BACKGROUND: An increase in the use of medications for Attention-Deficit Hyperactivity Disorder (ADHD) has been reported globally. This study aims to estimate the trends of ADHD medications use among children and adults across Europe from 2010 to 2023. METHODS: We conducted a population-level observational study using electronic health records from five European countries: Belgium, Germany, the Netherlands, Spain, and the UK. We estimated the prevalence and incidence of methylphenidate, dexamphetamine, lisdexamfetamine, atomoxetine and guanfacine use among individuals aged 3 years and older. We used the proportion of patients covered to measure treatment adherence. All analyses were reported by country and stratified by age group and sex. FINDINGS: The prevalence of ADHD medication use increased across all five countries during the study period. Between 2010 and 2023, prevalence rose more than threefold in the UK (from 0.12% to 0.39%) and more than doubled in the Netherlands (from 0.67% to 1.56%). Adult use increased substantially in all countries, particularly among females. In the UK, prevalence among adults aged over 25 increased from 0.01% in 2010 to approximately 0.20% in 2023, representing a more than twenty-fold increase in females and fifteen-fold in males. Although ADHD medication use remained higher among males, the sex gap in treatment narrowed over time and with increasing age. After 1-year of medication initiation, 14.9%, 16.0%, 43.9%, and 30.8% of participants were covered by treatment in Germany, the Netherlands, Spain, and the UK respectively. Among initiators, the prevalence of psychiatric conditions and prior use of psycholeptic medications was higher in females and in older age groups. INTERPRETATION: Over 14 years, ADHD medication prevalence increased across Europe, with varying incidence trends by country, age, and sex. Understanding the utilisation of ADHD medications can provide useful information in monitoring use, as well as for anticipation and planning to minimise potential shortages. FUNDING: European Medicines Agency.