(SLB-034) Treatment Patterns in Pediatrics with Attention-Deficit Hyperactivity Disorder (ADHD) in Taiwan

Background: The rising incidence and prevalence of ADHD make its treatment an important issue, encompassing both pharmacological and non-pharmacological therapies.

Objectives: Although Taiwan lacks clinical guidelines for ADHD, the National Health Insurance (NHI) payment criteria clearly define reimbursement conditions for therapies. Given ADHD's impact on children's neurological development, exploring real-world treatment patterns and influencing factors is crucial.

Methods: Patients under 18 years old diagnosed with ADHD between 2012 and 2018 were identified from the NHI database. Based on the type of treatment received, these patients were categorized into three groups: pharmacotherapy alone, behavioral therapy alone, or combination therapy. Baseline characteristics from the year prior to diagnosis were collected. Descriptive and inferential statistics were used to analyze treatment patterns. The chi-squared test and t-test were applied to compare categorical and continuous variables, respectively. A multivariate logistic regression model was employed to identify factors associated with treatment choices, and adjusted odds ratio (aOR) with 95% confidence intervals (CIs) were calculated.

Results: During the observation period, 144,387 patients were diagnosed with ADHD, of whom 48,293 received treatment. The majority (86.3%) underwent pharmacotherapy alone, 10.2% received combination therapy, and 3.5% received behavioral therapy alone. Among school-aged children and adolescents, pharmacotherapy was the predominant treatment, with a usage rate as high as 98%, while fewer than 2% received behavioral therapy alone. In contrast, among preschool children, the proportions of those receiving pharmacotherapy alone and behavioral therapy alone were similar (43.1% vs. 47.4%). Across all three age groups, approximately 10% of patients received combination therapy. Multivariate analysis showed that comorbidities influenced treatment choices. Older patients and those with oppositional defiant disorder, conduct disorder, or intellectual disabilities were more likely to receive pharmacotherapy or combination therapy. In contrast, patients with major depression, autism spectrum disorder, or developmental delays were more likely to receive behavioral therapy alone.

Conclusions: In a cohort of 144,387 patients diagnosed with ADHD under the age of 18, approximately one-third received treatment, with the majority undergoing pharmacotherapy alone. Treatment choices varied across age groups, with pharmacotherapy becoming increasingly predominant as age increased. Additionally, psychiatric and neurological comorbidities significantly influenced treatment patterns.