Treatment of childhood attention deficit and hyperactivity in the Hungarian public healthcare service

Abstract

In Hungary, no population-level survey has yet been conducted on the prevalence and incidence of attention deficit hyperactivity disorder (ADHD) in children and adolescents. Methylphenidate and atomoxetine are authorized for the treatment of pediatric ADHD in Hungary, however, it is unknown how many children with ADHD have access to publicly funded specialist care and how many receive pharmacotherapy.

Our study aimed to determine the annual prevalence and incidence of ADHD in children and adolescents within the Hungarian national healthcare system from 2013 to 2022, and to identify the proportion of children treated with pharmacotherapy. Anonymized raw data from the Hungarian public health fund were standardized to determine the annual prevalence and incidence of pediatric patients with ADHD diagnosis receiving care in the public healthcare system. As nationwide prevalence and incidence data on pediatric ADHD are not available, we used international meta-analyses to determine the expected number of children with ADHD. Descriptive analyses were performed by age groups (0– 6, 7–10, 11–14, and 15–18 years), sex, and geographical region within Hungary. Additionally, we assessed the proportion of diagnosed children receiving medication, the time elapsed between initial diagnosis and initiation of medication , and the type of pharmacotherapy initially prescribed.

Our analysis revealed a progressive increase in the annual prevalence of children with ADHD in the Hungarian public healthcare system from 2013 to 2022, although it remained significantly lower than the expected 5% based on international epidemiological data: the highest prevalence during these 10 years was 0.69% in 2022. The male to female ratio was 4:1 for newly diagnosed cases (incident patients) and 5:1 for prevalent patients. The data suggest a trend towards earlier referral of children with ADHD symptoms: the number of new cases gradually increased in the two younger age groups, with fewer new cases in the older age groups. In terms of pharmacological treatment, only 21.7% of diagnosed children received medication, with atomoxetine emerging as the predominant first-line pharmacotherapy (65.0%).

Based on our findings, there is an increasing trend in the diagnosis and treatment of ADHD in children in Hungary. However, this increase remains considerably lower than expected based on international epidemiological data, and the vast majority of children with ADHD still do not appear in the publicly funded healthcare system. Regional differences in the prevalence of children with ADHD are large, with some regions lagging even behind the already low national average. The difference in the prevalence and incidence between males and females suggests that many girls with ADHD are only seen once and treatment is not initiated. Besides, current pharmacotherapeutic practices in Hungary appear to deviate from established international recommendations. Firstly, the majority of children with ADHD are not treated with any medication, and secondly, the non-stimulant atomoxetine is the first choice of medication in most the treated cases.