Abstract
BackgroundCultural views of Attention-Deficit/Hyperactivity Disorder (ADHD), differing healthcare systems and funding mechanisms, and the availability of mental health services can greatly influence the perceptions, diagnosis, and treatment of ADHD. There is, however, lack of information about treatment practice and the treatment decision-making process for ADHD, particularly in non-Western countries. Our study compared characteristics of paediatric patients newly diagnosed with ADHD symptoms who did and who did not initiate treatment, and also examined whether any differences varied by region in Central Europe and East Asia.MethodsData were taken from a 1-year prospective, observational study that included 1,068 paediatric patients newly diagnosed with ADHD symptoms. Clinical severity was measured using the Clinical Global Impression-ADHD-Severity (CGI-ADHD-S) scale and the Child Symptom Inventory-4 (CSI-4) checklist. Logistic regression was used to explore patient characteristics associated with treatment initiation (pharmacotherapy and/or psychotherapy) at baseline for each region.ResultsA total of 74.3% of patients initiated treatment at baseline (78.3% in Central Europe and 69.9% in East Asia). Of these, 48.8% started with both pharmacotherapy and psychotherapy in Central Europe, and only 17.1% did so in East Asia. The level of clinical severity was highest in the combination treatment group in Central Europe, but was highest in the psychotherapy only group in East Asia. In East Asia, treatment initiation was associated with being older, being male, and having a higher CGI-ADHD-S score. In Central Europe, treatment initiation was associated with parental psychological distress, having a higher CSI-4 score, and not being involved in bullying.ConclusionsAlthough factors associated with treatment initiation differed to some extent between Central Europe and East Asia, clinical severity appeared to be one of the most important determinants of treatment initiation in both regions. However, the choice between pharmacotherapy and psychotherapy, either alone or in combination, varied substantially across the regions.Electronic supplementary materialThe online version of this article (doi:10.1186/s12888-014-0304-x) contains supplementary material, which is available to authorized users.
Highlights
Cultural views of Attention-Deficit/Hyperactivity Disorder (ADHD), differing healthcare systems and funding mechanisms, and the availability of mental health services can greatly influence the perceptions, diagnosis, and treatment of ADHD
The U.S guidelines developed by the American Academy of Paediatrics recommend the first-line use of pharmacotherapy, preferably combined with behavioural therapies, for school-aged children and adolescents with ADHD, but only behavioural therapies for preschool-aged children [10], whereas the European guidelines developed by the European Network for Hyperkinetic Disorders and the UK guideline developed by the National Institute for Health and Care Excellence recommend that the use of drug treatments be reserved only for those with severe symptoms and impairments or when patients fail to respond to an initial trial of psychological treatments [8,11]
Using data from a 1-year, prospective, observational study involving 1,068 paediatric patients newly diagnosed with ADHD symptoms from Central Europe and East Asia, this study compared the demographic and clinical characteristics of those patients who did and did not initiate treatment in routine clinical practice in Central Europe and East Asia and examined whether any differences between them varied by region
Summary
Cultural views of Attention-Deficit/Hyperactivity Disorder (ADHD), differing healthcare systems and funding mechanisms, and the availability of mental health services can greatly influence the perceptions, diagnosis, and treatment of ADHD. Attention-Deficit/Hyperactivity Disorder (ADHD) is a neurobehavioural condition, characterised by the core symptoms of inattention and/or hyperactivity/impulsivity [1] It is among the most prevalent mental disorders in childhood and adolescence across countries and regions [2]. The U.S guidelines developed by the American Academy of Paediatrics recommend the first-line use of pharmacotherapy, preferably combined with behavioural therapies, for school-aged children and adolescents with ADHD, but only behavioural therapies for preschool-aged children [10], whereas the European guidelines developed by the European Network for Hyperkinetic Disorders and the UK guideline developed by the National Institute for Health and Care Excellence recommend that the use of drug treatments be reserved only for those with severe symptoms and impairments or when patients fail to respond to an initial trial of psychological treatments [8,11]. European guidelines are, in general, more conservative about the use of pharmacotherapy as a first-line therapy for ADHD due to concerns over potential adverse events during treatment with ADHD medications (albeit rare and mostly manageable [12]), these guidelines consider both pharmacotherapy and psychotherapy as important treatment options for ADHD and suggest that patient age and clinical severity are the most important clinical factors to consider when making treatment decisions for ADHD
Sign-in/Register to view highlights & summary Sign-in/Register to access full text options 
Talk to us
Join us for a 30 min session where you can share your feedback and ask us any queries you have
Schedule a callDisclaimer: All third-party content on this website/platform is and will remain the property of their respective owners and is provided on "as is" basis without any warranties, express or implied. Use of third-party content does not indicate any affiliation, sponsorship with or endorsement by them. Any references to third-party content is to identify the corresponding services and shall be considered fair use under The CopyrightLaw.
