JMIR Publications

ABSTRACT

Background:

Attention-Deficit/Hyperactivity Disorder (ADHD) is a common neurodevelopmental disorder associated with significant impairments in academic, social, and daily functioning. Despite the availability of clinical practice guidelines in Malaysia, evidence on real-world treatment patterns and outcomes remains limited. The lack of multicentre data on treatment utilisation and clinical outcomes hinders the evaluation of current ADHD care and informs opportunities for service improvement.

Objective:

The primary objective of this study is to observe treatment patterns among children with ADHD referred to psychiatry and mental health services in Malaysia after receiving treatment for 18 months. This study will also compare the treatment outcomes between the children with the ADHD and children who do not receive any ADHD treatment.

Methods:

This multicentre retrospective cohort study will utilise secondary data from clinical records of children aged 4 - 16 years with a confirmed diagnosis of ADHD. Data on sociodemographic characteristics, clinical features, ADHD subtype and comorbidities, treatment modalities, healthcare utilisation, treatment trajectories, and clinical outcomes will be extracted using a standardised case report form and anonymised prior to analysis. Data collection will be undertaken by trained site investigators and medical officers across participating centres. Statistical analyses will be conducted using the R statistical software environment (R Foundation for Statistical Computing, Vienna, Austria). Descriptive statistics will be used to summarise children with ADHD characteristics, treatment patterns, healthcare utilisation, and clinical outcomes. Treatment patterns will be characterised according to pharmacological and non-pharmacological interventions, treatment modifications, and service utilisation. Comparative analyses will be performed to examine associations between treatment patterns and clinical outcomes across children with ADHD and clinical subgroups.

Results:

This study will be funded through the Ministry of Health (MOH) Research Grant (MRG) in August 2026 and will commence from August 2026 to December 2028. Based on the sample size calculation, a minimum of 2,771 eligible children with ADHD records will be included in the study. The study will be reported in accordance with the Strengthening the Reporting of Observational Studies in Epidemiology (STROBE) guidelines for retrospective cohort studies and anlyzed using R statistical software. The findings will be disseminated through presentations and article publications at national and international level. This study is expected to generate the first nationwide multicentre evidence on ADHD treatment practices and outcomes in Malaysian healthcare settings.

Conclusions:

This study will address a critical evidence gap in ADHD care by providing comprehensive real-world data on treatment patterns and outcomes among Malaysian children with ADHD. Findings will identify variations in treatment approaches, treatment trajectories, and clinical outcomes across hospitals and regions, assess the alignment of real-world practice with national recommendations, and highlight potential disparities in access to specialist ADHD services. The findings are expected to support evidence-based clinical decision-making, guide strategic healthcare planning, optimise resource utilisation, and contribute to the development of a more coordinated, efficient, and equitable system of ADHD care across diverse healthcare settings in Malaysia.