OBJECTIVES: Between 2003 and 2009, psychostimulant prescriptions in Germany increased 2.75-fold.  During the same period, administrative prevalence of ADHD in Nordbaden/Germany grew from 0.53% (overall; age group 6-12 years, 4.74%; age 13-17 years, 1.73%, in 2003) to 0.95% (overall; 8.02% and 4.21%, respectively, in 2009).  In our earlier analyses for year 2003, we did not identify overprescribing.  The present analysis revisits the use of medication in children and adolescents with ADHD in light of its recent increase. METHODS: The complete claims database of the organization of physicians registered with statutory health insurance [SHI] (Kassenaerztliche Vereinigung, KV) in Nordbaden/Germany was available for analysis, covering the total regional population enrolled in SHI (>2.2 million).  Data were available for calendar years 2003 to 2009 and were combined with prescription data from the SHI in order to create a patient-centered database enabling health care utilization research.  RESULTS: During the observation period, the use of medication among patients diagnosed with ADHD (in Germany, methylphenidate and atomoxetine) increased continuously in children age 6 to 12 years, from 32.5% (2003) over 35.3% (2006) and 40.9% (2009), whereas the increase flattened in adolescents (45.7% in 2003; 53.9% in 2006, and 54.3% in 2009). Male patients and patients with externalizing comorbidities, in particular conduct disorder, were more likely to receive medication (peak among male adolescents with hyperkinetic conduct disorder: 56.9% in 2003; 60.0% in 2006; 59.5% in 2009).  The nonstimulant, atomoxetine, was prescribed rarely (overall, 3.1%versus 38.2% of patients with ADHD), but used more often in adolescents with externalizing comorbidity (up to 9.7% in male adolescents, 2009).  Compared to these numbers, only few control patients without a diagnosis of ADHD (total number, 29) received psychostimulants in 2009. CONCLUSIONS: Although medication use grew faster than the number of cases diagnosed with ADHD, our data provide no evidence of overprescribing.