Objective: ADHD is a neuro-behavioral disorder and one of the most common chronic health problems in school-aged children. While data on the prevalence of ADHD in non-Western countries, Central Europe and East Asia for example, are limited, they suggest that prevalence rates in these regions are similar to those in Western countries. Treatment options for ADHD include both behavioral and pharmacological therapies. Non conventional interventions such as complementary and alternative medicine (e.g. herbal medicine and homeopathy) are also available in some cultures. There is, however, lack of information on treatment practices and treatment decision process for ADHD, particularly in non-Western countries. This study aimed to explore factors associated with time to medication initiation during follow-up among patients who were newly diagnosed with ADHD symptoms and did not initiate pharmacotherapy at baseline in Central Europe and East Asia.
Method: Data were taken from a 1-year prospective, observational study that included a total of 1,068 newly diagnosed paediatric patients with ADHD symptoms from eight countries/areas in Central Europe (Czech Republic, Hungary, Romania, Slovakia and Turkey) and East Asia (China, South Korea and Taiwan). This post-hoc analysis included all patients with at least one post-baseline visit (n=977). Clinical severity was measured using the Clinical Global Impression (CGI) scale and the Child Symptom Inventory-4 (CSI-4) Checklist. A Kaplan-Meier survival curve was used to depict the proportion of patients remaining on no medication during follow-up. Cox-regression was employed to explore baseline patient characteristics associated with time to medication initiation during follow-up.
Results: Of the 977 patients analyzed, about two-thirds of patients (67%, n=651) initiated pharmacotherapy with/without psychotherapy at baseline. The remaining 316 patients (33%) received psychotherapy (9%), other treatments (e.g. herbal therapy and homeopathy) (8%), or no treatments (17%) at baseline. Of these, 71% (n=231) started pharmacotherapy soon after baseline, with a median time of 44 days. The KM survival curve also confirmed a prompt shift from no medication-to-medication during follow-up. The percentage of patients who remained on no medication at 400 days was 23.4% (KM survival estimate). Having other children living at home was found to be the most important predictor of medication initiation during follow-up (HR=1.47; 95% CI=1.03, 2.10), followed by increased patient age (HR=1.13; 95% CI=1.06, 1.21) and higher clinical severity at baseline (higher CSI-4 scores) (HR=1.02; 95% CI=1.00, 1.04).
Conclusion: Pharmacotherapy was fairly common in the treatment of newly diagnosed paediatric patients with ADHD symptoms in Central Europe and East Asia. Although one in three of these patients did not initiate pharmacotherapy at baseline, the majority of them were quickly switched to pharmacotherapy during follow-up. Having other children living at home, older age of the patient, and having higher clinical severity were associated with time to medication initiation. Given the observational design however, the associations found in our study do not imply causal relationships.