A Prospective Observational Study of Attention-Deficit Hyperactivity Disorder in Asia: Baseline Characteristics of Symptom Severity and Treatment Options in a Paediatric Population
Martényi, F., Zheng, Y., Huang, Y. S., Lee, Y. S., Walton, R., Harrison, G., Treuer, T., East Asian Archives of Psychiatry
Objectives: To better understand the burden and management of attention-deficit hyperactivity disorder in East Asia, this subanalysis of the baseline characteristics of a large prospective, observational, nonrandomised study investigating the relationships between symptom severity, treatments, co-morbidities, and health outcomes provides information about the diagnosis of, and treatment patterns for, attentiondeficit hyperactivity disorder in this region.
Methods: Outpatients with attention-deficit hyperactivity disorder symptoms participated in this 12- month study performed in China, Korea, and Taiwan. Patients were grouped according to whether they received conventional treatment or no or other treatment. Attention-deficit hyperactivity disorder symptom severity and co-morbidities were assessed using the Clinical Global Impressions-Attention-deficit Hyperactivity Disorder-Severity scale and Child Symptom Inventory-4: Parent Checklist (categories B to J) / Adolescent Symptom Inventory-4: Parent Checklist (categories L and O), respectively.
Results: A total of 502 patients aged 6 to 18 years were enrolled. Investigators were psychiatrists (69%) and paediatricians (31%), who used the 4th edition of the Diagnostic and Statistical Manual of Mental Disorders (86%), the 10th revision of the International Classification of Diseases (6%), and other attention-deficit hyperactivity disorder diagnostic criteria (8%) for diagnosis. Pharmacotherapy was the most commonly prescribed treatment (n = 251; 50%), and treated patients were older (9.1 vs. 8.2 years; p < 0.001) and more severely ill (Clinical Global Impressions-Attention-deficit Hyperactivity Disorder- Severity scale, 4.6 vs. 4.2; p < 0.001) than those who were not treated. Anxiety and oppositional comorbidities were commonly reported.
Conclusions: These data provide an insight into the demographics, diagnosis, and treatment of paediatric patients with attention-deficit hyperactivity disorder in East Asia, and provide a baseline for assessing changes in treatment practices in this population.
Key words: Asia; Attention deficit disorder with hyperactivity; Diagnosis; Quality of life; Therapeutics
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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 substantially2; 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 study11 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 crosscultural 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. …