Use of medication for attention‐deficit/hyperactivity disorder and risk of unintentional injuries in children and adolescents with co‐occurring neurodevelopmental disorders

Abstract

Background: Attention-deficit/hyperactivity disorder (ADHD) is often associated with other neurodevelopmental disorders (NDs) and with risky behaviors and adverse health outcomes, including injuries. Treatment with ADHD medication has been associated with reduced risk of injuries. However, it is unknown whether the association is present in individuals with co-occurring NDs. The aim of the present study was to estimate the association between ADHD medication use and unintentional injuries in Sweden in children and adolescents with ADHD, including those with co-occurring NDs. Methods: Using a linkage of several national registers via the unique personal identification number, we identified individuals with a diagnosis of ADHD and of other NDs, including autism spectrum disorder, intellectual disability, communication disorders, learning disorders and motor disorders. The primary outcome was unintentional injuries. Secondary outcome was traumatic brain injury (TBI). Individuals were followed from January 1st 2006 or their 5th birthday or the date of the first unintentional injury, whichever came last, to December 31st 2013 or their 18th birthday or death, whichever came first. We compared the rate of injuries during periods ontreatment with the rate of injuries during periods off-treatment within the same individual using stratified Cox regression to calculate hazard ratio (HR) with 95% confidence intervals (CIs). Results: For children and adolescents with ADHD (N = 9,421) the rate of any unintentional injuries (HR = 0.85; 95% CI = 0.78-0.92) and TBIs (HR = 0.27; 95% CIs = 0.20-0.38) during medicated periods was lower than during non-medicated periods. Similar results were found among individuals with co-occurring NDs (N = 2,986), for unintentional injuries (HR = 0.88; 95% CI = 0.77-1.01) and for TBIs (HR = 0.27; 95% CI = 0.16-0.44). Conclusions: Beneficial effects of ADHD medication may extend beyond reduction of ADHD core symptoms to prevention of unintentional injuries in children and adolescents, including individuals with co-occurring NDs. Key pointsADHD medication use has been associated with reduced risk of injuries. Despite high comorbidity rates, little is known on the association between ADHD medication and injuries among children with co-occurring NDs.In this study, we found that ADHD medication use is associated with reduced risk of injuries in children and adolescents with co-occurring NDs and in the subgroup with ASD.

The management of ADHD in children and adolescents: bringing evidence to the clinic: perspective from the European ADHD Guidelines Group (EAGG)

“…Despite their clear limitations [57], observational studies have certain advantages and can helpfully complement RCTs. They importantly often include real-world outcomes, such as criminal convictions [58,59], violent re-offending [60], depression [61], suicidality [62,63], substance misuse [64,65], psychotic disorders and hallucinations in childhood and adolescence [66], childhood injuries [67][68][69], emergency visits [70][71][72], and transport accidents [73], motor vehicle crashes [31], and school performance [74,75]. Further strengths of these studies include their large samples and potential for observation over extended periods.…”

Attention deficit hyperactivity disorder, physical abuse and methylphenidate treatment in children

“…In addition, reducing ADHD symptoms in childhood may also be associated with reduced risk of abuse. Previous studies have suggested that medications for ADHD, such as the psychostimulant methylphenidate (MPH) 25,26 , may lower the risk of physical injury [27][28][29] . This was hypothesized to be due to a reduction of core symptoms of impulsivity, inattentiveness and hyperactivity, which results in a decreased likelihood of involvement in accidents 27 .…”

Editorial: From risk prediction to action: leveraging electronic health records to improve pediatric population mental health

“…Also leveraging the substantial value of Swedish National Registry data, Ghirardi et al (this issue) extend findings on the protective effects of medication use to prevent unintentional injuries in youth with ADHD (Ghirardi et al, ), by demonstrating that this risk‐reducing effect extends to individuals who have co‐occurring neurodevelopmental disorders in addition to ADHD. Using a cohort of more than 9,000 individuals, their results show that the risk for unintentional injuries is reduced significantly during time periods in which youth with ADHD are medicated compared to those times when they are unmedicated, regardless of the presence of co‐occurring neurodevelopmental disorders (e.g., ASD, intellectual disability).…”