Utilization of pharmacological and non-pharmacological treatment in children and adolescents with attention deficit/hyperactivity disorder: Analyses based on primary and secondary data

Attention deficit/hyperactivity disorder (ADHD) is one of the most common mental disorders in childhood and adolescence. It is associated with health and social impairments over the life course. Its early detection and optimized treatment are of essential importance for the affected, their family members, and society. This work intends to illustrate the current state of research into the efficacy, safety, and use of pharmacological and non-pharmacological therapies in children and adolescents with ADHD. The focus is on the utilization of these therapies in routine care. For this purpose, own research is presented, in which both primary and secondary data were evaluated covering the therapy types "pharmacological interventions", "psychological interventions", "complementary and alternative medicine interventions", and "combined interventions". Drug utilization in routine care is well investigated in (cross-sectional) trend studies; however, there are research gaps with regard to longitudinal studies and the use of non-pharmacological therapies. The research presented in this thesis showed, among other things, that an increasing prevalence of ADHD diagnoses and larger amounts of dispensations per drug-treated child were the main reasons for increased use of methylphenidate until 2008. The longitudinal analyses showed that about a quarter of all children and adolescents with ADHD received an ADHD drug in the first year after diagnosis (in 2010), while the proportion with medication and (additional) psychotherapeutic treatment was only 3% despite the positive recommendation of psychotherapy in guidelines. Regarding drug treatment, the combination treatment of methylphenidate and other psychotropic substances, such as antipsychotics, is of particular importance and was observed in up to 6% of all ADHD patients after a treatment period of nine years. It was also shown that some children and adolescents with ADHD potentially took multiple different nutritional supplements instead of pharmacological treatment. Primary and secondary data play an important role in research on the utilization of pharmacological and non-pharmacological treatment in children and adolescents with ADHD. Linking these data sources holds significant potential for the investigation of the safety and utilization of therapies and should be considered when planning future studies