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Doctor Report 2013: More and more children with ADHD?

Doctor Report 2013: More and more children with ADHD?

The number of ADHD diagnoses increased massively again

Attention Deficit Hyperactivity Disorder (ADHD) - also known as fidgety syndrome - is a commonly diagnosed diagnosis today, but for years, medical professionals have been warning against carelessly putting the ADHD stamp on troubled children. The increase in diagnoses is downright inflationary, according to the deputy chairman of the Barmer GEK, Dr. Rolf-Ulrich Schlenker, at the presentation of the "Doctor Report 2013". Overall, the researchers at the Institute for Social Medicine, Epidemiology and Health System Research (ISEG) in Hanover evaluated the data of more than eight million insured persons from the Barmer GEK from 2006 to 2011 for the report.

ADHD is the main topic of the Barmer GEK doctor report 2013. On behalf of the health insurance company, the institute for social medicine, epidemiology and health system research has for the first time for the current doctor report also "some parent-dependent factors, which the risk for an ADHD diagnosis and the prescription of medication with Affect methylphenidate in children, ”reports the health insurance. Overall, the number of ADHD diagnoses in children and adolescents up to the age of 19 “rose from 2.92 to 4.14 percent between 2006 and 2011,” according to the Barmer GEK. This corresponds to an increase of 42 percent. "Across all ages, the proportion of the population diagnosed with ADHD", according to the health insurance company, "has even increased by 49 percent."

Diagnoses of ADHD are particularly common at the end of primary school. From when a child becomes pathologically unfocused and hyperactive remains a matter of controversy among experts. However, in practice, doctors currently seem much more likely to be diagnosed than they were just a few decades ago. Although doctors have long warned against careless ADHD diagnosis, according to the Barmer GEK medical report, ADHD diagnoses have increased again significantly. The authors of the report come to the conclusion that the increased diagnosis also reflects the expectations of the parents. Eye-catching, restless, unconcentrated, particularly active children apparently simply do not fit properly into our education system. Particularly high diagnosis rates were recorded at the end of primary school age before the transition to secondary schools, report authors report. Thomas G. Grobe and Professor Dr. Friedrich W. Schwartz from the Institute for Social Medicine, Epidemiology and Health System Research. They are extremely critical of the renewed increase in ADHD diagnoses. "ADHD is diagnosed more and more frequently in Germany, even though we have had public and technical awareness of this disease for more than a decade," emphasized Prof. Schwartz.

750,000 ADHD diagnoses in 2011 According to the Barmer GEK medical report, a total of 750,000 people were diagnosed with ADHD in 2011, with a majority of the diagnoses (620,000) affecting people aged up to 19 years. Men were diagnosed with ADHD significantly more often than women (552,000 men versus 197,000 women). The diagnosis rates, however, showed considerable regional differences. Almost twelve percent of boys between the ages of ten and twelve received an ADHD diagnosis nationwide, while the diagnosis rate in Lower Franconia, for example, was well above average 18.8 percent, reports the Barmer GEK. The girls in Lower Franconia were found to have exceeded the national average even more (around four percent in Germany, 8.8 percent in Lower Franconia). The authors of the medical report write that the regional differences also occurred in the drug prescriptions for ADHD. While an average of around 6.5 percent of ten to twelve-year-old boys received a prescription, it was 13.3 percent in Lower Franconia. In Lower Franconia, 5.5 percent of the girls received appropriate medication compared to two percent on a national average. Apparently, the doctors in Lower Franconia are more likely to be diagnosed with ADHD and medicated with methylphenidate (trade name Ritalin). Why the diagnosis rate here is so clearly above the national average remains open in the medical report of the Barmer GEK.

20 percent of boys with ADHD In the course of the ADHD diagnoses it becomes clear that just under “20 percent of all boys who were born in 2000 were affected by an ADHD diagnosis between 2006 and 2011”, reports the Barmer GEK. In the girls of this year it was 7.8 percent. According to the ISEG experts, based on the current data, "a quarter of all men and more than 10 percent of all women" can expect to be diagnosed with ADHD in the course of their lives. The development of the prescriptions for Ritalin (methylphenidate) is similarly frightening. These also increased significantly between 2006 and 2011, although a decrease in the prescribed daily doses was registered for the first time in 2010. In 2011, around seven percent of boys and two percent of girls aged eleven received Ritalin. According to the figures in the doctor's report, the drug was prescribed to around 336,000 people in 2011. "In the course of childhood and adolescence, an estimated 10 percent of all boys and 3.5 percent of all girls should receive methylphenidate at least once," according to the Barmer GEK. The risks associated with this have not yet been conclusively clarified. Possible side effects include growth disorders in children, sleep disorders, loss of appetite and cardiac arrhythmias.

Parents' low level of education as a risk factor for ADHD As part of the doctor's report, the ISEG scientists also identified some parent-dependent factors that influence the risk of an ADHD diagnosis and the prescription of medications with methylphenidate in children. They found that as parents 'levels of education increased, the risk of ADHD decreased, while parents' low levels of education were associated with the increased incidence of ADHD. Children of unemployed parents are also affected more often and "ADHD tends to be diagnosed less often by children with high earners," reports the Barmer GEK. In addition, there is “evidence that children of younger parents are at a higher risk of diagnosis than those of middle-aged parents.” According to the 2013 doctor's report, children with a parent between the ages of 20 and 24 years are about 1.5 times more likely to get one Diagnosing ADHD as children with parents between 30 and 35 years old. The CEO of Barmer GEK, Dr. Rolf-Ulrich Schlenker, do not deliver. "It remains to be seen whether this is due to the greater serenity of parents in advanced age or the problems with bringing up children younger," says Dr. Schlenker.

Difficult diagnosis of the behavioral problem According to the experts, the difficult thing about the diagnosis of ADHD is the determination of the limit from which there is a pathological behavioral problem. Basically, this requires an intensive discussion with the patients, for whom the time is often lacking in everyday practice. The renowned health economist and drug researcher Gerd Glaeske from the University of Bremen told the “Stern” that the first problem with ADHD diagnosis was already emerging. Often there is hardly enough time for extensive examinations. Parents and teachers want to see the problem solved and are looking for quick treatment. The diagnosis is often made quickly and offers the parents supposedly simple answers to many questions. However, not every restless child suffers from ADHD and treatment with Ritalin is by no means always necessary.

Alternative Options for ADHD Therapy Depending on the severity of the disease, there are other options for ADHD therapy, such as effective parent training or behavioral therapy, explained Manfred Döpfner, an expert in child and adolescent psychiatry at the University of Cologne. "The therapeutic support of the children, but also of the parents, is elementary for a successful treatment of ADHD", Döpfner told the "Stern". However, alternative treatment options are in short supply and the waiting lists are overcrowded. The doctors are therefore "often in an ethical dilemma: either they treat the children with Ritalin or they do not treat them at all", the expert explained and also called for greater commitment from the health insurance companies. The "therapeutic capacities for parents and children" would have to be expanded and, of course, paid for, according to the child and adolescent psychologist. (fp)

Also read about ADHD:
ADHD: Many adults unconsciously suffer from it
Study: ADHD is often misdiagnosed
ADHD: physiotherapy instead of psychostimulants?
More and more children are being given ADHD medication
Trend reversal in ADHD therapy?
ADHD: concentration through noise
Environmental factors in ADHD hardly examined

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