ADHD diagnoses in care-dependent children rise as Germany’s care caseload tops six million
MD report: ADHD diagnoses in care-dependent children rose to 24% in 2025, the MD reports, as Germany’s care caseload tops six million and reforms spark funding debates.
The Medical Service (Medizinischer Dienst, MD) reports a rise in ADHD diagnoses among care-dependent children and adolescents, with ADHD accounting for 24 percent of assessments in 2025. The increase, up three percentage points from the previous year, comes as the total number of people classified as care-dependent in Germany exceeded six million for the first time. The new data has intensified discussion about thresholds, financing and preventive measures in the country’s care system.
ADHD becomes most common diagnosis among care-dependent youth
The MD found that ADHD was the single most frequent diagnosis for applicants aged up to 17, surpassing other developmental disorders. In 2025 specialists from the MD examined about 190,000 children and adolescents, nearly four times the number assessed in 2015. Officials say the rise reflects both an increase in demand for assessments and broader recognition of cognitive and behavioral impairments within the care framework.
Care dependency in Germany tops six million
Overall, the MD’s report shows Germany’s population of care-dependent people rose by roughly 360,000 cases compared with the prior year, pushing the total above six million in 2025. That figure represents a doubling of care case numbers since 2015, underscoring long-term growth in demand for services and support. The report also notes that Care Grade 2 was the most frequently assigned level last year, at 34.5 percent, followed by Care Grade 1 at 29 percent, and that nearly 60 percent of care-dependent individuals receive informal home care from family members.
2017 reform and debate over raising care-grade thresholds
Experts link much of the growth to the 2017 care reform, which replaced three care levels with five care grades and broadened the definition of care dependency to include cognitive and psychological impairments. That change made more people eligible for assessments and benefits, contributing substantially to the upward trend. As a consequence, policymakers and insurers are now debating whether to adjust the thresholds used to assign care grades to limit further expansion of entitlements.
Leading the call for higher thresholds, the National Association of Statutory Health Insurance Funds (GKV) argued the sharp rise poses financial and structural challenges for the nursing care insurance system. GKV leadership has urged reforms to secure long-term financing, a stance echoed by some officials who say recalibrating eligibility could relieve immediate budget pressure.
Ministry plans and criticism of slower subsidy growth
Federal Health Minister Nina Warken has signaled an intention to revisit parameters of the care system and indicated changes to subsidy growth for nursing home residents. Reports suggest planned adjustments would slow the scheduled increases in stepped subsidies that currently reduce residents’ personal contributions, a move critics say will raise costs for people in long-term residential care. Opposition and advocacy groups have already voiced concern that slowing subsidy growth would shift greater financial burden to residents and their families.
Prevention and early advisory role proposed by the Medical Service
MD deputy chair Carola Engler characterized the debate over thresholds as understandable but urged that prevention remain central to any reform. She called for the initial care assessment to be used as a preventive advisory moment, with assessors recommending practical steps to reduce or delay further deterioration. The MD highlighted that in roughly four out of ten advisory consultations, assessors suggest technical aids such as grab rails or barrier-free showers, while physiotherapy and other therapies are recommended in about six out of ten cases.
Calls to expand video assessments and streamline coordination
The MD also urged improved coordination among care actors and wider use of video assessments to make the process easier and more inclusive. Currently, video-based evaluations are limited and generally confined to follow-up cases when sufficient documentation exists, restricting the participation of relatives who live far away. The report pointed to inconsistent internet access in care settings as a practical barrier and called for faster communication and better networking between payers, assessors, providers and local advice services.
The MD reiterated its independent role in conducting first assessments, collecting system data and advising statutory insurers, funded through a share of health and nursing insurance contributions. Policymakers now face pressure to balance fiscal sustainability with measures that preserve access and emphasize prevention, even as debate over thresholds and subsidy growth continues ahead of the next reform decisions.
