When ADHD patients become adults, their disorder is not necessarily over - but treatment often stops, according to scientists at the university. The Oldenburg ADHD outpatient clinic would therefore also like to better dovetail adolescent and adult psychiatry.
Is it due to the living conditions of young adults who may move house to start training or studying and do not yet have a doctor in their new place of residence? Or is it perhaps due to the mistaken belief that the problem is over when puberty ends? In any case, treatment for attention deficit/hyperactivity disorder (ADHD) is often discontinued when affected patients become adults - even though the disorder and its risks may persist. This is the conclusion drawn by healthcare researcher Prof. Dr Falk Hoffmann and psychiatrist Prof. Dr Alexandra Philipsen together with Marburg child and adolescent psychiatrist Prof. Dr Dr Christian Bachmann from the health insurance data of 24 million people insured by the local general health insurance funds.
The trio of authors looked at ADHD patients who were 15 years old in 2008 - at the beginning of the period analysed: 4340 boys and 1523 girls. At the age of 21, only 31.2 per cent of the young people had been diagnosed, although a persistent disorder would be expected in around 50 per cent. "Half of ADHD patients still show symptoms in adulthood, as we know from other studies," says Philipsen, Head of the University Department of Psychiatry and Psychotherapy. "The notion that ADHD usually progresses with puberty is outdated."
Medication treatment decreased even more in the same period. While 51.8 per cent of 15-year-old patients were prescribed medication for ADHD, only 6.6 per cent of the original group were still on medication at the age of 21. Untreated ADHD harbours various risks, from a higher risk of poorer school results or job loss to higher mortality. According to the authors, a good transition to adult medical care is all the more important if the child and adolescent psychiatrist or paediatrician is no longer responsible when the child reaches the age of 18 - or 21 at the latest.
Overall, the experts assume that there are many unrecognised disorders of this kind in adults. The frequency of diagnosis among 18 to 69-year-olds has almost doubled from 0.22 per cent in 2009 to 0.4 per cent within five years. "In reality, however, at least one per cent of adults are likely to have ADHD - and that would be a conservative estimate," emphasises Philipsen. In view of the months-long waiting periods for appointments in ADHD outpatient clinics for adults, more such facilities are needed.
The outpatient clinic at Oldenburg University Hospital is also experiencing "enormous demand" with registrations from all over north-west Germany as far as Osnabrück and Hanover, and in some cases even further afield. In view of the complex diagnostics involving a biographical interview, discussions with relatives, the review of certificates and organic and psychological examinations, the waiting period for new patients is currently almost a year. "We have opened a door and can hardly get it closed," says Philipsen, whose team in the ESCAlife research network is investigating different treatment methods for 16 to 45-year-old ADHD patients, among other things.
In order to better accompany the so-called transition phase of ADHD patients as they grow up, the ADHD outpatient clinic is endeavouring to further strengthen cooperation between child and adolescent psychiatry and adult psychiatry in the future. According to psychiatrist Philipsen, this also includes closer links with psychiatrists in private practice in the region.
In another study, healthcare researcher Hoffmann, together with other scientists, compared the prescription of ADHD medication to children and adolescents in Germany with that in other countries. According to the data from nine million people insured by Barmer GEK, the proportion of children and adolescents up to the age of 19 who were prescribed ADHD medication rose from 1.3 to 2.2 per cent between 2005 and 2012. The increase was less marked than in the Netherlands, for example, where the medication rate more than doubled to 3.9 per cent.
Decisive: how sensitive parents are
and how quickly doctors pull out the prescription pad
The biggest increase in Germany was among 15 to 19-year-olds, whose medication rate also more than doubled from 0.89 to 1.96 per cent. In Germany, 10 to 14-year-olds received ADHD medication most frequently: 4.34 per cent - i.e. one in 23 - an increase of almost 50 per cent compared to 2005, when the figure was 2.91 per cent. Among five to nine-year-olds, the medication rate rose by around 24 per cent, while it only fell among even younger children - by two thirds - and was virtually zero.
An international comparison shows some very large differences. It was noticeable, for example, that the prescription of ADHD medication in the Netherlands recently even exceeded the level in the USA, while it remained relatively stable at a low level in the United Kingdom (UK). This means that doctors in the USA and the Netherlands prescribe ADHD medication around seven times as often as in the UK and almost twice as often as in Germany.
"Such striking results can be explained less by actual differences in the incidence of the disease between countries," explains Hoffmann. They are most likely due to differences in parental awareness - and how quickly doctors reach for the prescription pad. "The high prescription figures in the USA are hardly surprising," Hoffmann continues, "as other medications are also used more frequently for children with mental illnesses there than in other countries." Germany is in the middle of the international field here. However, further research is needed to show whether the right patients are being treated.