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Pharmacoepidemiol Drug Saf. 2016 Jun;25(6):652-60. doi: 10.1002/pds.3962. Epub 2016 Jan 29.

Stimulant use for ADHD and relative age in class among children in Israel.

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Clalit Research Institute, Chief Physician's Office, Clalit Health Services, Tel Aviv, Israel.
Department of Epidemiology, Mailman School of Public Health, Columbia University, New York, NY, USA.
Centre of Public Health Sciences, Faculty of Medicine, University of Iceland, Reykjavik, Iceland.



Diagnosis of children with attention-deficit/hyperactivity disorder (ADHD) is increasing. The present study sought to identify characteristics and medication treatment patterns of children with ADHD and compare them by relative age in class, sex, ethnicity, family size, sibling order, and other socioeconomic status, as well as find trends in disparity of pharmacotherapy.


This study was based on data from 1 013 149 Clalit Health Services members aged 6-17 years during 2006-2011. Centrally acting sympathomimetic drug purchases were compared according to children's estimated relative age in class; youngest third (born August to November), middle third (born April to July), and oldest third (born December to March). Treatment trends were determined and compared according to sociodemographic and family-related factors.


The overall prevalence of stimulant use in the population was 2.6% in 2006 and 4.9% in 2011. The annual incidence of stimulant use increased from 0.75% to 1.36%, rising more sharply among children in the older age groups (≥12) than among younger ones. Moreover, the youngest third of children in class was more likely to use medication than the oldest third (risk ratio (RR) 1.17, confidence interval (CI) 1.12-1.23) or the middle third (RR 1.06, CI 1.01-1.11). Of the different ethnic sectors, incidence of stimulant use was highest among general Jewish (1.8% in 2011) and lowest among Arabs (0.37% in 2011).


The use of stimulant medication is growing among children in Israel. Although the overall use does not exceed the estimated prevalence of ADHD among children, the appropriateness of prescribing to the Israeli pediatric population, especially to the youngest children in class, may be questionable. Copyright © 2016 John Wiley & Sons, Ltd.


ADHD; Israel; children; ethnicity; pharmacoepidemiology; relative age; stimulant use

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