Is the Treatment the Problem?
The article would have benefited by presenting the data — as it means a restriction of the entire population—as e.g. „prevalence of consultations of AOK members“ . The sample displayed in the study excluded AOK insured persons with ADHD who did not utilise the healthcare system during that time period. So the displayed prevalence of consultations is definitely below the actual overall prevalence. Similarly, the selection bias of the AOK population should be discussed since some social classes are underrepresented. To exclude such bias phenomena, prevalence analysis should be limited to the total prevalence from cross sectional studies.
With regard to the prescription frequencies: “The treatment of children and adolescents with methylphenidate ... has been described as an important public health problem.”
This statement solely shows the authors’ emotional attitude to using methylphenidate (MPH). Sticking to the facts it is irritating to call the indication conform use of a licensed drug in an enormously impairing pathology a problem. Is MPH treatment a problem? A discussion would be desirable.
Compared with the total prevalence of 5–7% (2), the treatment prevalence of 1–1.5% in the comparison groups in the study results in a proportion of the medication of 15–20%. Compared with other psychiatric disorders this is rather low and does not give rise to the suspicion that too many patients with the disorder receive medication without a good reason.
Regarding the increase in overall amount of MPH that is being prescribed: the longer duration of treatment up to adulthood follows recent scientific realization that hyperactivity disappears around the 10th birthday whereas the disorder does not. A comparable insight leads to the increased daily dosages. The result of prescribing the drug beyond the time the patients spend at school means that 4–6 additionally treated hours per day increase the prescribed quantities of the drug.
Dr. med. Karsten Dietrich
Conflict of interest statement
The author declares that no conflict of interest exists according to the guidelines of the International Committee of Medical Journal Editors.
|1.||Schubert I, Köster I, Lehmkuhl G: The changing prevalence of attention-deficit/hyperactivity disorder and methylphenidate prescriptions: A study of data from a random sample of insurees of the AOK health insurance company in the german state of Hesse, 2000–2007. Dtsch Arztebl Int 2010; 107(36): 615–21. VOLLTEXT|
|2.||Schlack R, Hölling H, Kurth BM, Huss M: Die Prävalenz der Aufmerksamkeitsdefizit-/Hyperaktivitätsstörung (ADHS) bei Kindern und Jugendlichen in Deutschland. Bundesgesundheitsbl – Gesundheitsforsch – Gesundheitsschutz 2007; 50: 827–35. MEDLINE|