[Regional differences of ADHD diagnosis rates in health insurance data from 2005 to 2015 : Methodological considerations and results]

Bundesgesundheitsblatt Gesundheitsforschung Gesundheitsschutz. 2017 Dec;60(12):1336-1345. doi: 10.1007/s00103-017-2640-8.
[Article in German]


Background and objectives: Attention deficit hyperactivity disorders (ADHD) are among the most common mental disorders in children and adolescents. For a number of years there has been evidence of regional differences in Germany. This article provides current results on the frequency of diagnosis and treatment and also discusses methodological aspects.

Materials and methods: The analysis is based on routine data of a statutory health insurance company including annual diagnoses and drug prescriptions from 2005 to 2015 of at least 1.34 million children and adolescents between 0 and 19 years of age. Small-area results of ADHD diagnosis rates and methylphenidate prescriptions are presented with a standardized differentiation according to 413 districts pursuant to territorial status from the end of 2008.

Results: From 2005 to 2014, ADHD diagnoses were documented for an increasing proportion of 0 to 19-year-olds in Germany. In 2015 the proportion was 4.2%; boys aged 10 were affected most frequently with a proportion of 11.1%. Regional diagnosis rates vary considerably. Two counties showed diagnosis and prescription rates that were more than twice as high as regionally expected for all years in question; other districts showed rates that were continually lower than expected by at least a third.

Discussion: Analyses on the level of administratively defined districts have some advantages but alternative regional structuring would be desirable due to very heterogeneous population figures. Regarding ADHD diagnoses and documented methylphenidate prescriptions on an outpatient basis, significant regional differences in Germany were detected, for which plausible medical justifications do not yet exist. Specialist discussions seem urgently needed.

Keywords: ADHD diagnosis rates; Attention Deficit Hyperactivity Disorders (ADHD); Methylphenidate prescription frequency; Regional variation; Routine data.

Publication types

  • Review

MeSH terms

  • Adolescent
  • Adult
  • Attention Deficit Disorder with Hyperactivity / diagnosis*
  • Attention Deficit Disorder with Hyperactivity / drug therapy
  • Attention Deficit Disorder with Hyperactivity / epidemiology*
  • Child
  • Child, Preschool
  • Cross-Sectional Studies
  • Female
  • Humans
  • Infant
  • Male
  • Methylphenidate / therapeutic use
  • National Health Programs / statistics & numerical data*
  • National Health Programs / trends
  • Prescriptions / statistics & numerical data
  • Young Adult


  • Methylphenidate