Academic journal article East Asian Archives of Psychiatry

A Prospective Observational Study of Attention-Deficit Hyperactivity Disorder in Asia: Baseline Characteristics of Symptom Severity and Treatment Options in a Paediatric Population

Academic journal article East Asian Archives of Psychiatry

A Prospective Observational Study of Attention-Deficit Hyperactivity Disorder in Asia: Baseline Characteristics of Symptom Severity and Treatment Options in a Paediatric Population

Article excerpt

Introduction

Attention-deficit hyperactivity disorder (ADHD) is a relatively common psychiatric condition in children and adolescents that is estimated to occur in approximately 3 to 10% of school-aged children worldwide. (1) However, the prevalence rates appear to vary substantially (2); in the US, estimates range from 5 to 10%,3-5 whereas in Europe, ADHD is reported to affect approximately 4 to 18% of school-aged children. (3)

Data on the prevalence of ADHD in Asia are limited, although the prevalence has been suggested to be similar to that of western countries. (6,7) In Taiwan, it is estimated that 7.5 to 10% of the paediatric population has ADHD, while in Japan, approximately 8% of school-aged children are reported to have the condition. (6-9) Hyperactivity was found to affect 9% of schoolboys in Hong Kong, (10) and a Korean study (11) suggested that ADHD may affect up to 12% of adolescent non-delinquent children. Regional differences in reported prevalence rates could reflect the variable methodological tools used to assess ADHD, or cross-cultural differences in disease recognition. (2,12,13)

In the US and other countries, diagnoses are made using the 4th edition of American Psychiatric Association's Diagnostic and Statistical Manual of Mental Disorders (DSM-IV) classification of ADHD. (14,15) European countries tend to use the 10th revision of World Health Organization's International Statistical Classification of Diseases and Related Health Problems (ICD-10) hyperkinetic disorder (HKD) criteria, (16) which generally corresponds with those classified by the DSM-IV. (16) There are differences in the categorisation of symptomatic ADHD behaviours between the DSM-IV and ICD-10 diagnostic criteria, and establishing a diagnosis can therefore vary. (2,17,18) Although studies have demonstrated the validity of western diagnostic criteria for ADHD in Asian countries, limitations remain, suggesting that there are differences in how ADHD is diagnosed between cultures. (13,19) Disease prevalence can also vary between ethnic groups. (20)

Up to 50% or more of ADHD patients may present with psychiatric co-morbidities or learning disabilities in western countries, (18,21-23) and increasing severity of ADHD is associated with poor health-related quality of life (QoL). (24,25) Treatment plans for ADHD should therefore aim to reduce symptoms, enhance functionality, and improve individual well-being. (26) Information on how ADHD is treated in Asia is limited, and data on ADHD co-morbidities in the region are also scarce. (7,23,27) There is a need to further understand treatment practices for ADHD in the region and to identify factors that influence the management of ADHD, which may help inform effective treatment strategies.

This study represents a subanalysis of the baseline characteristics of a large prospective, observational, non-randomised study designed to provide information about the diagnosis of, and treatment patterns for, ADHD in lesser studied parts of the world, including Central and East Europe (CEE) and East Asia. (28) Given that there is a gap in the current knowledge of ADHD treatment practices and the impact of ADHD on patients' QoL in these regions, this subanalysis attempted to redress the balance of information by describing treatment regimens as prescribed in real-life clinical settings, in a large and diverse paediatric population from East Asia (China, Korea, and Taiwan). In addition, the subanalysis evaluated the relationship between demographics, severity of ADHD symptoms, co-morbidities, functional status, and QoL, as well as the criteria used to diagnose the illness, and treatment patterns and correlates at study initiation (baseline).

Methods

Patients

Patients eligible for enrolment were male and female children or adolescent outpatients aged 6 to 18 years who had ADHD symptoms and presented to a physician, and had not been previously diagnosed with or treated for ADHD. …

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