Risk of unintentional injuries in children and adolescents with ADHD and the impact of ADHD medications: A systematic review and meta-analysis
Open accessAbstract
A systematic review with meta-analyses was performed to: 1) quantify the association between ADHD and risk of unintentional physical injuries in children/adolescents ("risk analysis"); 2) assess the effect of ADHD medications on this risk ("medication analysis"). We searched 114 databases through June 2017. For the risk analysis, studies reporting sex-controlled odds ratios (ORs) or hazard ratios (HRs) estimating the association between ADHD and injuries were combined. Pooled ORs (28 studies, 4,055,620 individuals without and 350,938 with ADHD) and HRs (4 studies, 901,891 individuals without and 20,363 with ADHD) were 1.53 (95% CI=1.40,1.67) and 1.39 (95% CI=1.06,1.83), respectively. For the medication analysis, we meta-analysed studies that avoided the confounding-by-indication bias [four studies with a self-controlled methodology and another comparing risk over time and groups (a "difference in differences" methodology)]. The pooled effect size was 0.879 (95% CI=0.838,0.922) (13,254 individuals with ADHD). ADHD is significantly associated with an increased risk of unintentional injuries and ADHD medications have a protective effect, at least in the short term, as indicated by self-controlled studies.
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Behaviors such as impulsivity and/or inattention can be contributing factors for injuries and unintentional incidents in children with ASD/ADHD.
“Behaviors such as impulsivity and/or inattention can be contributing factors for injuries and unintentional incidents in children with ASD/ADHD.58,59”
From Mortality in Persons With Autism Spectrum Disorder or Attention-Deficit/Hyperactivity Disorder: A Systematic Review and Meta-analysis (2022) · cites this paper as [59]
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- Authors
- Ruiz-Goikoetxea, M., Cortese, S., Aznarez-Sanado, M., Magallón, S., Alvarez Zallo, N., Luis, E. O., de Castro-Manglano, P., Soutullo, C., & Arrondo, G.
- Affiliations
- Servicio Navarro de Salud (ES)
- NYU Langone Health (US)
- Universidad de Navarra (ES)
- Corresponding author
- Arrondo, Gonzalo
- Venue
- Neuroscience & Biobehavioral Reviews
- Publisher
- Elsevier BV
- Published
- 2018-01
- Volume
- 84
- Pages
- 63-71
- ISSN
- 0149-7634 (ISSN-L)
- OpenAlex
- W2769961275
- Cited by
- 175
- References
- 116
- Citations by year
- 2026: 14 · 2025: 20 · 2024: 21 · 2023: 26 · 2022: 22 · 2021: 36 · 2020: 14 · 2019: 14 · 2018: 7 · 2017: 1
- FWCI
- 1.49
- Type
- journal article
- Language
- en
- Open access
- hybrid
- doi.org
- Locations
- Neuroscience & Biobehavioral Reviews (publishedVersion, cc-by)
- PubMed (publishedVersion)
- ePrints Soton (University of Southampton) (acceptedVersion)
- Deposito Adademico Digital Universidad De Navarra (University of Navarra) (submittedVersion, other-oa)
- Funders
- 2016 research program of the Health department of the Government of Navarre (89/2016)
- operational programme of the European Regional Development Fund
- Solent National Health Service (NHS) Trust, UK
- Association for Child and Adolescent Mental Health (ACAMH)
- Caja Navarra Foundation and Shire
- Topics
- Health Sciences › Medicine › Psychiatry and Mental health › Attention Deficit Hyperactivity Disorder
- Health Sciences › Medicine › Public Health, Environmental and Occupational Health › Injury Epidemiology and Prevention
- Health Sciences › Health Professions › Emergency Medical Services › Patient Safety and Medication Errors
- Keywords
- attention deficit hyperactivity disorder, unintentional injuries, childhood injuries, adolescents, ADHD medication, injury risk, confounding by indication, self-controlled study, confounding by treatment
- MeSH terms
- Accidents, Attention Deficit Disorder with Hyperactivity, Humans, Proportional Hazards Models, Odds Ratio, Protective Agents
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