Medication for Attention Deficit–Hyperactivity Disorder and Criminality
Open accessAbstract
BACKGROUND: Attention deficit-hyperactivity disorder (ADHD) is a common disorder that has been associated with criminal behavior in some studies. Pharmacologic treatment is available for ADHD and may reduce the risk of criminality. METHODS: Using Swedish national registers, we gathered information on 25,656 patients with a diagnosis of ADHD, their pharmacologic treatment, and subsequent criminal convictions in Sweden from 2006 through 2009. We used stratified Cox regression analyses to compare the rate of criminality while the patients were receiving ADHD medication, as compared with the rate for the same patients while not receiving medication. RESULTS: As compared with nonmedication periods, among patients receiving ADHD medication, there was a significant reduction of 32% in the criminality rate for men (adjusted hazard ratio, 0.68; 95% confidence interval [CI], 0.63 to 0.73) and 41% for women (hazard ratio, 0.59; 95% CI, 0.50 to 0.70). The rate reduction remained between 17% and 46% in sensitivity analyses among men, with factors that included different types of drugs (e.g., stimulant vs. nonstimulant) and outcomes (e.g., type of crime). CONCLUSIONS: Among patients with ADHD, rates of criminality were lower during periods when they were receiving ADHD medication. These findings raise the possibility that the use of medication reduces the risk of criminality among patients with ADHD. (Funded by the Swedish Research Council and others.).
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Compared with the general population, the risk of smoking and substance use disorders is increased in patients with ADHD, especially among patients who also have conduct or antisocial personality disorder.
“compared with the general population, the risk of smoking and substance use disorders is increased in patients with ADHD, especially among patients who also have conduct or antisocial personality dis order 213,214 .”
From Attention-deficit/hyperactivity disorder (2015) · cites this paper as [214]
The Methods (Sensitivity analyses; page not provided) say ADHD is often comorbid with substance abuse, conduct disorder, and antisocial personality disorder. The paper does not establish that smoking or substance use disorders are more common than in the general population, or that their risk is especially high in patients with those additional disorders. (LLM, conf=0.84)
Experimental — accuracy not yet measuredFindings from national registry studies indicate that the use of medication, particularly stimulants, might have protective effects on substance abuse, suicidal and delinquent behaviour.
“might have protective effects on substance abuse, suicidal and delinquent behaviour 175,214,232,233 .”
From Attention-deficit/hyperactivity disorder (2015) · cites this paper as [214]
The Results and Discussion report lower criminality rates during ADHD medication, including stimulant treatment, which supports the tentative claim about delinquent behaviour. The Methods identify substance-related crimes as an outcome, but the paper does not establish a protective effect on substance abuse itself or address suicidal behaviour. The stimulant and non-stimulant associations were similar, rather than showing a benefit particular to stimulants. (LLM, conf=0.88)
Experimental — accuracy not yet measuredMedications for ADHD reduce criminal behaviour.
“This very large population study found an association of ADHD with criminal behaviour and that medications for ADHD reduce such behaviour.”
From Attention-deficit/hyperactivity disorder (2015) · cites this paper as [214]
The Abstract Results report lower criminality rates during medicated periods than during unmedicated periods for the same individuals. But the Abstract Conclusions describe an association and say the findings only “raise the possibility” that medication reduces criminality; the citing sentence presents that causal effect as established. (LLM, conf=0.88)
Experimental — accuracy not yet measuredThey have increased rates of incarceration.
“They also have lower educational achievement than those without ADHD73,74 and increased rates of incarceration.75–77”
From Clinical Practice Guideline for the Diagnosis, Evaluation, and Treatment of Attention-Deficit/Hyperactivity Disorder in Children and Adolescents (2019) · cites this paper as [77]
The Results report substantially higher criminal-conviction rates among people with ADHD than among matched general-population controls (36.6% versus 8.9% for men; 15.4% versus 2.2% for women). But the Methods identify conviction as the main outcome; although the study linked to a prison register, these passages do not establish higher incarceration rates. (LLM, conf=0.86)
Experimental — accuracy not yet measuredTreatment discontinuation places individuals with ADHD at higher risk for catastrophic outcomes, such as motor vehicle crashes, criminality, including drug-related crimes and violent reoffending, depression, interpersonal issues, and other injuries.
“Treatment discontinuation also places individuals with ADHD at higher risk for catastrophic outcomes, such as motor vehicle crashes78,79; criminality, including drug-related crimes77 and violent reoffending76; depression71; interpersonal issues80; and other injuries.81,82”
From Clinical Practice Guideline for the Diagnosis, Evaluation, and Treatment of Attention-Deficit/Hyperactivity Disorder in Children and Adolescents (2019) · cites this paper as [77]
The Abstract Results and Results—Sensitivity analyses report lower criminality rates during ADHD-medication periods, including for substance-related crimes. That supports the criminality and drug-related-crime portion attributed to this paper, but the claim that discontinuation *places* people at higher risk is stronger than the paper’s observational finding; the Discussion cautions that confounding cannot be excluded. The other outcomes in the citing sentence carry separate citations. (LLM, conf=0.85)
Experimental — accuracy not yet measured
Central stimulants reduce behaviors related to emotional impulsivity and instability in ADHD such as suicide rate, drug use and criminal behavior, possibly indicating a specific effect on emotional dysregulation in ADHD.
“Interestingly, central stimulants also reduce behaviors related to emotional impulsivity and instability in ADHD such as suicide rate (Chen et al., 2014), drug use (Chang et al., 2014) and criminal behavior (Lichtenstein et al., 2012)—possibly indicating a specific effect on emotional dysregulation in ADHD.”
From Top-Down Dysregulation—From ADHD to Emotional Instability (2016) · cites this paper as Lichtenstein et al., 2012
The Results (Sensitivity analyses) report lower criminality rates during stimulant treatment (HR=0.66), supporting the criminal-behavior portion attached to this citation. The Abstract (Conclusions) describes an association and says medication may reduce criminality; it does not establish the unqualified causal reduction stated in the citing sentence. The suicide and drug-use claims have separate citations, and the emotional-dysregulation interpretation is the citing authors’ own inference. (LLM, conf=0.84)
Experimental — accuracy not yet measuredSSRIs served as a negative control exposure in the tenth sensitivity analysis to assess specificity.
“Finally, in order to evaluate the specificity of the association to ADHD medication, the tenth used selective serotonin reuptake inhibitors (SSRIs) as a negative control medication exposure (27, 30).”
From ADHD Medication and Substance-Related Problems (2017) · cites this paper as [27]
Investigators have adopted observational designs using large health-record datasets and within-person comparisons between medicated and un-medicated periods, with each patient serving as their own control.
“Consequently, researchers have turned to observational approaches that combine large-scale health-record data with designs that make within-individual comparisons across medicated and un-medicated periods, treating each patient as their own control (26, 27).”
From ADHD Medication and Substance-Related Problems (2017) · cites this paper as [27]
A Swedish cohort study of over 25,000 ADHD patients found a one-third reduction in criminality among men receiving ADHD medication and a 40% reduction among women.
“A Swedish cohort study of over 25,000 ADHD patients found a one-third reduction in criminality among men receiving ADHD medication, and a 40% reduction for women”
From The World Federation of ADHD International Consensus Statement: 208 Evidence-based conclusions about the disorder (2021) · cites this paper as Lichtenstein et al., 2012
ADHD medication is associated with reductions in criminality while under treatment.
“This is supported by a recent large study indicating significant associations between ADHD medication and reductions in criminality while under treatment (Lichtenstein et al., 2012).”
From Stimulant <scp>ADHD</scp> medication and risk for substance abuse (2014) · cites this paper as Lichtenstein et al., 2012
ADHD is associated with criminal behaviour.
“This very large population study found an association of ADHD with criminal behaviour and that medications for ADHD reduce such behaviour.”
From Attention-deficit/hyperactivity disorder (2015) · cites this paper as [214]
Findings from national registry studies indicate that the use of medication, particularly stimulants, reduces the risk of accidents and trauma-related emergency department admissions.
“findings from national registry studies indicate that the use of medication, particularly stimulants, reduces the risk of accidents and traumarelated emergency department admissions”
From Attention-deficit/hyperactivity disorder (2015) · cites this paper as [214]
The Methods and Results describe Swedish registry analyses of ADHD medication and criminality, including separate analyses of stimulants and non-stimulants. Searches for accidents, trauma, injuries, and emergency department admissions found no passage in our copy addressing those outcomes. (LLM, conf=0.77)
Experimental — accuracy not yet measured
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Long-term criminal outcome of children with attention deficit hyperactivity disorder
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ADHD and hyperkinetic disorder
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Attention deficit hyperactivity disorder in adults: What the non-specialist needs to know
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“This suggestion is supported by a recent epidemiological survey from Sweden that points towards not only a higher risk of criminal behaviour among those with a diagnosis of ADHD, but also the effects of medical treatment [with stimulants or atomoxetine (Strattera®; Eli Lilly and Company, Indianapolis, IN, USA)] on red…”
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- Authors
- Lichtenstein, P., Halldner, L., Zetterqvist, J., Sjölander, A., Serlachius, E., Fazel, S., Långström, N., & Larsson, H.
- Affiliations
- Karolinska Institutet (SE)
- University of Oxford (GB)
- ORCID
- Venue
- New England Journal of Medicine
- Publisher
- Massachusetts Medical Society
- Published
- 2012-11-22
- Volume
- 367
- Issue
- 21
- Pages
- 2006-2014
- ISSN
- 0028-4793 (ISSN-L)
- 1533-4406
- PMC
- PMC3664186
- OpenAlex
- W2155681415
- Semantic Scholar
- ab2c33a481a2761ec35f6679206f02cce4dd2b3d
- Cited by
- 611
- References
- 37
- Citations by year
- 2026: 26 · 2025: 31 · 2024: 54 · 2023: 50 · 2022: 42 · 2021: 54 · 2020: 63 · 2019: 57 · 2018: 38 · 2017: 43 · 2016: 34 · 2015: 43 · 2014: 43 · 2013: 28 · 2012: 3
- FWCI
- 26.64
- Type
- journal article
- Language
- en
- Open access
- bronze
- doi.org
- Locations
- New England Journal of Medicine (publishedVersion)
- PubMed (publishedVersion)
- Europe PMC (PubMed Central) (acceptedVersion)
- PubMed Central (acceptedVersion)
- Funders
- Wellcome Trust (095806)
- Eunice Kennedy Shriver National Institute of Child Health and Human Development (R01HD061817, HD061817)
- Topics
- Health Sciences › Medicine › Psychiatry and Mental health › Attention Deficit Hyperactivity Disorder
- Social Sciences › Psychology › Clinical Psychology › Psychopathy, Forensic Psychiatry, Sexual Offending
- Social Sciences › Sociology and Political Science › Crime Patterns and Interventions
- Keywords
- attention deficit hyperactivity disorder, ADHD medication, criminality, criminal conviction, stimulant medication, non-stimulant medication, sex differences
- MeSH terms
- Adolescent, Adult, Central Nervous System Stimulants, Attention Deficit Disorder with Hyperactivity, Crime, Female, Humans, Male, Registries, Sweden, Proportional Hazards Models, Young Adult
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