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Prevalence rates of youths diagnosed with and medicated for ADHD in a nationwide survey in Taiwan from 2000 to 2011

  • L.-J. Wang (a1), S.-Y. Lee (a2) (a3), S.-S. Yuan (a4), C.-J. Yang (a5) (a6), K.-C. Yang (a4) (a7), T.-S. Huang (a6) (a8) (a9) (a10), W.-J. Chou (a1), M.-C. Chou (a1), M.-J. Lee (a1), T.-L. Lee (a11) and Y.-C. Shyu (a6) (a12)...



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.


Corresponding author

*Address for correspondence: Y.-C. Shyu, PhD, Associate Research Fellow, Community Medicine Research Center, Chang-Gung Memorial Hospital, Keelung, Taiwan. (E-mail:


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Atladottir, HO, Gyllenberg, D, Langridge, A, Sandin, S, Hansen, SN, Leonard, H, Gissler, M, Reichenberg, A, Schendel, DE, Bourke, J, Hultman, CM, Grice, DE, Buxbaum, JD, Parner, ET (2015). The increasing prevalence of reported diagnoses of childhood psychiatric disorders: a descriptive multinational comparison. European Child and Adolescent Psychiatry 24, 173183.
Barbaresi, WJ, Katusic, SK, Colligan, RC, Pankratz, VS, Weaver, AL, Weber, KJ, Mrazek, DA, Jacobsen, SJ (2002). How common is attention-deficit/hyperactivity disorder? Incidence in a population-based birth cohort in Rochester, Minn. Archives of Pediatrics and Adolescent Medicine 156, 217224.
Barbaresi, WJ, Katusic, SK, Colligan, RC, Weaver, AL, Jacobsen, SJ (2007). Modifiers of long-term school outcomes for children with attention-deficit/hyperactivity disorder: does treatment with stimulant medication make a difference? Results from a population-based study. Journal of Developmental and Behavioral Pediatrics 28, 274287.
Bruchmuller, K, Margraf, J, Schneider, S (2012). Is ADHD diagnosed in accord with diagnostic criteria? Overdiagnosis and influence of client gender on diagnosis. Journal of Consulting and Clinical Psychology 80, 128138.
Chan, E, Fogler, JM, Hammerness, PG (2016). Treatment of attention-deficit/hyperactivity disorder in adolescents: a systematic review. JAMA 315, 19972008.
Chen, CY, Yeh, HH, Chen, KH, Chang, IS, Wu, EC, Lin, KM (2011). Differential effects of predictors on methylphenidateinitiation and discontinuation among young people with newly diagnosed attention-deficit/hyperactivity disorder. Journal of Child and Adolescent Psychopharmacology 21, 265273.
Cherkasova, M, Sulla, EM, Dalena, KL, Ponde, MP, Hechtman, L (2013). Developmental course of attention deficit hyperactivity disorder and its predictors. Journal of the Canadian Academy of Child and Adolescent Psychiatry 22, 4754.
Chien, IC, Lin, CH, Chou, YJ, Chou, P (2012). Prevalence, incidence, and stimulant use of attention-deficit hyperactivity disorder in Taiwan, 1996–2005: a national population-based study. Social Psychiatry and Psychiatric Epidemiology 47, 18851890.
Coon, ER, Quinonez, RA, Moyer, VA, Schroeder, AR (2014). Overdiagnosis: how our compulsion for diagnosis may be harming children. Pediatrics 134, 10131023.
Dalsgaard, S, Nielsen, HS, Simonsen, M (2013). Five-fold increase in national prevalence rates of attention-deficit/hyperactivity disorder medications for children and adolescents with autism spectrum disorder, attention-deficit/hyperactivity disorder, and other psychiatric disorders: a Danish register-based study. Journal of Child and Adolescent Psychopharmacology 23, 432439.
Directorate-General of Budget Accounting and Statistics, Executive Yuan, Taiwan (2015). Resident Population by 5-Year, 10-Year Age Group.
Evans, SW, Owens, JS, Bunford, N (2014). Evidence-based psychosocial treatments for children and adolescents with attention-deficit/hyperactivity disorder. Journal of Clinical Child and Adolescent Psychology 43, 527551.
Feldman, HM, Reiff, MI (2014). Clinical practice. Attention deficit-hyperactivity disorder in children and adolescents. New England Journal of Medicine 370, 838846.
Findling, RL (2008). Evolution of the treatment of attention-deficit/hyperactivity disorder in children: a review. Clinical Therapeutics 30, 942957.
Garbe, E, Mikolajczyk, RT, Banaschewski, T, Petermann, U, Petermann, F, Kraut, AA, Langner, I (2012). Drug treatment patterns of attention-deficit/hyperactivity disorder in children and adolescents in Germany: results from a large population-based cohort study. Journal of Child and Adolescent Psychopharmacology 22, 452458.
Garfield, CF, Dorsey, ER, Zhu, S, Huskamp, HA, Conti, R, Dusetzina, SB, Higashi, A, Perrin, JM, Kornfield, R, Alexander, GC (2012). Trends in attention deficit hyperactivity disorder ambulatory diagnosis and medical treatment in the United States, 2000–2010. Academic Pediatrics 12, 110116.
Gau, SS, Chong, MY, Chen, TH, Cheng, AT (2005). A 3-year panel study of mental disorders among adolescents in Taiwan. American Journal of Psychiatry 162, 13441350.
Getahun, D, Jacobsen, SJ, Fassett, MJ, Chen, W, Demissie, K, Rhoads, GG (2013). Recent trends in childhood attention-deficit/hyperactivity disorder. JAMA Pediatrics 167, 282288.
Hodgkins, P, Sasane, R, Meijer, WM (2011). Pharmacologic treatment of attention-deficit/hyperactivity disorder in children: incidence, prevalence, and treatment patterns in the Netherlands. Clinical Therapeutics 33, 188203.
Holden, SE, Jenkins-Jones, S, Poole, CD, Morgan, CL, Coghill, D, Currie, CJ (2013). The prevalence and incidence, resource use and financial costs of treating people with attention deficit/hyperactivity disorder (ADHD) in the United Kingdom (1998 to 2010). Child and Adolescent Psychiatry and Mental Health 7, 34.
Hong, M, Kwack, YS, Joung, YS, Lee, SI, Kim, B, Sohn, SH, Chung, US, Yang, J, Bhang, SY, Hwang, JW, Choi, HY, Oh, IH, Lee, YJ, Bahn, GH (2014). Nationwide rate of attention-deficit hyperactivity disorder diagnosis and pharmacotherapy in Korea in 2008–2011. Asia-Pacific Psychiatry 6, 379385.
Huang, CL, Chu, CC, Cheng, TJ, Weng, SF (2014). Epidemiology of treated attention-deficit/hyperactivity disorder (ADHD) across the lifespan in Taiwan: a nationwide population-based longitudinal study. PLoS ONE 9, e95014.
LeFever, GB, Dawson, KV, Morrow, AL (1999). The extent of drug therapy for attention deficit-hyperactivity disorder among children in public schools. American Journal of Public Health 89, 13591364.
Liang, KY, Zeger, SL (1986). Longitudinal data analysis using generalized linear models. Biometrika 73, 1322.
Lien, YT, Yeh, HH, Soong, WT, Jeng, SF, Huang, N, Chen, CY (2015). Factors associated with treatment mode and termination among preschoolers with ADHD in Taiwan. Psychiatric Services 66, 177185.
McCarthy, S, Wilton, L, Murray, ML, Hodgkins, P, Asherson, P, Wong, IC (2012). The epidemiology of pharmacologically treated attention deficit hyperactivity disorder (ADHD) in children, adolescents and adults in UK primary care. BMC Pediatrics 12, 78.
Mohr Jensen, C, Steinhausen, HC (2015). Time trends in incidence rates of diagnosed attention-deficit/hyperactivity disorder across 16 years in a nationwide Danish registry study. Journal of Clinical Psychiatry 76, e334e341.
Morrow, RL, Garland, EJ, Wright, JM, Maclure, M, Taylor, S, Dormuth, CR (2012). Influence of relative age on diagnosis and treatment of attention-deficit/hyperactivity disorder in children. CMAJ 184, 755762.
Nussbaum, NL (2012). ADHD and female specific concerns: a review of the literature and clinical implications. Journal of Attention Disorders 16, 87100.
Oner, O, Yilmaz, ES, Karada, XFH, Vural, M, Vural, EH, Akbulat, A, Gursoz, HX, Turkcapar, H, Kerman, S (2014). ADHD Medication Trends in Turkey: 2009–2013. Journal of Attention Disorders. doi:10.1177/1087054714523129.
Partridge, B, Lucke, J, Hall, W (2012). Public attitudes towards the acceptability of using drugs to treat depression and ADHD. Australian and New Zealand Journal of Psychiatry 46, 958965.
Partridge, B, Lucke, J, Hall, W (2014). Over-diagnosed and over-treated: a survey of Australian public attitudes towards the acceptability of drug treatment for depression and ADHD. BMC Psychiatry 14, 74.
Polanczyk, G, de Lima, MS, Horta, BL, Biederman, J, Rohde, LA (2007). The worldwide prevalence of ADHD: a systematic review and metaregression analysis. American Journal of Psychiatry 164, 942948.
Polanczyk, GV, Willcutt, EG, Salum, GA, Kieling, C, Rohde, LA (2014). ADHD prevalence estimates across three decades: an updated systematic review and meta-regression analysis. International Journal of Epidemiology 43, 434442.
Ponizovsky, AM, Marom, E, Fitoussi, I (2014). Trends in attention deficit hyperactivity disorder drugs consumption, Israel, 2005–2012. Pharmacoepidemiology and Drug Safety 23, 534538.
Rapoport, JL (2013). Pediatric psychopharmacology: too much or too little? World Psychiatry 12, 118123.
Rowland, AS, Umbach, DM, Stallone, L, Naftel, AJ, Bohlig, EM, Sandler, DP (2002). Prevalence of medication treatment for attention deficit-hyperactivity disorder among elementary school children in Johnston County, North Carolina. American Journal of Public Health 92, 231234.
Rucklidge, JJ (2010). Gender differences in attention-deficit/hyperactivity disorder. Psychiatric Clinics of North America 33, 357373.
Safer, DJ (2000). Are stimulants overprescribed for youths with ADHD? Annals of Clinical Psychiatry 12, 5562.
Safer, DJ (2015). Is ADHD really increasing in youth? Journal of Attention Disorders. doi: 10.1177/1087054715586571.
Safer, DJ, Zito, JM, Fine, EM (1996). Increased methylphenidate usage for attention deficit disorder in the 1990s. Pediatrics 98, 10841088.
Sciutto, MJ, Eisenberg, M (2007). Evaluating the evidence for and against the overdiagnosis of ADHD. Journal of Attention Disorders 11, 106113.
Stuhec, M, Locatelli, I, Svab, V (2015). Trends in attention-deficit/hyperactivity disorder drug consumption in children and adolescents in Slovenia from 2001 to 2012: a drug use study from a national perspective. Journal of Child and Adolescent Psychopharmacology 25, 254259.
Thapar, A, Cooper, M (2016). Attention deficit hyperactivity disorder. Lancet 19, 12401250.
Thomas, R, Sanders, S, Doust, J, Beller, E, Glasziou, P (2015). Prevalence of attention-deficit/hyperactivity disorder: a systematic review and meta-analysis. Pediatrics 135, e994e1001.
Treceno, C, Martin Arias, LH, Sainz, M, Salado, I, Garcia Ortega, P, Velasco, V, Jimeno, N, Escudero, A, Velasco, A, Carvajal, A (2012). Trends in the consumption of attention deficit hyperactivity disorder medications in Castilla y Leon (Spain): changes in the consumption pattern following the introduction of extended release methylphenidate. Pharmacoepidemiology and Drug Safety 21, 435441.
Vaughan, BS, March, JS, Kratochvil, CJ (2012). The evidence-based pharmacological treatment of paediatric ADHD. International Journal of Neuropsychopharmacology 15, 2739.
Visser, SN, Lesesne, CA, Perou, R (2007). National estimates and factors associated with medication treatment for childhood attention-deficit/hyperactivity disorder. Pediatrics 119 (Suppl. 1), S99S106.
Visser, SN, Danielson, ML, Bitsko, RH, Holbrook, JR, Kogan, MD, Ghandour, RM, Perou, R, Blumberg, SJ (2014). Trends in the parent-report of health care provider-diagnosed and medicated attention-deficit/hyperactivity disorder: United States, 2003–2011. Journal of the American Academy of Child & Adolescent Psychiatry 53, 3446 e32.
Winterstein, AG, Gerhard, T, Shuster, J, Zito, J, Johnson, M, Liu, H, Saidi, A (2008). Utilization of pharmacologic treatment in youths with attention deficit/hyperactivity disorder in Medicaid database. Annals of Pharmacotherapy 42, 2431.
Wu, CS, Lai, MS, Gau, SS, Wang, SC, Tsai, HJ (2014). Concordance between patient self-reports and claims data on clinical diagnoses, medication use, and health system utilization in Taiwan. PLoS ONE 9, e112257.


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Prevalence rates of youths diagnosed with and medicated for ADHD in a nationwide survey in Taiwan from 2000 to 2011

  • L.-J. Wang (a1), S.-Y. Lee (a2) (a3), S.-S. Yuan (a4), C.-J. Yang (a5) (a6), K.-C. Yang (a4) (a7), T.-S. Huang (a6) (a8) (a9) (a10), W.-J. Chou (a1), M.-C. Chou (a1), M.-J. Lee (a1), T.-L. Lee (a11) and Y.-C. Shyu (a6) (a12)...


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