, et al. Attention-deficit hyperactivity disorder and hyperkinetic disorder. Lancet 1998; 351: 429–33PubMedCrossRefGoogle Scholar
  28. 28.
    Diller LH, Chervin RD, Robison LM, et al. Attention-deficit-hyperactivity disorder. N Engl J Med 1999; 340: 1766–7PubMedCrossRefGoogle Scholar
  29. 29.
    Williams RJ, Goodale LA, Shay-Fiddler MA, et al. Methylphenidate and dextroamphetamine abuse in substance-abusing adolescents. Am J Addict 2004; 13: 381–9PubMedCrossRefGoogle Scholar
  30. 30.
    Elia J, Ambrosini PJ, Rapoport JL. Treatment of attention-deficit-hyperactivity disorder. N Engl J Med 1999; 340: 780–8PubMedCrossRefGoogle Scholar
  31. 31.
    Jensen PS, Kettle L, Roper MT, et al. Are stimulants overprescribed? Treatment of ADHD in four U.S. communities. J Am Acad Child Adolesc Psychiatry 1999; 38: 797–804PubMedCrossRefGoogle Scholar

Copyright information

© Adis Data Information BV 2006

Authors and Affiliations

  1. 1.Department of Family Medicine, Sackler Faculty of MedicineTel Aviv UniversityTel AvivIsrael
  2. 2.Central District, Clalit Health ServicesRishon LeZionIsrael
  3. 3.Maccabi Health ServicesAshdodIsrael
  4. 4.AshdodIsrael

Personalised recommendations