OBJECTIVES: To explore health care utilization and treatment patterns for attention-deficit/hyperactivity disorder (ADHD) in Germany, with particular emphasis on psychostimulant prescriptions. METHODS: The complete claims database of the organization of physicians registered with statutory health insurance (SHI) in Nordbaden/Germany was available for analysis, covering the total regional population enrolled in SHI (2.24 million lives).  The dataset for years 2003 to 2009 was reorganized as to allow patient-centered evaluation.  For calendar year 2009, 21,287 patients with ADHD  (male, 15,108; female, 6,179; including 5,931 patients or 27.9% [male, 4,582; female, 1,349] with coexisting conduct disorder [F90.1 or a combination of F90 and F91 codes according to ICD-10]) were available for analysis.  RESULTS:  Preschool children (age 0-5 years) with ADHD were prescribed medication in very rare cases (1.6% in 2009) and after an average lead time of more than one year only.  Most received some form of nonpharmacological therapy or were left untreated (42%).  In contrast, 41% of children (age group 6-12 years, since 2003, continuously increasing from 32%) and 54% of adolescents (age group 13-17 years, rate remaining stable since 2006) were prescribed either stimulant (methylphenidate, MPH, or amphetamine) or nonstimulant (atomoxetine) drugs.  Males and patients with concomitant conduct disorder were more likely to receive medication treatment.  Modified-release MPH formulations were more widely used than immediate-release MPH.  Overall use of medication increased steadily, from 32.2% of ADHD patients in 2003 to 39.9% in 2009, whereas its rate decreased over time in adult patients (declining from 38% in 2003 to 26% in 2009).  – Upon individual review of all prescriptions of ADHD medication for members of the control group, no evidence was found supporting potentially inappropriate use of stimulant medication.  CONCLUSIONS: Treatment patterns were highly age and gender specific.  Except for preschoolers, therapeutic management of patients with ADHD relied heavily on drug treatment.