title: Twelve-year retrospective analysis of outpatients with Attention-Deficit/Hyperactivity Disorder in Shanghai.
abstract: BACKGROUND
  Attention-Deficit/Hyperactivity Disorder (ADHD) is the most common diagnosis among children treated in outpatient psychiatric clinics in China, accounting for up to 50% of all patients.
  
  
  OBJECTIVE
  Understand changes over time in the characteristics and treatment of children with ADHD seen at specialty psychiatric clinics in China.
  
  
  METHODS
  For each year from 2000 through 2011, 250 charts of patients who made their initial visit to the Child and Adolescent Psychological Counseling Clinic of the Shanghai Mental Health Center were randomly selected. Among the 3000 selected patients, 998 (33%) had a diagnosis of ADHD.
  
  
  RESULTS
  About 80% of the ADHD patients were male and the majority of them fell ill prior to the age of seven. The mean (sd) age at the time of first attendance at the clinic was 10.0 (2.6) years and the mean duration of illness at the time of the initial visit was 2.9 (1.2) years; both of these values decreased significantly over time. About 20% of them were non-residents of Shanghai and about 11% had comorbid psychiatric diagnoses (primarily depression and tic disorder); both of these proportions increased significantly over time. Among the 576 (58%) who visited the clinic more than once, 77% were treated with central nervous system stimulants, but the proportion administered behavioral treatments (either solely on in combination with medications) increased significantly over time.
  
  
  CONCLUSIONS
  ADHD remains the most common diagnosis of children seen in specialty psychiatric clinics in China but the proportion of clinic attendees with ADHD is gradually declining as non-specialty treatment services expand and other diagnoses become more prominent. There are encouraging trends of earlier identification and treatment of ADHD and of increasing use of non-pharmacological interventions. Nevertheless, most children with ADHD have been ill for at least two years at the time of the initial diagnosis, so continued research efforts are needed to identify the best ways to speed up the recognition and treatment of this disabling condition.
authors.affiliation: Shanghai Mental Health Center, Shanghai Jiao Tong University School of Medicine, Shanghai, China.
authors.forename: Lingxiao
authors.initials: L
authors.lastname: Jiang
authors.affiliation: Shanghai Mental Health Center, Shanghai Jiao Tong University School of Medicine, Shanghai, China.
authors.forename: Yan
authors.initials: Y
authors.lastname: Li
authors.affiliation: Shanghai Mental Health Center, Shanghai Jiao Tong University School of Medicine, Shanghai, China.
authors.forename: Xiyan
authors.initials: X
authors.lastname: Zhang
authors.affiliation: Shanghai Mental Health Center, Shanghai Jiao Tong University School of Medicine, Shanghai, China.
authors.forename: Wenqing
authors.initials: W
authors.lastname: Jiang
authors.affiliation: Shanghai Mental Health Center, Shanghai Jiao Tong University School of Medicine, Shanghai, China.
authors.forename: Caohua
authors.initials: C
authors.lastname: Yang
authors.affiliation: Shanghai Mental Health Center, Shanghai Jiao Tong University School of Medicine, Shanghai, China.
authors.forename: Nan
authors.initials: N
authors.lastname: Hao
authors.affiliation: Shanghai Mental Health Center, Shanghai Jiao Tong University School of Medicine, Shanghai, China.
authors.forename: Lili
authors.initials: L
authors.lastname: Hao
authors.affiliation: Shanghai Mental Health Center, Shanghai Jiao Tong University School of Medicine, Shanghai, China.
authors.forename: Mengyao
authors.initials: M
authors.lastname: Li
authors.affiliation: Shanghai Mental Health Center, Shanghai Jiao Tong University School of Medicine, Shanghai, China.
authors.forename: Wenwen
authors.initials: W
authors.lastname: Liu
authors.affiliation: Shanghai Mental Health Center, Shanghai Jiao Tong University School of Medicine, Shanghai, China.
authors.forename: Linna
authors.initials: L
authors.lastname: Zhang
authors.affiliation: Shanghai Mental Health Center, Shanghai Jiao Tong University School of Medicine, Shanghai, China.
authors.forename: Yasong
authors.initials: Y
authors.lastname: DU