Use of medication for attention-deficit/hyperactivity disorder and risk of unintentional injuries in children and adolescents with co-occurring neurodevelopmental disorders
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Background: Attention‐deficit/hyperactivity disorder ( ADHD ) is often associated with other neurodevelopmental disorders ( ND s) 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 ND s. 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 ND s. 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 ND s, 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 on‐treatment 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 ( CI s). 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 TBI s ( HR = 0.27; 95% CI s = 0.20–0.38) during medicated periods was lower than during non‐medicated periods. Similar results were found among individuals with co‐occurring ND s ( N = 2,986), for unintentional injuries ( HR = 0.88; 95% CI = 0.77–1.01) and for TBI s ( 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 ND s.
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A Swedish national register study of youths with ADHD found that during medicated periods both those with ADHD alone and those with ADHD plus other psychiatric diagnoses had greater than 10% reduction in unintended injuries and greater than 70% reduction in traumatic brain injuries.
“During medicated periods both groups had a greater than 10% reduction in unintended injuries, and a greater than 70% reduction in traumatic brain injuries”
From The World Federation of ADHD International Consensus Statement: 208 Evidence-based conclusions about the disorder (2021) · cites this paper as Ghirardi et al., 2020
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“803 than 10 % reduction in unintended injuries, and a greater than 70 % reduction in traumatic brain injuries (Ghirardi et al., 2020).”
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- Authors
- Ghirardi, L., Chen, Q., Chang, Z., Kuja‐Halkola, R., Skoglund, C., Quinn, P. D., D'Onofrio, B. M., & Larsson, H.
- Affiliations
- Karolinska Institutet (SE)
- Indiana University Bloomington (US)
- Örebro University (SE)
- Corresponding author
- Ghirardi, Laura
- ORCID
- Venue
- Journal of Child Psychology and Psychiatry
- Publisher
- Wiley
- Published
- 2019-10-18
- Volume
- 61
- Issue
- 2
- Pages
- 140-147
- ISSN
- 0021-9630 (ISSN-L)
- 1469-7610
- PMC
- PMC6980200
- OpenAlex
- W2980916776
- Cited by
- 20
- References
- 49
- Citations by year
- 2026: 2 · 2025: 2 · 2024: 4 · 2023: 1 · 2022: 2 · 2021: 6 · 2020: 3
- FWCI
- 2.19
- Type
- journal article
- Language
- en
- Open access
- green
- europepmc.org
- Locations
- Journal of Child Psychology and Psychiatry (publishedVersion)
- PubMed (publishedVersion)
- Europe PMC (PubMed Central) (acceptedVersion)
- PubMed Central (acceptedVersion)
- IUScholarWorks Open (Indiana University) (submittedVersion)
- Funders
- Vetenskapsrådet (2013‐2280, 2014‐3831, 2018‐02213)
- 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 › Medicine › Pediatrics, Perinatology and Child Health › Pharmaceutical studies and practices
- Keywords
- attention deficit hyperactivity disorder, ADHD medication, unintentional injuries, traumatic brain injury, neurodevelopmental disorders, autism spectrum disorder, intellectual disability, children and adolescents, injury prevention, comorbidities
- MeSH terms
- Brain Injuries, Traumatic, Accidental Injuries, Adolescent, Central Nervous System Stimulants, Attention Deficit Disorder with Hyperactivity, Child, Child, Preschool, Female, Humans, Male, Registries, Sweden, Time Factors, Comorbidity, Adrenergic Uptake Inhibitors, Neurodevelopmental Disorders
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