ADHD pharmacological treatment patterns and duration: a population-based study in Navarre

Background

Attention-deficit/hyperactivity disorder (ADHD) is a common neurodevelopmental disorder in childhood. Although pharmacological treatment is widely used, population-based evidence on real-world treatment patterns remains limited. This study aimed to describe pharmacological treatment patterns in children and adolescents with ADHD.

Methods

Population-based cohort study using healthcare administrative data from the Navarra Health Service (BARDENA), covering ∼97% of the population. Individuals born between 1991 and 2011 with an ADHD diagnosis were included. Diagnoses were identified using ICPC-2 and ICD-10 codes. Prescription and dispensing records were used to identify ADHD medications and concomitant psychotropic drug use. Treatment patterns and duration of continuous treatment were analysed.

Results

The cohort included 8300 individuals with ADHD (median age 9.8 years; 72.9% male), of whom 4371 received pharmacological treatment. Methylphenidate was the most frequently prescribed medication (90.3%), followed by lisdexamfetamine (16.3%), atomoxetine (8.5%) and guanfacine (1.3%). Median treatment duration differed across medications, ranging from 147.8 months (atomoxetine) to 302.0 months (guanfacine). Temporal analysis showed a marked seasonal pattern (range −278 to 314; amplitude 592), with the lowest treatment prevalence during summer periods (−278).

Conclusions

ADHD pharmacological treatment was common and largely dominated by stimulant medications. Treatment duration differed significantly across drug classes, indicating variability in real-world management. In addition, a marked seasonal pattern was observed, with consistent reductions in treatment during summer periods. These findings highlight the dynamic and heterogeneous nature of ADHD pharmacological care and the importance of considering temporal patterns in treatment monitoring and clinical decision-making.

Key messages

• Real-world ADHD treatment is common and dominated by stimulants, with variability in treatment duration reflecting differences in clinical management.

• Seasonal patterns show the correlation between medication periods and academic requirements.