Outpatient prescription patterns of attention deficit hyperactivity disorder medications in Tabriz Iran 2021 to 2022

Outpatient prescription patterns of attention deficit hyperactivity disorder medications in Tabriz Iran 2021 to 2022 | Research Square window.SnipcartSettings = { analytics: { enabled: false } }; (function() { var accessVector = localStorage.getItem('access_vector') || ''; window.dataLayer = window.dataLayer || []; if (accessVector) { window.dataLayer.push({ user: { profile: { profileInfo: { snid: accessVector } } } }); } })(); (function(w,d,s,l,i){w[l]=w[l]||[];w[l].push({'gtm.start':new Date().getTime(),event:'gtm.js'});var f=d.getElementsByTagName(s)[0],j=d.createElement(s),dl=l!='dataLayer'?'&l='+l:'';j.async=true;j.src='https://www.googletagmanager.com/gtm.js?id='+i+dl;f.parentNode.insertBefore(j,f);})(window,document,'script','dataLayer','GTM-K279D39R'); Browse Preprints In Review Journals COVID-19 Preprints AJE Video Bytes Research Tools Research Promotion AJE Professional Editing AJE Rubriq About Preprint Platform In Review Editorial Policies Our Team Advisory Board Help Center Sign In Submit a Preprint Cite Share Download PDF Research Article Outpatient prescription patterns of attention deficit hyperactivity disorder medications in Tabriz Iran 2021 to 2022 Ali Fakhari, Mostafa Farahbakhsh, Ali Azimian, Amin khameneh, and 2 more This is a preprint; it has not been peer reviewed by a journal. https://doi.org/ 10.21203/rs.3.rs-7468341/v1 This work is licensed under a CC BY 4.0 License Status: Posted Version 1 posted You are reading this latest preprint version Abstract Background Attention-deficit hyperactivity disorder (ADHD) is a common neurodevelopmental disorder treated primarily with pharmacological interventions. The prescription patterns of these medications vary considerably across regions due to diagnostic practices, physician availability, and cultural factors. Objective This study aimed to examine the demographic characteristics and prescribing patterns of ADHD medications among outpatients in Tabriz, Iran, over a 12-month period. Methods In this descriptive cross-sectional study, prescription data for methylphenidate, atomoxetine, lisdexamfetamine, and modafinil were collected from the Iranian Social Security Organization from March 2021 to March 2022. The data were analyzed based on patient age, sex, physician specialty, and graduation year. Results Out of a population of 920,617 insured individuals, 1% received prescriptions for ADHD medications. The average age of patients was 18.27 years, and two-thirds were male. Psychiatrists accounted for 81.2% of prescriptions. Methylphenidate was the most frequently prescribed medication. Conclusion The ADHD medication prescription rate in Tabriz was lower than international averages, indicating possible underdiagnoses or limited access to treatment. Expanding awareness, screening, and training among non-specialists could improve ADHD management in this region. ADHD prescription pattern methylphenidate Iran psychiatrists epidemiology Figures Figure 1 Figure 2 Introduction Attention-deficit hyperactivity disorder (ADHD) is a neurodevelopmental condition characterized by persistent patterns of inattention, hyperactivity, and impulsivity that interfere with functioning or development. According to the Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition (DSM-5), these symptoms must be present in more than one setting and negatively impact social, academic, or occupational performance [ 1 ]. ADHD affects both children and adults, though it often begins in early childhood [ 2 ]. Early detection and treatment can significantly improve long-term outcomes, including academic performance, interpersonal relationships, and mental health [ 3 ]. Pharmacological interventions, particularly stimulant medications, remain the first-line treatment in moderate to severe cases[ 4 ]. Commonly prescribed medications include methylphenidate, atomoxetine, lisdexamfetamine, and modafinil. In recent decades, global prescription rates for ADHD medications have risen, driven by increased awareness, changes in diagnostic criteria, and improved access to psychiatric services[ 5 ]. However, considerable variability exists across countries due to differences in health care infrastructure, cultural attitudes, and diagnostic practices. Despite the growing attention to ADHD in high-income countries, data from low- and middle-income nations remains limited[ 6 , 7 ]. In Iran, there is a lack of published research evaluating the prescription trends of ADHD medications, especially among adult and pediatric populations in outpatient settings. Understanding these patterns is crucial to identifying gaps in diagnosis and treatment and to informing healthcare planning and provider training. Method Study design The primary objective of our study was to identify new patterns in the administration of ADHD drugs, taking into account variables such as drug, patient age and sex, physician experience (related to graduation year), and specific medical specialties. First, the list of ADHD medications was extracted from the psychiatric references of Kaplan, Sadock, and Oxford. We examined the Iranian pharmacopoeia and conducted a thorough assessment to determine the availability of drugs in Iran. The analysis distinguished four types of medication: methylphenidate, atomoxetine, lisdexamfetamine, and modafinil. Data source The Social Security Organization provided the data used in this study (Tamin Ejtemaei). The Social Security Organization (SSO) in Iran includes wage earners, paid employees, and self-employed people who voluntarily enlist. The government (3%), employers (20–23%), and insured individuals (7%), as well as other participating parties, fund the nongovernmental organization SSO solely through contributions. We obtained prescriptions for ADHD drugs that were available in Tabriz, Iran, from March 2021 to March 2022. Data analysis Data were cleaned, coded, and analyzed using SPSS software version 26 (IBM Corp., Armonk, NY, USA). Descriptive statistics were used to summarize the data: categorical variables (e.g., medication type, physician specialty) were reported as frequencies and percentages. Continuous variables (e.g., age) were reported using mean, median, mode, standard deviation (SD), minimum, and maximum. Age distributions were further visualized using histograms and bar charts. Cross-tabulations were used to explore relationships between medication type and physician specialty, as well as between patient sex and age group. No inferential statistics (e.g., regression, hypothesis testing) were performed due to the descriptive nature of the study. Variables and classification Patients were categorized into four age groups: children up to 12 years, adolescents aged 13–17 years, adults aged 18–64 years, and older adults aged 65 years and above. Sex was classified as male or female. Physicians were grouped based on their national physician identification number and graduation year, which served as proxies for professional experience. Accordingly, six categories were defined: graduated before 1979 (more than 45 years of practice), 1979–1987 (more than 35 years), 1987–1997 (more than 25 years), 1997–2007 (more than 15 years), 2007–2017 (more than 5 years), and 2017–2022 (recent graduates). In addition, medical specialties were divided into six groups: general practitioners, neurologists, pediatricians, internists, psychiatrists, and surgeons. Based on these classifications, both overall and subgroup trends in ADHD medication prescribing were examined. Results A total of 21,083 prescriptions for ADHD-related medications were issued during the study period in Tabriz. These prescriptions were provided to 9,208 unique individuals, representing approximately 1% of the insured population (n = 920,617). 575 different doctors prescribed these drugs. Patient demographics The mean age of patients was 18.27 years (SD = 8.95). The median age was 11.85 years, and the mode was 8 years, suggesting that a significant portion of prescriptions were concentrated in younger populations. The total population was composed of 66.8% men and 33.2% women. Males had a lower mean age (15.57 years) compared to females (23.7 years), indicating that boys were more likely to be diagnosed and treated earlier (Fig. 1 ). Age group distribution We categorized individuals into four unique age groups based on age ranges: preadolescent and younger, adolescent, adult, and elderly. Prescriptions for ADHD drugs are most common among preadolescent age groups, according to the study (Table 1 ). Prescription by medication type Among the 21,083 prescriptions, methylphenidate was the most frequently prescribed medication, followed by atomoxetine. Modafinil and lisdexamfetamine were prescribed less frequently, possibly due to regulatory access, cost, or prescriber preference (Table 1 ). Physician experience and graduation cohorts Prescribing physicians were grouped by graduation year: physicians who graduated between 1987 and 2007 contributed to over 83% of all ADHD prescriptions, suggesting a peak in ADHD-related clinical activity among mid-career practitioners. The vast majority of prescriptions were issued by psychiatrists (81.2%), followed by neurologists (14%), while general practitioners and other specialties accounted for less than 5% combined (Table 1 ). Table 1 Characteristics of demographic variables: age group of patients, specialty of physicians, graduation year of physicians, and ADHD medication prescription frequency and percentage Variables Frequency Percent Gender of patients Male 6152 66.8 Female 3056 33.2 Age group of patients ≤ 12: preadolescent 5166 56.1 13–17: adolescents 1952 21.2 18–64: adults 1888 20.5 > 65: older adults 202 2.2 Specialty of physicians Surgeons 71 0.3 GP 190 0.9 Internist 314 1.5 Pediatrician 451 2.1 Neurologist 2943 14.0 Psychiatrist 17114 81.2 Graduation year of physicians -1979 36 0.2 1979–1987 206 1.0 1987–1997 9161 43.5 1997–2007 8450 40.1 2007–2017 3150 14.9 2017–2022 80 0.4 Prescribed ADHD medications in Tabriz Methylphenidate 9122 43.3 Atomoxetine 7525 35.7 Lisdexamfetamine 2644 12.5 Modafinil 1792 8.5 Medication preference by specialty Methylphenidate was the most commonly prescribed drug across all specialties, particularly among psychiatrists, neurologists, and pediatricians. Atomoxetine was most frequently prescribed by general practitioners. Modafinil and lisdexamfetamine had the lowest prescription rates and were mainly used by specialists (Fig. 2 ). Discussion This study investigated the prescription trends of four ADHD medications among outpatients in Tabriz, Iran, over a 12-month period. The findings revealed several key patterns that merit further exploration in light of existing literature. Low overall prescription rate Only 1% of the insured population received prescriptions for ADHD medications. This rate is substantially lower than many high-income countries. For example, in the United States, the prevalence of children treated for ADHD ranges from 6% to 16% [ 8 ], and in the UK, the prescription rate increased from 0.4% in 2000 to 3.9% in 2015 [ 9 ]. Several factors may contribute to this gap, including underdiagnoses, limited access to specialists, low awareness of adult ADHD, and stigma associated with mental health disorders in Iranian culture. Moreover, the lack of standardized national ADHD screening and referral pathways may hinder timely diagnosis and treatment[ 10 ]. Sex differences in prescription Male patients accounted for 66.8% of prescriptions, a ratio consistent with international reports indicating higher ADHD diagnosis rates in boys. This may be due to sex-based differences in symptom expression. Boys often display more externalizing behaviors (e.g., hyperactivity) [ 11 ], which are easier to detect, while girls are more likely to present with inattentive symptoms that may be misinterpreted or overlooked. This finding aligns with studies that have highlighted underdiagnoses and undertreatment of ADHD in females [ 12 ]. Additionally, social stigma and gender stereotypes may discourage women from seeking diagnosis or adhering to medication regimens [ 13 – 15 ]. Age distribution of patients The mean age of patients was 18.27 years, indicating that many individuals continue to receive ADHD treatment into late adolescence or early adulthood. This finding is comparable to data from Germany, where Grimmsmann et al. reported a similar average age of 18.9 years [ 16 ]. The peak in adolescent and young adult prescriptions may reflect both delayed diagnoses and sustained treatment beyond childhood [ 17 ]. Notably, women in this study had a significantly higher average age at the time of prescription compared to men (23.7 vs. 15.6 years), possibly indicating late diagnosis in females or shifting treatment patterns among adults [ 14 ]. Dominance of methylphenidate Methylphenidate accounted for 43.3% of all prescriptions, making it the most widely used ADHD medication in this population. Similar patterns have been reported in the UK [ 18 ] and Canada [ 19 ]. Methylphenidate’s high prescription rate may be due to its long-standing use, familiarity among prescribers, local availability, and cost-effectiveness compared to newer medications like lisdexamfetamine [ 20 – 22 ]. However, reliance on a single medication class may limit personalized treatment options and neglect patient-specific responses or tolerability profiles[ 23 , 24 ]. Specialist-centered prescribing A striking 81.2% of prescriptions were prescribed by psychiatrists, followed by neurologists at 14%. This concentration suggests that ADHD diagnosis and treatment are largely confined to specialist care. While this may ensure more accurate diagnosis, it can also pose a barrier to access, especially in regions with limited numbers of trained psychiatrists [ 25 , 26 ]. Encouragingly, international guidelines recommend a broader role for primary care physicians in the management of ADHD, especially for straightforward cases [ 27 ]. Expanding ADHD-specific training and clinical guidelines for non-specialists in Iran may increase early detection and reduce delays in treatment[ 28 ]. Comparison with other studies Our results are generally consistent with global patterns in terms of male predominance, dominance of methylphenidate, and specialist-driven treatment. However, the low overall prescription rate and limited diversity in medication choice reflect structural and systemic differences that should be addressed through policy reform, public health education, and primary care capacity building[ 29 ]. Public health implications The findings underscore the need for: Greater awareness campaigns targeting both the public and healthcare providers; Improved screening strategies, especially in primary care; Better recognition of ADHD in adults and females; Diversified pharmacological and non-pharmacological treatment options. Without such measures, a large proportion of individuals with ADHD—especially adult women and underserved populations—may remain undiagnosed or inadequately treated. Limitations The limitation we encountered in this study was the fact that despite the extensive searches of similar studies and articles, we could not find congruent results for some of the facts we found in our study. Moreover, the gathered data were raw, and we were unable to calculate the proportion of prescriptions to doctors who prescribed those medications. Additionally, the data collected did not contain the diagnoses of the patients, which prevented us from assessing the prescriptions in accordance with the final diagnosis. Conclusion This study provides the first descriptive analysis of ADHD medication prescription patterns in Tabriz, Iran. The findings reveal a notably low overall prescription rate—only 1% of the insured population—suggesting possible underdiagnoses or limited access to treatment for ADHD. This is especially concerning in light of global prevalence estimates, which indicate much higher rates of diagnosis and medication use. Prescription trends showed a significant gender disparity, with males receiving twice as many prescriptions as females. This reinforces concerns about under-recognition of ADHD in women and the need for more gender-sensitive diagnostic approaches. The average age of patients (18.27 years) indicates that many individuals continue ADHD treatment into adolescence and early adulthood. This highlights the importance of long-term care planning and increased diagnostic attention for adults, particularly women, who may be diagnosed later in life. Methylphenidate was the most commonly prescribed medication, reflecting both clinical familiarity and limited access to alternative treatments. The overwhelming majority of prescriptions were issued by psychiatrists, underlining the current dependence on specialist care. While this ensures a high degree of diagnostic precision, it also raises concerns about the accessibility of ADHD treatment for the broader population. To improve ADHD care in Iran, we recommend the following: expanding ADHD education and screening initiatives, especially in primary care settings; reducing barriers to adult ADHD diagnosis, particularly for women; promoting rational pharmacotherapy, including greater awareness of non-stimulant and second-line medication options; and empowering non-specialist physicians through targeted training and national guidelines to facilitate earlier diagnosis and broaden treatment capacity. Addressing these gaps could lead to earlier detection, more equitable treatment, and improved quality of life for individuals affected by ADHD. Abbreviations ADHD Attention-Deficit Hyperactivity Disorder SSO Social Security Organization Declarations Author contributions All authors contributed to the study conception and design. Material preparation and data collection were performed by E.A., A.A., and M.M. Data analysis was performed by E.A., M.F., and A.K.. The first draft of the manuscript was written by A.F., and all authors commented on previous versions of the manuscript. All authors read and approved the final manuscript. Ethical approval and consent to participate The ethics review board of Tabriz University of Medical Science endorsed the investigation with the ethical code IR.TBZMED.REC.1402.284. The ethics review board had the discretion to waive the requirement for human participant consent in this database study, as it was anonymous and retrospective in nature. In compliance with social security insurance legislation, insured medical information may be employed in research studies. The procedures employed in this investigation were consistent with the principles of the Declaration of Helsinki. https://ethics.research.ac.ir/IR.TBZMED.REC.1402.284 is the address of the online version of the statement, which is accessible to the public. Clinical trial number Not applicable Consent for publication Not applicable Statement Despite the fact that authors have made use of advanced large language models (LLMs) such as ChatGPT, Copilot (Bing AI), and a writing platform (QuillBot) to help assess linguistic quality and assist in the utilization of data analysis software such as Excel and SPSS, it was ultimately the authors who conducted the analysis and interpretation of the results. Competing interests The authors have no relevant financial or nonfinancial interests to disclose. Informed Consent Statement This study was based on secondary analysis of anonymized insurance claims data. Since the dataset did not contain any personal identifiers and individual patients could not be traced, obtaining informed consent from participants was not applicable. The study protocol was reviewed and approved in accordance with institutional and national ethical guidelines. Data availability and material The data that support the findings of this study are available from the Social Security Organization (Tamin Ejtemaei), but restrictions apply to the availability of these data, which were used under license for the current study and are not publicly available. The data are, however, available from the authors upon reasonable request and with the permission of the Social Security Organization (Tamin Ejtemaei). Kindly reach the corresponding author, as indicated on the initial page, to obtain access to the data. Funding No funding was received for conducting this study. Acknowledgment We would like to express our gratitude to the social security organization for their kind assistance in providing the necessary data for our research. References Association AP. Diagnostic and Statistical Manual of Mental Disorders (DSM-5®). American Psychiatric Publishing; 2013. Quinn P. ADHD not for ‘boys only’girls and women are affected. Behav Health Manage. 2004;24(4):30–3. Sassi RB. Attention-deficit hyperactivity disorder and gender. Arch Women Ment Health. 2010;13:29–31. Shier AC, et al. Pharmacological treatment of attention deficit hyperactivity disorder in children and adolescents: clinical strategies. J Cent Nerv Syst Dis. 2013;5:1–17. Nazarova VA, et al. Treatment of ADHD: Drugs, psychological therapies, devices, complementary and alternative methods as well as the trends in clinical trials. Front Pharmacol. 2022;13:1066988. Tam LYC, Taechameekietichai Y, Allen JL. Individual child factors affecting the diagnosis of attention deficit hyperactivity disorder (ADHD) in children and adolescents: a systematic review. Eur Child Adolesc Psychiatry. 2025;34(5):1469–96. Young S, et al. Failure of Healthcare Provision for Attention-Deficit/Hyperactivity Disorder in the United Kingdom: A Consensus Statement. Front Psychiatry. 2021;12:649399. Danielson ML, et al. ADHD prevalence among US children and adolescents in 2022: diagnosis, severity, co-occurring disorders, and treatment. J Clin Child Adolesc Psychol. 2024;53(3):343–60. Renoux C, et al. Prescribing trends of attention-deficit hyperactivity disorder (ADHD) medications in UK primary care, 1995–2015. Br J Clin Pharmacol. 2016;82(3):858–68. Parisi MA, et al. When is the best time to screen and evaluate for treatable genetic disorders? A lifespan perspective. Am J Med Genet C Semin Med Genet. 2023;193(1):44–55. McKechnie DG, et al. Attention-deficit hyperactivity disorder diagnoses and prescriptions in UK primary care, 2000–2018: population-based cohort study. BJPsych Open. 2023;9(4):e121. Russell A, Ford T, Russell G. Barriers and predictors of medication use for childhood ADHD: findings from a UK population-representative cohort. Soc Psychiatry Psychiatr Epidemiol. 2019;54:1555–64. Kok FM, et al. The female side of pharmacotherapy for ADHD—A systematic literature review. PLoS ONE. 2020;15(9):e0239257. Attoe DE, Climie EA. Miss. Diagnosis: A systematic review of ADHD in adult women. J Atten Disord. 2023;27(7):645–57. Young S, et al. Females with ADHD: An expert consensus statement taking a lifespan approach providing guidance for the identification and treatment of attention-deficit/hyperactivity disorder in girls and women. BMC Psychiatry. 2020;20:1–27. Grimmsmann T, Himmel W. The 10-year trend in drug prescriptions for attention-deficit/hyperactivity disorder (ADHD) in Germany. Eur J Clin Pharmacol. 2021;77:107–15. Popit S, et al. Prevalence of attention-deficit hyperactivity disorder (ADHD): systematic review and meta-analysis. Eur Psychiatry. 2024;67(1):e68. Beau-Lejdstrom R, et al. Latest trends in ADHD drug prescribing patterns in children in the UK: prevalence, incidence and persistence. BMJ open. 2016;6(6):e010508. Morkem R, et al. Recent trends in the prescribing of ADHD medications in Canadian primary care. J Atten Disord. 2020;24(2):301–8. Jaeschke RR, Sujkowska E, Sowa-Kućma M. Methylphenidate for attention-deficit/hyperactivity disorder in adults: a narrative review. Psychopharmacology. 2021;238(10):2667–91. Cortese S, et al. Comparative efficacy and tolerability of medications for attention-deficit hyperactivity disorder in children, adolescents, and adults: a systematic review and network meta-analysis. Lancet Psychiatry. 2018;5(9):727–38. Storebø OJ et al. Methylphenidate for attention deficit hyperactivity disorder (ADHD) in children and adolescents–assessment of adverse events in non-randomised studies. Cochrane Database Syst Reviews, 2018(5). Marques L et al. Advancing Precision Medicine: A Review of Innovative In Silico Approaches for Drug Development, Clinical Pharmacology and Personalized Healthcare. Pharmaceutics, 2024. 16(3). Singh D, et al. Personalized medicine: An alternative for cancer treatment. Cancer Treat Res Commun. 2024;42:100860. Ryan M. Training and specialisation of psychiatrists in ADHD. Australasian Psychiatry. 2023;31(5):613–5. Drechsler R, et al. ADHD: Current concepts and treatments in children and adolescents. Neuropediatrics. 2020;51(05):315–35. Asherson P, et al. Mainstreaming adult ADHD into primary care in the UK: guidance, practice, and best practice recommendations. BMC Psychiatry. 2022;22(1):640. McKenna K, et al. Barriers and Enablers of Service Access and Utilization for Children and Adolescents With Attention Deficit Hyperactivity Disorder: A Systematic Review. J Atten Disord. 2024;28(3):259–78. Vandecasteele R, et al. Barriers and facilitators to culturally sensitive care in general practice: a reflexive thematic analysis. BMC Prim Care. 2024;25(1):381. Additional Declarations No competing interests reported. Cite Share Download PDF Status: Posted Version 1 posted You are reading this latest preprint version Research Square lets you share your work early, gain feedback from the community, and start making changes to your manuscript prior to peer review in a journal. As a division of Research Square Company, we’re committed to making research communication faster, fairer, and more useful. We do this by developing innovative software and high quality services for the global research community. Our growing team is made up of researchers and industry professionals working together to solve the most critical problems facing scientific publishing. Also discoverable on Platform About Our Team In Review Editorial Policies Advisory Board Help Center Resources Author Services Accessibility API Access RSS feed Manage Cookie Preferences © Research Square 2026 | ISSN 2693-5015 (online) Privacy Policy Terms of Service Do Not Sell My Personal Information {"props":{"pageProps":{"initialData":{"identity":"rs-7468341","acceptedTermsAndConditions":true,"allowDirectSubmit":true,"archivedVersions":[],"articleType":"Research Article","associatedPublications":[],"authors":[{"id":531409169,"identity":"6405072d-8b18-4712-b165-f9783b99927f","order_by":0,"name":"Ali Fakhari","email":"","orcid":"","institution":"Research Center of Psychiatry and Behavioral Sciences, Tabriz University of Medical Science","correspondingAuthor":false,"prefix":"","firstName":"Ali","middleName":"","lastName":"Fakhari","suffix":""},{"id":531409170,"identity":"4b1ccd63-72a2-4f7b-b03c-e1834e0e6b20","order_by":1,"name":"Mostafa Farahbakhsh","email":"","orcid":"","institution":"Research Center of Psychiatry and Behavioral Sciences, Tabriz University of Medical Science","correspondingAuthor":false,"prefix":"","firstName":"Mostafa","middleName":"","lastName":"Farahbakhsh","suffix":""},{"id":531409172,"identity":"68e4ab47-deb4-45f0-b88f-83029f984540","order_by":2,"name":"Ali Azimian","email":"","orcid":"","institution":"Student Research Committee, Tabriz University of Medical Sciences","correspondingAuthor":false,"prefix":"","firstName":"Ali","middleName":"","lastName":"Azimian","suffix":""},{"id":531409175,"identity":"180db5ae-5440-494b-bad3-f830a37e18c5","order_by":3,"name":"Amin khameneh","email":"","orcid":"","institution":"Student Research Committee, Tabriz University of Medical Sciences","correspondingAuthor":false,"prefix":"","firstName":"Amin","middleName":"","lastName":"khameneh","suffix":""},{"id":531409178,"identity":"045b7c50-f87d-40fc-ac70-de4e3039ac31","order_by":4,"name":"Mahsa Matinkia","email":"","orcid":"","institution":"Research Center of Psychiatry and Behavioral Sciences, Tabriz University of Medical Science","correspondingAuthor":false,"prefix":"","firstName":"Mahsa","middleName":"","lastName":"Matinkia","suffix":""},{"id":531409180,"identity":"049ffce3-26e0-4cd2-b7f9-56ff752d5141","order_by":5,"name":"Ehsan Aghajani","email":"data:image/png;base64,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","orcid":"","institution":"Research Center of Psychiatry and Behavioral Sciences, Tabriz University of Medical Science","correspondingAuthor":true,"prefix":"","firstName":"Ehsan","middleName":"","lastName":"Aghajani","suffix":""}],"badges":[],"createdAt":"2025-08-27 06:23:30","currentVersionCode":1,"declarations":"","doi":"10.21203/rs.3.rs-7468341/v1","doiUrl":"https://doi.org/10.21203/rs.3.rs-7468341/v1","draftVersion":[],"editorialEvents":[],"editorialNote":"","failedWorkflow":false,"files":[{"id":93945950,"identity":"46e47994-6400-46fe-bcdf-ddd9545ae4be","added_by":"auto","created_at":"2025-10-20 14:23:19","extension":"docx","order_by":0,"title":"","display":"","copyAsset":false,"role":"acdc-reference","size":184088,"visible":true,"origin":"","legend":"","description":"","filename":"Manuscript.docx","url":"https://assets-eu.researchsquare.com/files/rs-7468341/v1/d7f55e6c8b7ddd14436f46f2.docx"},{"id":93946005,"identity":"6c49d09e-45cd-4e8c-8278-22a4b25fcd5a","added_by":"auto","created_at":"2025-10-20 14:23:23","extension":"json","order_by":1,"title":"","display":"","copyAsset":false,"role":"acdc-reference","size":7810,"visible":true,"origin":"","legend":"","description":"","filename":"6ed647f4b81a4bc9a2ebb7bf315a9087.json","url":"https://assets-eu.researchsquare.com/files/rs-7468341/v1/e44a6e6de7c251a09c550287.json"},{"id":93946011,"identity":"b791e6fa-262d-40e8-89ea-e03e8dd5776a","added_by":"auto","created_at":"2025-10-20 14:23:24","extension":"xml","order_by":2,"title":"","display":"","copyAsset":false,"role":"acdc-reference","size":67294,"visible":true,"origin":"","legend":"","description":"","filename":"6ed647f4b81a4bc9a2ebb7bf315a90871enriched.xml","url":"https://assets-eu.researchsquare.com/files/rs-7468341/v1/f53b49b61473f97fa5570ba9.xml"},{"id":93945970,"identity":"7082ea6d-c431-490d-862d-53f935b28b38","added_by":"auto","created_at":"2025-10-20 14:23:20","extension":"png","order_by":5,"title":"","display":"","copyAsset":false,"role":"acdc-reference","size":9483,"visible":true,"origin":"","legend":"","description":"","filename":"Onlinefloatimage1.png","url":"https://assets-eu.researchsquare.com/files/rs-7468341/v1/75f791049b1c6d2499dbfaa3.png"},{"id":93945984,"identity":"d6008e95-6a0c-4f90-9ca0-e9a7d400237a","added_by":"auto","created_at":"2025-10-20 14:23:21","extension":"png","order_by":6,"title":"","display":"","copyAsset":false,"role":"acdc-reference","size":15182,"visible":true,"origin":"","legend":"","description":"","filename":"Onlinefloatimage2.png","url":"https://assets-eu.researchsquare.com/files/rs-7468341/v1/cb22ca37677b3096d72a1b6d.png"},{"id":93945990,"identity":"a1aab6d2-d4bf-4162-92bb-f5ea48ec59c0","added_by":"auto","created_at":"2025-10-20 14:23:21","extension":"xml","order_by":7,"title":"","display":"","copyAsset":false,"role":"acdc-reference","size":65231,"visible":true,"origin":"","legend":"","description":"","filename":"6ed647f4b81a4bc9a2ebb7bf315a90871structuring.xml","url":"https://assets-eu.researchsquare.com/files/rs-7468341/v1/5147203cc1042bf6d57e3ec0.xml"},{"id":93946002,"identity":"59f01170-c5e5-4d8f-a761-e75518a00887","added_by":"auto","created_at":"2025-10-20 14:23:22","extension":"html","order_by":8,"title":"","display":"","copyAsset":false,"role":"acdc-reference","size":72748,"visible":true,"origin":"","legend":"","description":"","filename":"earlyproof.html","url":"https://assets-eu.researchsquare.com/files/rs-7468341/v1/089c73e4501cdbe3a10599e3.html"},{"id":93945994,"identity":"4de5cccd-e661-4db4-9976-3c2b680800ed","added_by":"auto","created_at":"2025-10-20 14:23:22","extension":"png","order_by":1,"title":"Figure 1","display":"","copyAsset":false,"role":"figure","size":39312,"visible":true,"origin":"","legend":"\u003cp\u003eBar chart displaying the age and sex distributions of the prescriptions\u003c/p\u003e","description":"","filename":"floatimage1.png","url":"https://assets-eu.researchsquare.com/files/rs-7468341/v1/03a6df6fde1773738817415a.png"},{"id":93945998,"identity":"115381f6-0d08-4270-b9d8-273a1d9c391a","added_by":"auto","created_at":"2025-10-20 14:23:22","extension":"png","order_by":2,"title":"Figure 2","display":"","copyAsset":false,"role":"figure","size":82526,"visible":true,"origin":"","legend":"\u003cp\u003eThe number of ADHD medications prescribed by different specialties\u003c/p\u003e","description":"","filename":"floatimage2.png","url":"https://assets-eu.researchsquare.com/files/rs-7468341/v1/37836bc0b4c46250561c3063.png"},{"id":99686923,"identity":"b29086b6-7a08-4072-892c-7191c11be1bb","added_by":"auto","created_at":"2026-01-07 09:40:26","extension":"pdf","order_by":0,"title":"","display":"","copyAsset":false,"role":"manuscript-pdf","size":865679,"visible":true,"origin":"","legend":"","description":"","filename":"manuscript.pdf","url":"https://assets-eu.researchsquare.com/files/rs-7468341/v1/fe67a148-d87d-4272-a751-11d28eae635d.pdf"}],"financialInterests":"No competing interests reported.","formattedTitle":"Outpatient prescription patterns of attention deficit hyperactivity disorder medications in Tabriz Iran 2021 to 2022","fulltext":[{"header":"Introduction","content":"\u003cp\u003eAttention-deficit hyperactivity disorder (ADHD) is a neurodevelopmental condition characterized by persistent patterns of inattention, hyperactivity, and impulsivity that interfere with functioning or development. According to the Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition (DSM-5), these symptoms must be present in more than one setting and negatively impact social, academic, or occupational performance [\u003cspan citationid=\"CR1\" class=\"CitationRef\"\u003e1\u003c/span\u003e]. ADHD affects both children and adults, though it often begins in early childhood [\u003cspan citationid=\"CR2\" class=\"CitationRef\"\u003e2\u003c/span\u003e]. Early detection and treatment can significantly improve long-term outcomes, including academic performance, interpersonal relationships, and mental health [\u003cspan citationid=\"CR3\" class=\"CitationRef\"\u003e3\u003c/span\u003e]. Pharmacological interventions, particularly stimulant medications, remain the first-line treatment in moderate to severe cases[\u003cspan citationid=\"CR4\" class=\"CitationRef\"\u003e4\u003c/span\u003e]. Commonly prescribed medications include methylphenidate, atomoxetine, lisdexamfetamine, and modafinil. In recent decades, global prescription rates for ADHD medications have risen, driven by increased awareness, changes in diagnostic criteria, and improved access to psychiatric services[\u003cspan citationid=\"CR5\" class=\"CitationRef\"\u003e5\u003c/span\u003e]. However, considerable variability exists across countries due to differences in health care infrastructure, cultural attitudes, and diagnostic practices. Despite the growing attention to ADHD in high-income countries, data from low- and middle-income nations remains limited[\u003cspan citationid=\"CR6\" class=\"CitationRef\"\u003e6\u003c/span\u003e, \u003cspan citationid=\"CR7\" class=\"CitationRef\"\u003e7\u003c/span\u003e]. In Iran, there is a lack of published research evaluating the prescription trends of ADHD medications, especially among adult and pediatric populations in outpatient settings. Understanding these patterns is crucial to identifying gaps in diagnosis and treatment and to informing healthcare planning and provider training.\u003c/p\u003e"},{"header":"Method","content":"\u003cdiv id=\"Sec3\" class=\"Section2\"\u003e\u003ch2\u003eStudy design\u003c/h2\u003e\u003cp\u003eThe primary objective of our study was to identify new patterns in the administration of ADHD drugs, taking into account variables such as drug, patient age and sex, physician experience (related to graduation year), and specific medical specialties. First, the list of ADHD medications was extracted from the psychiatric references of Kaplan, Sadock, and Oxford. We examined the Iranian pharmacopoeia and conducted a thorough assessment to determine the availability of drugs in Iran. The analysis distinguished four types of medication: methylphenidate, atomoxetine, lisdexamfetamine, and modafinil.\u003c/p\u003e\u003c/div\u003e\n\u003ch3\u003eData source\u003c/h3\u003e\n\u003cp\u003eThe Social Security Organization provided the data used in this study (Tamin Ejtemaei). The Social Security Organization (SSO) in Iran includes wage earners, paid employees, and self-employed people who voluntarily enlist. The government (3%), employers (20\u0026ndash;23%), and insured individuals (7%), as well as other participating parties, fund the nongovernmental organization SSO solely through contributions. We obtained prescriptions for ADHD drugs that were available in Tabriz, Iran, from March 2021 to March 2022.\u003c/p\u003e\u003cdiv id=\"Sec5\" class=\"Section2\"\u003e\u003ch2\u003eData analysis\u003c/h2\u003e\u003cp\u003eData were cleaned, coded, and analyzed using SPSS software version 26 (IBM Corp., Armonk, NY, USA). Descriptive statistics were used to summarize the data: categorical variables (e.g., medication type, physician specialty) were reported as frequencies and percentages. Continuous variables (e.g., age) were reported using mean, median, mode, standard deviation (SD), minimum, and maximum. Age distributions were further visualized using histograms and bar charts. Cross-tabulations were used to explore relationships between medication type and physician specialty, as well as between patient sex and age group. No inferential statistics (e.g., regression, hypothesis testing) were performed due to the descriptive nature of the study.\u003c/p\u003e\u003c/div\u003e\n\u003ch3\u003eVariables and classification\u003c/h3\u003e\n\u003cp\u003ePatients were categorized into four age groups: children up to 12 years, adolescents aged 13\u0026ndash;17 years, adults aged 18\u0026ndash;64 years, and older adults aged 65 years and above. Sex was classified as male or female. Physicians were grouped based on their national physician identification number and graduation year, which served as proxies for professional experience. Accordingly, six categories were defined: graduated before 1979 (more than 45 years of practice), 1979\u0026ndash;1987 (more than 35 years), 1987\u0026ndash;1997 (more than 25 years), 1997\u0026ndash;2007 (more than 15 years), 2007\u0026ndash;2017 (more than 5 years), and 2017\u0026ndash;2022 (recent graduates). In addition, medical specialties were divided into six groups: general practitioners, neurologists, pediatricians, internists, psychiatrists, and surgeons. Based on these classifications, both overall and subgroup trends in ADHD medication prescribing were examined.\u003c/p\u003e"},{"header":"Results","content":"\u003cp\u003eA total of 21,083 prescriptions for ADHD-related medications were issued during the study period in Tabriz. These prescriptions were provided to 9,208 unique individuals, representing approximately 1% of the insured population (n\u0026thinsp;=\u0026thinsp;920,617). 575 different doctors prescribed these drugs.\u003c/p\u003e\u003cdiv id=\"Sec8\" class=\"Section2\"\u003e\u003ch2\u003ePatient demographics\u003c/h2\u003e\u003cp\u003eThe mean age of patients was 18.27 years (SD\u0026thinsp;=\u0026thinsp;8.95). The median age was 11.85 years, and the mode was 8 years, suggesting that a significant portion of prescriptions were concentrated in younger populations. The total population was composed of 66.8% men and 33.2% women. Males had a lower mean age (15.57 years) compared to females (23.7 years), indicating that boys were more likely to be diagnosed and treated earlier (Fig.\u0026nbsp;\u003cspan refid=\"Fig1\" class=\"InternalRef\"\u003e1\u003c/span\u003e).\u003c/p\u003e\u003cp\u003e\u003c/p\u003e\u003c/div\u003e\n\u003ch3\u003eAge group distribution\u003c/h3\u003e\n\u003cp\u003eWe categorized individuals into four unique age groups based on age ranges: preadolescent and younger, adolescent, adult, and elderly. Prescriptions for ADHD drugs are most common among preadolescent age groups, according to the study (Table\u0026nbsp;\u003cspan refid=\"Tab1\" class=\"InternalRef\"\u003e1\u003c/span\u003e).\u003c/p\u003e\n\u003ch3\u003ePrescription by medication type\u003c/h3\u003e\n\u003cp\u003eAmong the 21,083 prescriptions, methylphenidate was the most frequently prescribed medication, followed by atomoxetine. Modafinil and lisdexamfetamine were prescribed less frequently, possibly due to regulatory access, cost, or prescriber preference (Table \u003cspan refid=\"Tab1\" class=\"InternalRef\"\u003e1\u003c/span\u003e).\u003c/p\u003e\u003cdiv id=\"Sec11\" class=\"Section2\"\u003e\u003ch2\u003ePhysician experience and graduation cohorts\u003c/h2\u003e\u003cp\u003ePrescribing physicians were grouped by graduation year: physicians who graduated between 1987 and 2007 contributed to over 83% of all ADHD prescriptions, suggesting a peak in ADHD-related clinical activity among mid-career practitioners. The vast majority of prescriptions were issued by psychiatrists (81.2%), followed by neurologists (14%), while general practitioners and other specialties accounted for less than 5% combined (Table\u0026nbsp;\u003cspan refid=\"Tab1\" class=\"InternalRef\"\u003e1\u003c/span\u003e).\u003c/p\u003e\u003cp\u003e\u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab1\" border=\"1\"\u003e\u003ccaption language=\"En\"\u003e\u003cdiv class=\"CaptionNumber\"\u003eTable 1\u003c/div\u003e\u003cdiv class=\"CaptionContent\"\u003e\u003cp\u003eCharacteristics of demographic variables: age group of patients, specialty of physicians, graduation year of physicians, and ADHD medication prescription frequency and percentage\u003c/p\u003e\u003c/div\u003e\u003c/caption\u003e\u003ccolgroup cols=\"3\"\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e\u003cthead\u003e\u003ctr\u003e\u003cth align=\"left\" colname=\"c1\"\u003e\u003cp\u003eVariables\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c2\"\u003e\u003cp\u003eFrequency\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c3\"\u003e\u003cp\u003ePercent\u003c/p\u003e\u003c/th\u003e\u003c/tr\u003e\u003ctr\u003e\u003cth align=\"left\" colspan=\"3\" nameend=\"c3\" namest=\"c1\"\u003e\u003cp\u003eGender of patients\u003c/p\u003e\u003c/th\u003e\u003c/tr\u003e\u003c/thead\u003e\u003ctbody\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eMale\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e6152\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e66.8\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eFemale\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e3056\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e33.2\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colspan=\"3\" nameend=\"c3\" namest=\"c1\"\u003e\u003cp\u003e\u003cb\u003eAge group of patients\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e\u0026le;\u0026thinsp;12: preadolescent\u003c/p\u003e \u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e5166\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e56.1\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e13\u0026ndash;17: adolescents\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e1952\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e21.2\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e18\u0026ndash;64: adults\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e1888\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e20.5\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e\u0026gt;\u0026thinsp;65: older adults\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e202\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e2.2\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colspan=\"3\" nameend=\"c3\" namest=\"c1\"\u003e\u003cp\u003e\u003cb\u003eSpecialty of physicians\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eSurgeons\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e71\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e0.3\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eGP\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e190\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e0.9\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eInternist\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e314\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e1.5\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003ePediatrician\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e451\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e2.1\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eNeurologist\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e2943\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e14.0\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003ePsychiatrist\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e17114\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e81.2\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colspan=\"3\" nameend=\"c3\" namest=\"c1\"\u003e\u003cp\u003e\u003cb\u003eGraduation year of physicians\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e-1979\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e36\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e0.2\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e1979\u0026ndash;1987\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e206\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e1.0\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e1987\u0026ndash;1997\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e9161\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e43.5\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e1997\u0026ndash;2007\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e8450\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e40.1\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e2007\u0026ndash;2017\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e3150\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e14.9\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e2017\u0026ndash;2022\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e80\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e0.4\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colspan=\"3\" nameend=\"c3\" namest=\"c1\"\u003e\u003cp\u003e\u003cb\u003ePrescribed ADHD medications in Tabriz\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eMethylphenidate\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e9122\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e43.3\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eAtomoxetine\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e7525\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e35.7\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eLisdexamfetamine\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e2644\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e12.5\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eModafinil\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e1792\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e8.5\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003c/tbody\u003e\u003c/colgroup\u003e\u003c/table\u003e\u003c/div\u003e\u003c/p\u003e\u003c/div\u003e\u003cdiv id=\"Sec12\" class=\"Section2\"\u003e\u003ch2\u003eMedication preference by specialty\u003c/h2\u003e\u003cp\u003eMethylphenidate was the most commonly prescribed drug across all specialties, particularly among psychiatrists, neurologists, and pediatricians. Atomoxetine was most frequently prescribed by general practitioners. Modafinil and lisdexamfetamine had the lowest prescription rates and were mainly used by specialists (Fig.\u0026nbsp;\u003cspan refid=\"Fig2\" class=\"InternalRef\"\u003e2\u003c/span\u003e).\u003c/p\u003e\u003cp\u003e\u003c/p\u003e\u003c/div\u003e"},{"header":"Discussion","content":"\u003cp\u003eThis study investigated the prescription trends of four ADHD medications among outpatients in Tabriz, Iran, over a 12-month period. The findings revealed several key patterns that merit further exploration in light of existing literature.\u003c/p\u003e\u003cdiv id=\"Sec14\" class=\"Section2\"\u003e\u003ch2\u003eLow overall prescription rate\u003c/h2\u003e\u003cp\u003eOnly 1% of the insured population received prescriptions for ADHD medications. This rate is substantially lower than many high-income countries. For example, in the United States, the prevalence of children treated for ADHD ranges from 6% to 16% [\u003cspan citationid=\"CR8\" class=\"CitationRef\"\u003e8\u003c/span\u003e], and in the UK, the prescription rate increased from 0.4% in 2000 to 3.9% in 2015 [\u003cspan citationid=\"CR9\" class=\"CitationRef\"\u003e9\u003c/span\u003e]. Several factors may contribute to this gap, including underdiagnoses, limited access to specialists, low awareness of adult ADHD, and stigma associated with mental health disorders in Iranian culture. Moreover, the lack of standardized national ADHD screening and referral pathways may hinder timely diagnosis and treatment[\u003cspan citationid=\"CR10\" class=\"CitationRef\"\u003e10\u003c/span\u003e].\u003c/p\u003e\u003c/div\u003e\u003cdiv id=\"Sec15\" class=\"Section2\"\u003e\u003ch2\u003eSex differences in prescription\u003c/h2\u003e\u003cp\u003eMale patients accounted for 66.8% of prescriptions, a ratio consistent with international reports indicating higher ADHD diagnosis rates in boys. This may be due to sex-based differences in symptom expression. Boys often display more externalizing behaviors (e.g., hyperactivity) [\u003cspan citationid=\"CR11\" class=\"CitationRef\"\u003e11\u003c/span\u003e], which are easier to detect, while girls are more likely to present with inattentive symptoms that may be misinterpreted or overlooked. This finding aligns with studies that have highlighted underdiagnoses and undertreatment of ADHD in females [\u003cspan citationid=\"CR12\" class=\"CitationRef\"\u003e12\u003c/span\u003e]. Additionally, social stigma and gender stereotypes may discourage women from seeking diagnosis or adhering to medication regimens [\u003cspan additionalcitationids=\"CR14\" citationid=\"CR13\" class=\"CitationRef\"\u003e13\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR15\" class=\"CitationRef\"\u003e15\u003c/span\u003e].\u003c/p\u003e\u003c/div\u003e\u003cdiv id=\"Sec16\" class=\"Section2\"\u003e\u003ch2\u003eAge distribution of patients\u003c/h2\u003e\u003cp\u003eThe mean age of patients was 18.27 years, indicating that many individuals continue to receive ADHD treatment into late adolescence or early adulthood. This finding is comparable to data from Germany, where Grimmsmann et al. reported a similar average age of 18.9 years [\u003cspan citationid=\"CR16\" class=\"CitationRef\"\u003e16\u003c/span\u003e]. The peak in adolescent and young adult prescriptions may reflect both delayed diagnoses and sustained treatment beyond childhood [\u003cspan citationid=\"CR17\" class=\"CitationRef\"\u003e17\u003c/span\u003e]. Notably, women in this study had a significantly higher average age at the time of prescription compared to men (23.7 vs. 15.6 years), possibly indicating late diagnosis in females or shifting treatment patterns among adults [\u003cspan citationid=\"CR14\" class=\"CitationRef\"\u003e14\u003c/span\u003e].\u003c/p\u003e\u003c/div\u003e\u003cdiv id=\"Sec17\" class=\"Section2\"\u003e\u003ch2\u003eDominance of methylphenidate\u003c/h2\u003e\u003cp\u003eMethylphenidate accounted for 43.3% of all prescriptions, making it the most widely used ADHD medication in this population. Similar patterns have been reported in the UK [\u003cspan citationid=\"CR18\" class=\"CitationRef\"\u003e18\u003c/span\u003e] and Canada [\u003cspan citationid=\"CR19\" class=\"CitationRef\"\u003e19\u003c/span\u003e]. Methylphenidate\u0026rsquo;s high prescription rate may be due to its long-standing use, familiarity among prescribers, local availability, and cost-effectiveness compared to newer medications like lisdexamfetamine [\u003cspan additionalcitationids=\"CR21\" citationid=\"CR20\" class=\"CitationRef\"\u003e20\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR22\" class=\"CitationRef\"\u003e22\u003c/span\u003e]. However, reliance on a single medication class may limit personalized treatment options and neglect patient-specific responses or tolerability profiles[\u003cspan citationid=\"CR23\" class=\"CitationRef\"\u003e23\u003c/span\u003e, \u003cspan citationid=\"CR24\" class=\"CitationRef\"\u003e24\u003c/span\u003e].\u003c/p\u003e\u003c/div\u003e\u003cdiv id=\"Sec18\" class=\"Section2\"\u003e\u003ch2\u003eSpecialist-centered prescribing\u003c/h2\u003e\u003cp\u003eA striking 81.2% of prescriptions were prescribed by psychiatrists, followed by neurologists at 14%. This concentration suggests that ADHD diagnosis and treatment are largely confined to specialist care. While this may ensure more accurate diagnosis, it can also pose a barrier to access, especially in regions with limited numbers of trained psychiatrists [\u003cspan citationid=\"CR25\" class=\"CitationRef\"\u003e25\u003c/span\u003e, \u003cspan citationid=\"CR26\" class=\"CitationRef\"\u003e26\u003c/span\u003e]. Encouragingly, international guidelines recommend a broader role for primary care physicians in the management of ADHD, especially for straightforward cases [\u003cspan citationid=\"CR27\" class=\"CitationRef\"\u003e27\u003c/span\u003e]. Expanding ADHD-specific training and clinical guidelines for non-specialists in Iran may increase early detection and reduce delays in treatment[\u003cspan citationid=\"CR28\" class=\"CitationRef\"\u003e28\u003c/span\u003e].\u003c/p\u003e\u003c/div\u003e\u003cdiv id=\"Sec19\" class=\"Section2\"\u003e\u003ch2\u003eComparison with other studies\u003c/h2\u003e\u003cp\u003eOur results are generally consistent with global patterns in terms of male predominance, dominance of methylphenidate, and specialist-driven treatment. However, the low overall prescription rate and limited diversity in medication choice reflect structural and systemic differences that should be addressed through policy reform, public health education, and primary care capacity building[\u003cspan citationid=\"CR29\" class=\"CitationRef\"\u003e29\u003c/span\u003e].\u003c/p\u003e\u003c/div\u003e\u003cdiv id=\"Sec20\" class=\"Section2\"\u003e\u003ch2\u003ePublic health implications\u003c/h2\u003e\u003cp\u003eThe findings underscore the need for:\u003c/p\u003e\u003cp\u003eGreater awareness campaigns targeting both the public and healthcare providers;\u003c/p\u003e\u003cp\u003eImproved screening strategies, especially in primary care;\u003c/p\u003e\u003cp\u003eBetter recognition of ADHD in adults and females;\u003c/p\u003e\u003cp\u003eDiversified pharmacological and non-pharmacological treatment options.\u003c/p\u003e\u003cp\u003eWithout such measures, a large proportion of individuals with ADHD\u0026mdash;especially adult women and underserved populations\u0026mdash;may remain undiagnosed or inadequately treated.\u003c/p\u003e\u003c/div\u003e\u003cdiv id=\"Sec21\" class=\"Section2\"\u003e\u003ch2\u003eLimitations\u003c/h2\u003e\u003cp\u003eThe limitation we encountered in this study was the fact that despite the extensive searches of similar studies and articles, we could not find congruent results for some of the facts we found in our study. Moreover, the gathered data were raw, and we were unable to calculate the proportion of prescriptions to doctors who prescribed those medications. Additionally, the data collected did not contain the diagnoses of the patients, which prevented us from assessing the prescriptions in accordance with the final diagnosis.\u003c/p\u003e\u003c/div\u003e"},{"header":"Conclusion","content":"\u003cp\u003eThis study provides the first descriptive analysis of ADHD medication prescription patterns in Tabriz, Iran. The findings reveal a notably low overall prescription rate\u0026mdash;only 1% of the insured population\u0026mdash;suggesting possible underdiagnoses or limited access to treatment for ADHD. This is especially concerning in light of global prevalence estimates, which indicate much higher rates of diagnosis and medication use. Prescription trends showed a significant gender disparity, with males receiving twice as many prescriptions as females. This reinforces concerns about under-recognition of ADHD in women and the need for more gender-sensitive diagnostic approaches. The average age of patients (18.27 years) indicates that many individuals continue ADHD treatment into adolescence and early adulthood. This highlights the importance of long-term care planning and increased diagnostic attention for adults, particularly women, who may be diagnosed later in life. Methylphenidate was the most commonly prescribed medication, reflecting both clinical familiarity and limited access to alternative treatments. The overwhelming majority of prescriptions were issued by psychiatrists, underlining the current dependence on specialist care. While this ensures a high degree of diagnostic precision, it also raises concerns about the accessibility of ADHD treatment for the broader population. To improve ADHD care in Iran, we recommend the following: expanding ADHD education and screening initiatives, especially in primary care settings; reducing barriers to adult ADHD diagnosis, particularly for women; promoting rational pharmacotherapy, including greater awareness of non-stimulant and second-line medication options; and empowering non-specialist physicians through targeted training and national guidelines to facilitate earlier diagnosis and broaden treatment capacity. Addressing these gaps could lead to earlier detection, more equitable treatment, and improved quality of life for individuals affected by ADHD.\u003c/p\u003e"},{"header":"Abbreviations","content":"\u003cp\u003eADHD Attention-Deficit Hyperactivity Disorder\u003c/p\u003e\n\u003cp\u003eSSO Social Security Organization\u0026nbsp;\u003c/p\u003e"},{"header":"Declarations","content":"\u003cp\u003e\u003cstrong\u003eAuthor contributions\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eAll authors contributed to the study conception and design. Material preparation and data collection were performed by E.A., A.A., and M.M. Data analysis was performed by E.A., M.F., and A.K.. The first draft of the manuscript was written by A.F., and all authors commented on previous versions of the manuscript. All authors read and approved the final manuscript.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eEthical approval and consent to participate\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe ethics review board of Tabriz University of Medical Science endorsed the investigation with the ethical code IR.TBZMED.REC.1402.284. The ethics review board had the discretion to waive the requirement for human participant consent in this database study, as it was anonymous and retrospective in nature. In compliance with social security insurance legislation, insured medical information may be employed in research studies. The procedures employed in this investigation were consistent with the principles of the Declaration of Helsinki.\u0026nbsp;\u003c/p\u003e\n\u003cp\u003ehttps://ethics.research.ac.ir/IR.TBZMED.REC.1402.284 is the address of the online version of the statement, which is accessible to the public.\u0026nbsp;\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eClinical trial number\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eNot applicable\u0026nbsp;\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eConsent for publication\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eNot applicable\u0026nbsp;\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eStatement\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eDespite the fact that authors have made use of advanced large language models (LLMs) such as ChatGPT, Copilot (Bing AI), and a writing platform (QuillBot) to help assess linguistic quality and assist in the utilization of data analysis software such as Excel and SPSS, it was ultimately the authors who conducted the analysis and interpretation of the results.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eCompeting interests\u003c/strong\u003e\u0026nbsp;\u003c/p\u003e\n\u003cp\u003eThe authors have no relevant financial or nonfinancial interests to disclose.\u0026nbsp;\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eInformed Consent Statement\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThis study was based on secondary analysis of anonymized insurance claims data. Since the dataset did not contain any personal identifiers and individual patients could not be traced, obtaining informed consent from participants was not applicable. The study protocol was reviewed and approved in accordance with institutional and national ethical guidelines.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eData availability and material\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe data that support the findings of this study are available from the Social Security Organization (Tamin Ejtemaei), but restrictions apply to the availability of these data, which were used under license for the current study and are not publicly available. The data are, however, available from the authors upon reasonable request and with the permission of the Social Security Organization (Tamin Ejtemaei).\u0026nbsp;Kindly reach the corresponding author, as indicated on the initial page, to obtain access to the data.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eFunding\u003c/strong\u003e\u0026nbsp;\u003c/p\u003e\n\u003cp\u003eNo funding was received for conducting this study.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eAcknowledgment\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eWe would like to express our gratitude to the social security organization for their kind assistance in providing the necessary data for our research.\u003c/p\u003e"},{"header":"References","content":"\u003col\u003e\u003cli\u003e\u003cspan\u003eAssociation AP. Diagnostic and Statistical Manual of Mental Disorders (DSM-5\u0026reg;). American Psychiatric Publishing; 2013.\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eQuinn P. ADHD not for \u0026lsquo;boys only\u0026rsquo;girls and women are affected. Behav Health Manage. 2004;24(4):30\u0026ndash;3.\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eSassi RB. Attention-deficit hyperactivity disorder and gender. Arch Women Ment Health. 2010;13:29\u0026ndash;31.\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eShier AC, et al. Pharmacological treatment of attention deficit hyperactivity disorder in children and adolescents: clinical strategies. J Cent Nerv Syst Dis. 2013;5:1\u0026ndash;17.\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eNazarova VA, et al. Treatment of ADHD: Drugs, psychological therapies, devices, complementary and alternative methods as well as the trends in clinical trials. Front Pharmacol. 2022;13:1066988.\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eTam LYC, Taechameekietichai Y, Allen JL. Individual child factors affecting the diagnosis of attention deficit hyperactivity disorder (ADHD) in children and adolescents: a systematic review. Eur Child Adolesc Psychiatry. 2025;34(5):1469\u0026ndash;96.\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eYoung S, et al. Failure of Healthcare Provision for Attention-Deficit/Hyperactivity Disorder in the United Kingdom: A Consensus Statement. Front Psychiatry. 2021;12:649399.\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eDanielson ML, et al. ADHD prevalence among US children and adolescents in 2022: diagnosis, severity, co-occurring disorders, and treatment. J Clin Child Adolesc Psychol. 2024;53(3):343\u0026ndash;60.\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eRenoux C, et al. Prescribing trends of attention-deficit hyperactivity disorder (ADHD) medications in UK primary care, 1995\u0026ndash;2015. Br J Clin Pharmacol. 2016;82(3):858\u0026ndash;68.\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eParisi MA, et al. When is the best time to screen and evaluate for treatable genetic disorders? A lifespan perspective. Am J Med Genet C Semin Med Genet. 2023;193(1):44\u0026ndash;55.\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eMcKechnie DG, et al. Attention-deficit hyperactivity disorder diagnoses and prescriptions in UK primary care, 2000\u0026ndash;2018: population-based cohort study. BJPsych Open. 2023;9(4):e121.\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eRussell A, Ford T, Russell G. Barriers and predictors of medication use for childhood ADHD: findings from a UK population-representative cohort. Soc Psychiatry Psychiatr Epidemiol. 2019;54:1555\u0026ndash;64.\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eKok FM, et al. The female side of pharmacotherapy for ADHD\u0026mdash;A systematic literature review. PLoS ONE. 2020;15(9):e0239257.\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eAttoe DE, Climie EA. Miss. Diagnosis: A systematic review of ADHD in adult women. J Atten Disord. 2023;27(7):645\u0026ndash;57.\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eYoung S, et al. Females with ADHD: An expert consensus statement taking a lifespan approach providing guidance for the identification and treatment of attention-deficit/hyperactivity disorder in girls and women. BMC Psychiatry. 2020;20:1\u0026ndash;27.\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eGrimmsmann T, Himmel W. The 10-year trend in drug prescriptions for attention-deficit/hyperactivity disorder (ADHD) in Germany. Eur J Clin Pharmacol. 2021;77:107\u0026ndash;15.\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003ePopit S, et al. Prevalence of attention-deficit hyperactivity disorder (ADHD): systematic review and meta-analysis. Eur Psychiatry. 2024;67(1):e68.\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eBeau-Lejdstrom R, et al. Latest trends in ADHD drug prescribing patterns in children in the UK: prevalence, incidence and persistence. BMJ open. 2016;6(6):e010508.\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eMorkem R, et al. Recent trends in the prescribing of ADHD medications in Canadian primary care. J Atten Disord. 2020;24(2):301\u0026ndash;8.\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eJaeschke RR, Sujkowska E, Sowa-Kućma M. Methylphenidate for attention-deficit/hyperactivity disorder in adults: a narrative review. Psychopharmacology. 2021;238(10):2667\u0026ndash;91.\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eCortese S, et al. Comparative efficacy and tolerability of medications for attention-deficit hyperactivity disorder in children, adolescents, and adults: a systematic review and network meta-analysis. Lancet Psychiatry. 2018;5(9):727\u0026ndash;38.\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eStoreb\u0026oslash; OJ et al. Methylphenidate for attention deficit hyperactivity disorder (ADHD) in children and adolescents\u0026ndash;assessment of adverse events in non-randomised studies. Cochrane Database Syst Reviews, 2018(5).\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eMarques L et al. Advancing Precision Medicine: A Review of Innovative In Silico Approaches for Drug Development, Clinical Pharmacology and Personalized Healthcare. Pharmaceutics, 2024. 16(3).\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eSingh D, et al. Personalized medicine: An alternative for cancer treatment. Cancer Treat Res Commun. 2024;42:100860.\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eRyan M. Training and specialisation of psychiatrists in ADHD. Australasian Psychiatry. 2023;31(5):613\u0026ndash;5.\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eDrechsler R, et al. ADHD: Current concepts and treatments in children and adolescents. Neuropediatrics. 2020;51(05):315\u0026ndash;35.\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eAsherson P, et al. Mainstreaming adult ADHD into primary care in the UK: guidance, practice, and best practice recommendations. BMC Psychiatry. 2022;22(1):640.\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eMcKenna K, et al. Barriers and Enablers of Service Access and Utilization for Children and Adolescents With Attention Deficit Hyperactivity Disorder: A Systematic Review. J Atten Disord. 2024;28(3):259\u0026ndash;78.\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eVandecasteele R, et al. Barriers and facilitators to culturally sensitive care in general practice: a reflexive thematic analysis. BMC Prim Care. 2024;25(1):381.\u003c/span\u003e\u003c/li\u003e\u003c/ol\u003e"}],"fulltextSource":"","fullText":"","funders":[],"hasAdminPriorityOnWorkflow":false,"hasManuscriptDocX":true,"hasOptedInToPreprint":true,"hasPassedJournalQc":"","hasAnyPriority":false,"hideJournal":true,"highlight":"","institution":"","isAcceptedByJournal":false,"isAuthorSuppliedPdf":false,"isDeskRejected":"","isHiddenFromSearch":false,"isInQc":false,"isInWorkflow":false,"isPdf":false,"isPdfUpToDate":true,"isWithdrawnOrRetracted":false,"journal":{"display":true,"email":"[email protected]","identity":"researchsquare","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":true,"externalIdentity":"","sideBox":"","snPcode":"","submissionUrl":"/submission","title":"Research Square","twitterHandle":"researchsquare","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"","reportingPortfolio":"","inReviewEnabled":false,"inReviewRevisionsEnabled":true},"keywords":"ADHD, prescription pattern, methylphenidate, Iran, psychiatrists, epidemiology","lastPublishedDoi":"10.21203/rs.3.rs-7468341/v1","lastPublishedDoiUrl":"https://doi.org/10.21203/rs.3.rs-7468341/v1","license":{"name":"CC BY 4.0","url":"https://creativecommons.org/licenses/by/4.0/"},"manuscriptAbstract":"\u003cp\u003e\u003cstrong\u003eBackground\u003c/strong\u003e Attention-deficit hyperactivity disorder (ADHD) is a common neurodevelopmental disorder treated primarily with pharmacological interventions. The prescription patterns of these medications vary considerably across regions due to diagnostic practices, physician availability, and cultural factors.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eObjective\u003c/strong\u003e This study aimed to examine the demographic characteristics and prescribing patterns of ADHD medications among outpatients in Tabriz, Iran, over a 12-month period.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eMethods\u003c/strong\u003e In this descriptive cross-sectional study, prescription data for methylphenidate, atomoxetine, lisdexamfetamine, and modafinil were collected from the Iranian Social Security Organization from March 2021 to March 2022. The data were analyzed based on patient age, sex, physician specialty, and graduation year.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eResults\u003c/strong\u003e Out of a population of 920,617 insured individuals, 1% received prescriptions for ADHD medications. The average age of patients was 18.27 years, and two-thirds were male. Psychiatrists accounted for 81.2% of prescriptions. Methylphenidate was the most frequently prescribed medication.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eConclusion\u003c/strong\u003e The ADHD medication prescription rate in Tabriz was lower than international averages, indicating possible underdiagnoses or limited access to treatment. Expanding awareness, screening, and training among non-specialists could improve ADHD management in this region.\u003c/p\u003e","manuscriptTitle":"Outpatient prescription patterns of attention deficit hyperactivity disorder medications in Tabriz Iran 2021 to 2022","msid":"","msnumber":"","nonDraftVersions":[{"code":1,"date":"2025-10-20 14:23:10","doi":"10.21203/rs.3.rs-7468341/v1","editorialEvents":[{"type":"communityComments","content":0}],"status":"published","journal":{"display":true,"email":"[email protected]","identity":"researchsquare","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":true,"externalIdentity":"","sideBox":"","snPcode":"","submissionUrl":"/submission","title":"Research Square","twitterHandle":"researchsquare","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"","reportingPortfolio":"","inReviewEnabled":false,"inReviewRevisionsEnabled":true}}],"origin":"","ownerIdentity":"8b258ed2-10b9-4c2a-b101-8687f79a869d","owner":[],"postedDate":"October 20th, 2025","published":true,"recentEditorialEvents":[],"rejectedJournal":[],"revision":"","amendment":"","status":"posted","subjectAreas":[],"tags":[],"updatedAt":"2026-01-07T09:40:09+00:00","versionOfRecord":[],"versionCreatedAt":"2025-10-20 14:23:10","video":"","vorDoi":"","vorDoiUrl":"","workflowStages":[]},"version":"v1","identity":"rs-7468341","journalConfig":"researchsquare"},"__N_SSP":true},"page":"/article/[identity]/[[...version]]","query":{"redirect":"/article/rs-7468341","identity":"rs-7468341","version":["v1"]},"buildId":"8U1c8b4HqxoKbykW_rLl7","isFallback":false,"isExperimentalCompile":false,"dynamicIds":[84888],"gssp":true,"scriptLoader":[]}