Attention Deficit Hyperactivity Disorder (ADHD) is now considered the most common developmental age disorder. However, it is not easy to estimate the real prevalence of cases, because the diagnosis is based on specific clinical evaluations and there is no database or, as we know, a single Electronic Health Record operating at national level that allows for the collection of this type of data. We rely on surveys. In Italy, 15 studies have been published in recent years, which were compared in a 2018 review. Result: 2.9% of the 67,838 children and adolescents aged between 5 and 17, representing 9 of the 20 Italian region, received a diagnosis of ADHD. For comparison, the 2013 DSM-5 (The Diagnostic and Statistical Manual of Mental Disorders) estimates a prevalence of ADHD at 5%, with a preponderance in males over females, according to a ratio of approximately 2 to 1 in children.
ADHD is a developmental-onset neuropsychiatric disorder characterized by three prevalent symptoms: inattention, impulsivity and motor hyperactivity. Diagnosis of ADHD can be time-consuming and multidisciplinary assessment is required based on the presence of multiple symptoms, as described in the most recent versions of the DSM for developmental age.
How many drugs do they take?
The AIFA Atlas of Social Inequalities in the Use of Drugs (2021) shows that in Italy fewer drugs are taken for ADHD: 0.139 DDD (Daily doses per 100 inhabitants) in males and 0.019 DDD per 100 inhabitants in females. Currently in Italy, therapies for the pharmacological treatment of ADHD are authorized from 6 years of age and are represented by medicinal products based on the two active ingredients: methylphenidate, belonging to the class of psychoanaleptics and psychostimulants, which is considered at all. today the reference drug therapy is atomoxetine, a selective inhibitor of noradrenaline.
Consumption is higher in the North than in the South and in the more affluent tertiles than in the most deprived social groups. But be careful, in these tables the data on the economic status concerns the municipality, not the families. It is the municipalities that fall into one of the three income tertiles. “Not all the variability in the consumption rate between geographical areas and between levels of deprivation can be explained by the prevalence of the disease – explain the authors – other factors can play a significant role, such as the organization of services and coverage in terms of prescribing centers. child neuropsychiatry in the various Italian regions. […] At national level, child neuropsychiatry services are not homogeneously distributed among the regions in terms of number and size, with a better situation in the Center-North than in the South.”.
Recent data on services is missing
There are no publicly available online lists of all such services in Italy. The latest investigation in this sense by the Istituto Superiore di Sanità seems to date back to 2017, even if it had as its focus the Autism spectrum disorders in developmental age (if there are other more recent ones that have escaped us, please report them). This survey highlighted as the first criticality of the system, the lack of an information and monitoring system dedicated to neuropsychic disorders of the developmental age, which included information relating to the treatment paths actually provided, their appropriateness and the results obtained. The services of NPIA (NeuroPsychiatry of Childhood and Adolescence) are mainly composed of territorial structures, flanked by a limited number of centers of reference, semi-residential structures, residential and hospitalization structures. Clearly, the organization and health management in Italy is in the hands of the regions, which can coordinate their healthcare offer as they see fit.
Overall, in 2017 there was an insufficient network to meet the needs of families. Only 6% of the developing age population could receive the assistance they needed, compared to an estimated need of up to 20% of children and adolescents with some developmental neuropsychic disorder. “The prevalence of users treated in rehabilitation services is generally not known – the authors write – nor, above all, how many of them are simultaneously followed also in NPIA services. In situations in which it is possible to calculate it, the average number of performances received by each user is low, and is even decreasing, with 9 average performances per year per user against an expected one of at least 15. A user is able to access the diagnostic path on two that would need it. Only one in three who would need ordinary hospitalization can access an NPIA ward. Many users and families remain on the waiting list for months or even years, in particular with regard to therapeutic and rehabilitative paths and families find themselves increasingly resorting to private individuals, with significant costs that in times of economic crisis are less and less able to sustain. “