2026 ECNP Congress

PS01-1059

Antipsychotic and ADHD medication use patterns among young children in South Korea

Youngtae Won — Y.J. Kim, H.J. Kim, T. Lee · Asan Medical Center- University of Ulsan College of Medicine, Department of Psychiatry, Seoul, Korea- Rep

2026 ECNP Congress

Introduction: Neurodevelopmental disorders (NDDs) among children in South Korea have steadily increased. The rate of autism spectrum disorder (ASD) rose from 5.2 to 9.4 per 1,000 births across the 2002-2012 birth cohorts [1], and ADHD diagnoses also increased 1.47-fold between 2008 and 2018 [2]. Both conditions are among the most prevalent NDDs and are associated with growing demand for diagnosis and treatment. Management of NDDs differs by age and diagnosis, and guidelines recommend behavioral therapy including parent training as first-line treatment for children under 6 years. ADHD medications are not approved for this age group [3], given concerns about the effects of early pharmacological exposure on neurodevelopment. Antipsychotics have been reported in young children, yet systematic descriptions of actual prescribing patterns in this group remain limited.

Aims: To describe trends in ADHD medication and antipsychotic use among children aged 4–7 years, and to characterize prescribing patterns around the age of 6 years, using data from the Korean National Health Insurance Review and Assessment Service (HIRA).

Methods: Children aged 4–7 years prescribed at least one ADHD medication or antipsychotic between 2013 and 2022 were identified from the HIRA database (n = 189,374). Those with a single clinical visit, no qualifying prescription during follow-up, or fewer than 28 prescription days per year were excluded, yielding a final analytic sample of 83,379. Drug exposure was classified based on timing relative to the age of 6 years, and the distribution of subgroups was examined using descriptive statistics.

Results: In 83,379 individuals, the majority (77.42%, n = 64,558) received their first ADHD medication after the age of 6 years with no prior antipsychotic exposure. However, 7.01% (n = 5,848) had antipsychotic exposure before age 6 and subsequently transitioned to or co-initiated ADHD medication, and 1.46% (n = 1,220) used both classes concurrently before age 6 and continued thereafter. Age-stratified prescription volumes showed that antipsychotics markedly exceeded ADHD medications in younger children, with ratios of 8.8 at age 4 and 5.1 at age 5, reversing to 0.56 at age 6 and 0.49 at age 7. Across 2013–2022, prescriptions for both classes rose consistently, and aripiprazole showed the most pronounced growth at approximately 24-fold. The antipsychotic-to-ADHD medication ratio also increased steadily, from 0.34 in 2013 to 0.73 in 2022.

Conclusions: This study characterizes ADHD medication and antipsychotic use among children aged 4–7 years using HIRA data. A prescribing shift was observed around the age of 6 years, and a subset of children transitioned to or combined ADHD medication following antipsychotic exposure before this age. These findings highlight the need for careful consideration of early psychotropic use in preschool-aged children, particularly given current regulatory restrictions. Further studies incorporating diagnostic information, such as ASD and ADHD comorbidity profiles, and long-term outcome data are needed to clarify the clinical significance of these prescribing patterns and to inform evidence-based guidelines for psychotropic use in preschool-aged children.

References

  1. Yoo SM, Kim KN, Kang S, Kim HJ, Yun J, Lee JY. Prevalence and Premature Mortality Statistics of Autism Spectrum Disorder Among Children in Korea: A Nationwide Population-Based Birth Cohort Study. J Korean Med Sci. 2022;37(1):e1. Published 2022 Jan 3. doi:10.3346/jkms.2022.37.e1
  2. Seo JC, Jon DI, Shim SH, et al. Prevalence and Comorbidities of Attention Deficit Hyperactivity Disorder Among Adults and Children/Adolescents in Korea. Clin Psychopharmacol Neurosci. 2022;20(1):126-134. doi:10.9758/cpn.2022.20.1.126
  3. Wolraich ML, Hagan JF Jr, Allan C, et al. Clinical Practice Guideline for the Diagnosis, Evaluation, and Treatment of Attention-Deficit/Hyperactivity Disorder in Children and Adolescents. Pediatrics. 2019;144(4):e20192528. doi:10.1542/peds.2019-2528